Paul Cairney

Never the twain shall meet? - a comparison of implementation science and policy implementation research

BackgroundMany of society’s health problems require research-based knowledge acted on by healthcare practitioners together with implementation of political measures from governmental agencies. However, there has been limited knowledge exchange between implementation science and policy implementation research, which has been conducted since the early 1970s. Based on a narrative review of selective literature on implementation science and policy implementation research, the aim of this paper is to describe the characteristics of policy implementation research, analyze key similarities and differences between this field and implementation science, and discuss how knowledge assembled in policy implementation research could inform implementation science.DiscussionFollowing a brief overview of policy implementation research, several aspects of the two fields were described and compared: the purpose and origins of the research; the characteristics of the research; the development and use of theory; determinants of change (independent variables); and the impact of implementation (dependent variables). The comparative analysis showed that there are many similarities between the two fields, yet there are also profound differences. Still, important learning may be derived from several aspects of policy implementation research, including issues related to the influence of the context of implementation and the values and norms of the implementers (the healthcare practitioners) on implementation processes. Relevant research on various associated policy topics, including The Advocacy Coalition Framework, Governance Theory, and Institutional Theory, may also contribute to improved understanding of the difficulties of implementing evidence in healthcare. Implementation science is at a relatively early stage of development, and advancement of the field would benefit from accounting for knowledge beyond the parameters of the immediate implementation science literature.SummaryThere are many common issues in policy implementation research and implementation science. Research in both fields deals with the challenges of translating intentions into desired changes. Important learning may be derived from several aspects of policy implementation research.

Complexity Theory in Political Science and Public Policy

Advocates of complexity theory describe it as a new scientific paradigm. Complexity theory identifies instability and disorder in politics and policy making, and links them to the behaviour of complex systems. It suggests that we shift our analysis from individual parts of a political system to the system as a whole; as a network of elements that interact and combine to produce systemic behaviour. This article explores the use of complexity theory in public policy, highlighting a small literature using the language of complexity directly to describe complex policy-making systems, and a larger literature identifying complexity themes. It then highlights the main problems to be overcome before complexity theory can become truly valuable in politics and policy making.

The role of ideas in policy transfer: the case of UK smoking bans since devolution

This article explores the relationship between ideas and interests in policy change by examining tobacco control in each country of the United Kingdom (UK). In all four, the moves towards further prohibition reflected international trends, with evidence of policy transfer and the virus-like spread of ideas which has shifted the way that tobacco is framed. However, there are notable differences in the development of policy in each territory. This reinforces conceptions of transfer in which the importation of policy is mediated by political systems. Differences in policy conditions, institutions and ‘windows of opportunity’ mean that our conclusions on the role and influence of interest groups, institutions and agenda-setting vary by territory, even within a member state. This suggests that a focus on an ‘idea whose time has come’ should be supplemented by careful analysis of the political context in which the idea was articulated and accepted.

Does Devolution Make a Difference? Legislative Output and Policy Divergence in Scotland

Devolution provides large scope for Scotland to make its own policy. Primary legislation is one measure of this. Scottish legislation before devolution tended to replicate measures for the rest of the United Kingdom, with differences of style. Scottish legislation in the first four-year term of the Parliament shows a big increase in output. There is an autonomous sphere, in which Scotland has gone its own way without reference to the rest of the UK. In other areas, there is evidence of joint or parallel policy-making, with Scottish legislation meeting the same goals by different means. Finally there is a sphere in which Scottish legislation is essentially the same as that in England and Wales. Sewel motions have not been used to impose policy uniformity on Scotland. There is evidence that devolution has shifted influence both vertically, between the UK and Scottish levels, and horizontally, within a Scottish legislative system that has been opened up.

Policy Convergence, Transfer and Learning in the UK under Devolution

This paper explores the policy transfer and learning process within the UK since 1999, examining the conditions in which transfer takes place among central and devolved governments. We distinguish among concurrent policies, policy competition, coercive transfer and policy learning. Policy transfer can be more or less coercive and constrained, while policy learning is voluntary. Mechanisms for transfer include financial instruments, political parties, the civil service and policy communities. Transfer can take place from centre to periphery, from periphery to centre and across the periphery. There is also transfer at the European and international levels. As it is England that has tended to break with older policies, notably on public service provision, the pressure has been to follow its lead, with the devolved administrations resisting or conforming. The UK government has paid much less attention to possible learning from the devolved territories and sometimes has sought to insulate England from debates there, especially where politically sensitive matters or large resources are at stake. Learning among the devolved territories is only now really beginning.

Venue Shift Following Devolution: When Reserved Meets Devolved in Scotland

Abstract This article examines the means used to address blurred or shifting boundaries between reserved UK and devolved Scottish policy. It outlines the main issues of multi-level governance and intergovernmental relations in Scotland and the initial problems faced in identifying responsibility for policy action. While it suggests that legislative ambiguities are now mainly resolved with the use of ‘Sewel motions’, it highlights cases of Scottish action in reserved areas, including the example of smoking policy in which the Scottish Executive appears to ‘commandeer’ a previously reserved issue. However, most examples of new Scottish influence suggest the need for UK support or minimal UK interest.

The Impact of the Scottish Parliament in Amending Executive Legislation

This paper provides the first systematic attempt to investigate the legislative impact of the Scottish Parliament on Executive legislation, by analysing the fate of all amendments to Executive bills from the Parliaments first session (1999–2003). Initial findings on the success of bill amendments show that the balance of power inclines strongly in favour of ministers. However, when we account for the type of amendment and initial authorship we find evidence that the Parliament (both coalition and opposition MSPs) actually makes more of an impact, particularly in terms of the level of success of substantive amendments to Executive bills. Our findings have implications for much of the current literature that is sceptical of the existence of power sharing between the Executive and the Parliament and within the Parliament.

How can policy theory have an impact on policymaking? The role of theory-led academic–practitioner discussions

Policymakers and academics often hold different assumptions about the policymaking world based on their different experiences. Academics may enjoy enough distance from the policy process to develop a breadth of knowledge and produce generalisable conclusions across governments, while policymakers/ practitioners such as civil servants may develop in-depth expertise when developing policy for a number of years. In turn, both may learn from each other about how to understand the policymaking world. Academic–practitioner seminars and short training courses can help further that aim. Yet, there is a major barrier to such conversations: academics and practitioners may have their own language to understand policymaking, and a meaningful conversation may require considerable translation. The article explores this topic in four main ways. First, it considers the extent to which academic–practitioner discussions still use simple concepts, such as the policy cycle, rejected by policy scholars in favour of concepts explaining policymaking complexity. Second, it identifies a series of relatively simple key tenets, from policy theories designed to explain complexity, to explore the extent to which modern theories can provide straightforward insights to policy practitioners. Third, it considers how those insights, based largely on what governments do, can be used to recommend what they should do. Fourth, it considers how to engage directly with policymakers to encourage intelligent and reflexive policymaking.

Evidence-based policymaking is not like evidence-based medicine, so how far should you go to bridge the divide between evidence and policy?

There is extensive health and public health literature on the ‘evidence-policy gap’, exploring the frustrating experiences of scientists trying to secure a response to the problems and solutions they raise and identifying the need for better evidence to reduce policymaker uncertainty. We offer a new perspective by using policy theory to propose research with greater impact, identifying the need to use persuasion to reduce ambiguity, and to adapt to multi-level policymaking systems.We identify insights from secondary data, namely systematic reviews, critical analysis and policy theories relevant to evidence-based policymaking. The studies are drawn primarily from countries such as the United States, United Kingdom, Canada, Australia and New Zealand. We combine empirical and normative elements to identify the ways in which scientists can, do and could influence policy.We identify two important dilemmas, for scientists and researchers, that arise from our initial advice. First, effective actors combine evidence with manipulative emotional appeals to influence the policy agenda – should scientists do the same, or would the reputational costs outweigh the policy benefits? Second, when adapting to multi-level policymaking, should scientists prioritise ‘evidence-based’ policymaking above other factors? The latter includes governance principles such the ‘co-production’ of policy between local public bodies, interest groups and service users. This process may be based primarily on values and involve actors with no commitment to a hierarchy of evidence.We conclude that successful engagement in ‘evidence-based policymaking’ requires pragmatism, combining scientific evidence with governance principles, and persuasion to translate complex evidence into simple stories. To maximise the use of scientific evidence in health and public health policy, researchers should recognise the tendency of policymakers to base judgements on their beliefs, and shortcuts based on their emotions and familiarity with information; learn ‘where the action is’, and be prepared to engage in long-term strategies to be able to influence policy; and, in both cases, decide how far you are willing to go to persuade policymakers to act and secure a hierarchy of evidence underpinning policy. These are value-driven and political, not just ‘evidence-based’, choices.

New public management and the Thatcher healthcare legacy: enough of the theory, what about the implementation?

Initial evaluations of Thatcherism suggest that it represented a policy formulation success but implementation failure (Marsh and Rhodes 1992), with healthcare reforms particularly unsuccessful because they did not challenge the autonomy of the medical profession (Wistow 1992a and 1992b). More extensive analyses of the implementation of new public management (NPM) within health care take this challenge more seriously. According to Ferlie et al. (1996), doctors were gainers and losers, since the rise of the management function coincided with a rise in medical involvement in management decisions. However, this article argues that the rise of the purchasing function of health authorities undermined this ‘gain’ to the medical profession. Further, the significance of the case study—AIDS policy in Scotland—is that profound change has occurred in a policy area in which one would least expect this to happen.