Many acclaimed policies in Ireland have failed to deliver on their aspirations, leading some commentators to talk of a problem of implementation. The failure to fully implement some public service policies has led to frustrations on the part of policymakers, service providers and service users alike.
This book reviews the implementation literature from a number of perspectives. There are those who seek to implement policy from the 'top down'. Others seek to influence the implementation of policy from the 'bottom up'. Some seek to bring about implementation through change. The mental health policy A Vision for Change is taken as a case study. The content of reports of an Independent Monitoring Group is analysed. Interviews are undertaken with people associated with implementation of the policy. These include politicians, public servants, mental health professionals, mental health service users and mental health advocates.
The key finding is that two factors were found to be fundamental to successful implementation:
(1) authoritative, accountable leadership; and(2) identifying and addressing the main resisters to change. Many other factors were found to be important to some extent.
The book concludes that there is a need to acknowledge issues 'below the surface', including beliefs, values and power relationships in implementing policies. Innovation and creativity, along with local leadership, are important but on their own they are not enough to ensure successful implementation. These findings have relevance for the implementation of nationally designed policies which are intended to be implemented across the country in an even-handed way.
CONTENTS
1 Introduction
Rationale for the researchInititial insights from the Irish public serviceEmpirical study ResultsStructure of the Book
2 Implementation Concepts
An introduction to the implementation and organisational change literatureDefinition of policy implementationA landmark studyTop-down approach Bottom-up approachSynthesis approachesSummary of implementation approachesTransformative factors Inferences from the implementation literatureLines of enquiry put forward for investigationCommon factorsApplication of lines of enquiry
3 An Overview of Mental Health Policy in Ireland
Why mental health policy? The International context for mental health policyImplementation of A Vision for Change
4 An Analysis of the Implementation of the Mental Health Policy A Vision for Change
IntroductionOverview of documentary content analysis resultsAnalysis of interview findingsView of the policy A Vision for ChangeViews on the ‘Implementation’ section of the policyThe actual implementation of the policyWhat was implemented well?What was not implemented well?What is needed to have a modern mental health system?Examples of policies which have been implemented wellSummary of key findings
5 A Discussion of the Determinants of Implementation
IntroductionDriving Policy implementation from the top downInfluencing policy implementation from the bottom upInfluencing policy implementation common factors
6 Conclusions
IntroductionThe relative importance of the key determinants of implementationRelevance to the implementation literatureLimitations of the study and the potential for further researchFinal word Appendix A: Study MethodologyAppendix B: Summary of the Research Proposal Appendix C: Interview Schedule Appendix D: Summary of Content Analysis Findings Bibliography Index