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We acknowledge the traditional custodians of the land upon which this university sits.
1
Week 9: Policy implementation -
From intention to action: Part 1

September 2020
Acknowledgement of Country
In recognition of Aboriginal and Torres Strait Islander peoples
spiritual connection to Country and in continuing ACU’s
commitment to Reconciliation, it is customary to acknowledge
Country as we pass through it.

Today we acknowledge and pay our respects to the First Peoples,

the traditional custodians of the lands and waterways. We thank
them for their continued custodianship. We acknowledge and
celebrate the continuation of a living culture that has a unique role
in this region. We also acknowledge Elders past and present and
thank them for their wisdom and guidance as we walk in their
footsteps.
7 Policy advocacy, interests and stakeholders  

8 Policy advocacy: Case studies  

9 Policy implementation and evaluation

10 Public Health Protection - Food safety,  

workplace safety and environmental
protection

11 Health practitioner regulation  

12 Summary / Revision
 By the end of week 9, you should be able to:
1. Understand the theoretical perspectives and
models to explain policy implementation;
2. Understand the enablers of and barriers to policy
Learning implementation;
outcomes 3. Understand the instruments and tools that enable
policy implementation; and
4. Understand the purpose, benefits, challenges and
approaches to policy evaluation.
 1. Implementation – definitions
2. Relationship between policy formulation and
implementation
3. Theories and models
Lecture outline 4. Barriers to implementation
5. Policy instruments
6. Conclusion
  Process of turning a policy into practice (Buse,
Mays and Walt)
 Implementation has been defined as ‘what
happens between policy expectations and
(perceived) policy results’ (DeLeon 1999)
Policy
implementation:  Process of converting a policy (vision, direction,
statement) into action (program, service,
What is it? initiative) – ‘putting it on the ground’
 Operationalising policy intentions: actions of
people and organisations, use of various policy
instruments, establishing a program / service
  Public sector (Department) is responsible for
implementation; administrative direction; inspection &
enforcement

 Project management methodology (e.g. Gantt chart)

Common
understanding  Includes monitoring, feedback and improvement

 Requires communication and engagement

 Cannot understand policy implementation without

understanding policy development
 POLICY DESIGN

Policy design & Set objectives

Design
Train staff Operationalise
instruments
implementation
in complex
adaptive
systems
Learning & Monitor
(Swanson & Bhadwal, Understand
issues
Monitor, evaluate
& improve improvement & evaluate
2009)
 Consists of two interrelated parts:

1. Design – defining what the policy is and the

rules for how the policy instrument is to
Features perform, and
(Swanson &
Bhadwal, 2009)
2. Implementation – the way the
policy/program will be established; the
actions of people and organisations that
implement the rules of the policy instrument.
  Strong relationship between policy
development (vision, direction and design of
policy instruments) and policy / program
implementation (making it happen). The
components are interrelated
Swanson &  Model is cyclical and dynamic
Bhadwal, 2009  Policy designers need to give consideration to
all aspects of policy implementation (think
about implementation early in the process)
 Instruments for implementation are
important: need to design carefully
 Coordination

Consultation Decision

The ‘Black Box’ Policy Implementatio

of instruments n
implementation
Policy analysis Evaluation

Identify issues
  Policy implementation is a complex and uncertain
process – many challenges and uncertainties regarding
implementation outcomes

Why the ‘Black  Implementation is influenced by many factors: level of

Box’ of commitment & control, resources, time, plans and
execution of change management, etc.
implementation
?
 Implementation ‘gaps’, disconnect between policy
development and implementation, and policy failures
– policy literature is littered with references
 1. No crippling external constraints
2. Adequate time and resources
3. Suitable combination of resources at each stage
4. A valid theory of cause and effect
Ten conditions for 5. Direct links between cause and effect
perfect
6. Single implementation agency, or at least a dominant one
implementation
7. Understanding and agreement on the objectives to be
(Gunn, 1978) achieved
8. A detailed specification of tasks to be completed
9. Perfect communication and coordination
10.Perfect obedience
 1. Top-down – policy cycle

Theoretical 2. Bottom-up – street level bureaucracy

frameworks
3. Hybrid – process of negotiation and change
 Gunn, 1978; Mazmanian & Sabatier, 1979; Althaus et al.,
2007
 policy development & implementation seen as
discrete but related stages
 policy developed by government & implemented by
bureaucracy & agencies; the ‘levers’ and ‘instruments’
Top-down – are top down approaches controlling the process
policy cycle  a rational process of implementation in which
subordinate levels of a policy system implement the
intentions of higher levels based on set objectives
 policy implementation viewed as an administrative
activity
  Policies represent compromises between conflicting
interests – competing interests likely to be reflected
during implementation process
 Policy agreements may leave other conflicts to be
Critique of top- resolved during implementation
down model  Not possible for policy-makers to have all the facts and
to anticipate all potential impacts
 Social, political and economic circumstances change
 Lipsky, 1980; Hjern et al., 1978
 implementers are seen as active participants in policy
development & implementation process
 important role of local field level officials and program
Bottom-up – staff “street level bureaucrats” in shaping & influencing
implementation
street level
 implementation is a process of negotiation and conflict
bureaucracy between many players (within and outside government)
 distinction between policy formulation and
implementation is blurred as implementers can
transform policy goals
  More of a continuum between centrally determined policy
objectives and local autonomy - a synthesis of the two
approaches (Pulzl & Treib, 2006).
 Implementation as a process of continuous policy change;
Hybrid theories – change management; implementation as exploration,
implementation adaptation and evolution
as a process of  Multiple approaches; implementation as:
o Policy-action continuum: evolutionary process (Lewis & Flynn 1978,
negotiation and 1979; Barrett & Fudge, 1981; Majone and Widavsky, 1978) – an
change ‘interactive and negotiative’ process takes place over time bn those
seeking to put policy into effect & those upon whom action depends;
power, behaviour & resources are central factors in this relationship;
policy evolves & unfolds (change and adapt over time)
o Complex principal-agent relationship and political and organisational
context shape choice of policy instruments: principals delegate
responsibility to agents for implementation – agents may not support
the policy goals, may not be familiar with policy aims/objectives for
implementation, difficult to control process of implementation
  Implementation as inter-organisational analysis (Hjern
1982; Hjern & Porter 1981) – implementation by
organisations are linked to 2 approaches:
o power & resource dependency – relationships are
based on power, influence & resources (working
with others to secure their interests)
Hybrid theories o depends on organisational exchange –
implementing goals based on mutual benefits
 Implementation as a managerialist framework – it is an
operational paradigm in the administration of public
policy; how-to corporate and operational management
approach e.g. project management approach; means of
managing uncertainties & minimising risks
 Synthesise ideas of top-down and bottom-up theories into six
necessary conditions for effective implementation of policy
objectives:
1. Clear and consistent objectives
2. Adequate causal theory - to bring about change
Conditions for
3. Implementation structures - to enhance compliance for
effective implementers & targets of the policy
implementation 4. Committed and skilful implementers who apply discretion
(Sabatier and 5. Support of interest groups and ‘sovereigns’ in the legislature &
Mazmanian, executive
1979) 6. Changes in socio-economic conditions that do not undermine
the support of groups & sovereigns or subvert the causal
theory underpinning the policy
  Behaviour change required – securing compliance to
achieve desired endpoints
 Change of systems, structures, processes, programs
 Power – coercion or threat, shared beliefs or values,
Implementation inducement and rewards
as change  Authority – formally delegated, professional standing,
management sound evidence
 Leadership – exercising of influence (formal or
informal), embedding and reinforcement of culture
  Power and authority

Factors  Leadership
influencing
implementation
 Creating a conducive change management
environment
 How Great Expectations in
Washington are Dashed in
Oakland;
Or
Wildavsky and Why it’s Amazing that Federal
Pressman Programs Work at All, This
being a Saga of the Economic
(1973) Development Administration
as Told by Two Sympathetic
Observers Who Seek to Build
Morals on a Foundation of
Ruined Hopes
 Senior manager in Queensland:
We are highly dependent on a chain of
command to get to the front line, and the
Policy making in timeliness of that sometimes defeats us.
Australian Sometimes it’s just the actual practicality of
health getting it; if you take somewhere like
Mornington Island for example…
authorities
(Hughes, 2014)  Issues of distance between from centre
 Delivering programs/services in isolation; no
enforcement
 Policy practitioner, SA Health Department:

And I think no matter how well you plan a policy

Hughes, 2014 process and the steps you go through, you
always have to allow for that ‘curve ball’ that’s
going to throw you off course. Because it’s
never such a simple process…
  Political factors (changing government priorities, change
of government/minister, symbolic policies)
 Lack of ministerial / departmental commitment and
support
 Departmental structures and processes: separation of
policy development from program implementation
Barriers to (‘falling between the cracks’)
implementation  Lack of effective leadership (direction and guidance)
 Inadequate change management environment: technical
capacity, resources
 Lack of stakeholder support / resistance
 Lack of adequate resources
Implementation
failure
 Policy instruments are the mechanisms by
which governments implement their
Policy programmes (Peters, 2005)
instruments: an
important Policy instruments provide the method and
feature of the tools to implement the policy; they are
implementation practical strategies that target the nuts and
bolts of the problem (Haigh, 2012)
  Aim of policy instruments: change behaviour;
discover information; assemble resources
 Choice of policy instrument is important: needs
to be functional, fit government ideology, & have
Policy support (reflect societal values & norms)
instruments:  Policy instruments are as much political as they
Characteristics are technical
 Range of policy instruments may be used to
ensure implementation
‘Good policy advice relies on choosing the right mix of
instruments for the problem at hand’(Althaus, et al., 2007)
 1. Authority-based – uses legislation & regulation to prescribe
forms of behaviour (mandates, prohibits/permits conduct)
2. Monetary / market-based – uses positive & negative
financial incentives to encourage use/compliance with
actions required (taxes & fees); also uses disincentives
Types of policy (sanctions; user charges)
instruments 3. Organisation-based – uses structural arrangements that
deliver government goods & services; to deliver equitable
(Haigh, 2012) distribution / increase efficiencies (public/private
partnerships; privatisation)
4. Nodal & information-based – uses dispersal of information
from government ‘nodes’ to generate a desired outcome;
passive form of persuasion to encourage people to change
behaviour
 Legislation and regulation
 Regulation: specifies
governance, models,
conditions, enforcement
 Licensing: certification,
Policy accreditation, standards
instruments for  Health protection
implementation Planning
 Hospital relocation
 Service/program planning
 Planning ratios
Financing & organisation
• Funding formula
• Financial incentives/
disincentives
• Hospital integration/
networks
Information & persuasion
• Social marketing
• Report cards
• Education: appealing to
professional interests,
community
 Theory
 Redistribution - to address
the failings of the market
(through allocation or
purchasing)
 Transparent resource
Is planning a allocation - to ensure
useful policy
decision-making criteria for
scarce resources are
instrument?
known (and benefits
society)
 Chart vision, facilitate
agreement amongst
stakeholders, mobilise
resources and action
Practice
 Expansion of supply
 Community
awareness/participation
 Redistribution of resources
(service location)

Reorientation towards
population health issues?
 Pressure on provider
behaviour? (service
quality)
 Control cost??
Slip on a Shirt, Slop on Sunscreen, Slap on a Hat: Prevent Skin Cancer
 Skin cancer & sun safety: highest rate of skin cancer in
the world
o Public education programs (1981 - Slip! Slop! Slap!;
SunSmart program in schools with hats & covering up;
workplace sun-protective clothing & sunscreen)
Example – o Social marketing – screening & early identification of skin
policy cancers; sponsorship of sporting associations
instruments o Research – collecting data; quantifying the problem &
used identifying preventive measures; Cancer registries
monitoring melanoma incidence from 1985;
development & testing of vaccines against skin cancer)
o Product design and distribution (sunscreen; UV-
protective shade materials & clothing; SunSmart UV
Alert)
 Programs/interventions Key ingredients
 HIV education &
• Leadership, authority,
management
commitment
 Tobacco control
Public health • Technical capacity, strategic
 Early intervention screening policy direction, support
policy – (breast; bowel) (structures, processes,
successful  Maternal & child health people)
implementation (immunisation; baby centres)
• Suitable implementation
 Workplace safety tools: planning, financing,
 Road safety regulation, education
 Policies:
 De-institutionalisation of mental health services (expansion of
community-based mental health services)
 Salaried medical practitioners in primary health services
Not so  Universal dental health services
successful Key factors:
public health  Difference between policy intent and implementation (vision vs
reality)
policies &  Resources not committed / withdrawn
programs  Shift in political priorities
 Symbolic policy
 Opposition from organised interests
 Lack of community support
  Implementation is an essential step in the policy
process: formulation, conversion to action, monitoring
& review
 Multiple factors influencing implementation, which
make it challenging and unpredictable
 Many examples of implementation failure; disconnect
Conclusion between development and implementation
 Implementation can be viewed as a process of
continuous policy & health system change; also,
adaptation and evolution
 Need for careful consideration and selection of policy
instruments
 Barrett, S., & Fudge, C. (Eds.). (1981). Policy and action. London:
Methuen.
Bovens, M., & ‘t Hart, P. (1998). Understanding policy fiascos. New
Jersey: Transaction Publishers.
Goggin, M., Bowman, A., Lester, J. and O’Toole, L. Jr. (1990).
Implementation theory and practice: Toward a third generation.
Glenview, Illinois: Scott, Foreman/Little, Brown Higher Education.
Stephen, H., & Peters, B.G. (1987). A design perspective on policy
References implementation: The fallacies of misplaced prescription. Policy Studies
Review, 6(3), 459-475.
Lipsky, M. (1980). Street-level bureaucracy: Dilemmas of the individual in
public services. New York: Russell Sage Foundation.
Pressman, J.L., & Wildavsky, A. (1973). Implementation: How great
expectations in Washington are dashed in Oakland. Berkley, California:
University of California Press.
Pulzl, H., & Treib, O. (2006). Policy Implementation. In Fischer, F., Miller.
G.J., and Sidney, M.S. (eds.). Handbook of Public Policy Analysis: Theory,
Politics and Methods. Boca Raton, FL: CRC Press/Taylor & Francis, 89-
107.
 Part 2: Policy evaluation