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New ways to get policy into practice: A mixed-method participatory study of care coordination and street-level bureaucrats


Nugus, P and Ranmuthugala, G and Lamothe, J and Greenfield, D and Travaglia, J and Kolne, K and Kryluk, J and Braithwaite, J, New ways to get policy into practice: A mixed-method participatory study of care coordination and street-level bureaucrats, Journal of Health Organization and Management, 32, (6) pp. 809-824. ISSN 1477-7266 (2018) [Refereed Article]

Copyright Statement

© Emerald Publishing Limited

DOI: doi:10.1108/JHOM-09-2017-0239


Purpose - Health service effectiveness continues to be limited by misaligned objectives between policy makers and frontline clinicians. While capturing the discretion workers inevitably exercise, the concept of "street-level bureaucracy" has tended to artificially separate policy makers and workers. The purpose of this paper is to understand the role of social-organizational context in aligning policy with practice.

Design/methodology/approach - This mixed-method participatory study focuses on a locally developed tool to implement an Australia-wide strategy to engage and respond to mental health services for parents with mental illness. Researchers: completed 69 client file audits; administered 64 staff surveys; conducted 24 interviews and focus groups (64 participants) with staff and a consumer representative; and observed eight staff meetings, in an acute and sub-acute mental health unit. Data were analyzed using content analysis, thematic analysis and descriptive statistics.

Findings - Based on successes and shortcomings of the implementation (assessment completed for only 30 percent of clients), a model of integration is presented, distinguishing "assimilist" from "externalist" positions. These depend on the degree to which, and how, the work environment affords clinicians the setting to coordinate efforts to take account of clients’ personal and social needs. This was particularly so for allied health clinicians and nurses undertaking sub-acute rehabilitative-transitional work.

Originality/value - A new conceptualization of street-level bureaucracy is offered. Rather than as disconnected, it is a process of mutual influence among interdependent actors. This positioning can serve as a framework to evaluate how and under what circumstances discretion is appropriate, and to be supported by managers and policy makers to optimize client-defined needs.

Item Details

Item Type:Refereed Article
Keywords:healthcare, safety, quality, patient-centered care, mental health, policy, politics, organisational restructuring
Research Division:Health Sciences
Research Group:Health services and systems
Research Field:Health services and systems not elsewhere classified
Objective Division:Health
Objective Group:Evaluation of health and support services
Objective Field:Evaluation of health and support services not elsewhere classified
UTAS Author:Greenfield, D (Professor David Greenfield)
ID Code:127916
Year Published:2018
Web of Science® Times Cited:3
Deposited By:College Office - CoBE
Deposited On:2018-08-22
Last Modified:2021-07-06

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