Doctor of Business Administration
Graduate School of Business
Develin, Elizabeth, Implementation of “Top-Down” government policy: health promotion case studies in NSW, Doctor of Business Administration thesis, Graduate School of Business, University of Wollongong, 2010. http://ro.uow.edu.au/theses/3312
This study of the implementation of “top-down” government policy appraises the implementation of the health promotion components of the NSW Government’s State Plan and State Health Plan. Four case studies were conducted in a sample of 50% of NSW Area Health Services (AHSs). Mixed methods were used in each case study, with data collected from organisational documents, interviews and focus groups, and financial information. The data was triangulated where possible, using both qualitative and quantitative methodologies. Several codebooks were developed to guide the analyses. These were designed around a conceptual framework focusing on three streams for policy analysis: 1) policy; 2) process, and 3) resources.
The findings of this study are that NSW AHSs share the state policies’ vision of a greater focus on health promotion/prevention on paper, but not in reality. All AHSs have aligned their strategic plans, annual reports and performance indicators to the state policies, and in general there is agreement with the targets. The policies are used for advocacy and strengthening of stakeholder relationships, and do provide focus. However, it was found that health promotion is not as important to AHSs as the acute care sector. Consequently, health promotion/prevention receives a tiny share of the budget and little attention. There are a number of general barriers to the implementation of state policies; these include a lack of focus on health promotion, including the ability of the health system to actually influence some health behaviours; lack of intersectoral ownership; perceived ineffectiveness of strategies; a lack of workforce and workforce development; poor planning processes and communication; inadequate performance-management and accountability frameworks; and ad-hoc, insufficient and insecure funding.
While this study has found some basic, and not unusual, policy implementation failures, the overarching finding of this study is the need for a drastic rethink of how prevention and health promotion should be delivered. Health promotion will never reach its full potential if it continues to be delivered within an acute care-obsessed system. Hence, this study recommends the establishment of a separate prevention agency within NSW that would deliver standard programs across the state, introduce an appropriate performancemonitoring framework, and have transparent and monitored funding tied to program delivery.