In this thesis, priority setting to the form of the Swedish parliamental decision on priority setting, 1997, is considered an innovation for implementation in health care. The features of this innovation are investigated. The practical implications of implementation are identified by investigating the user organisation, ie, Swedish health care organisations and management systems. Also, a case of a three-stage process for macro-level priority setting that engaged the entire organisation in the Västerbotten County Council (VCC) is presented. This is done against a background of preceding implementation efforts in the VCC. Four specific research efforts and papers are presented. In Paper I, priority setting is operationalised into a multi-dimensional resource allocation task. On that basis, with the help of interviews (1998) and surveys (2002 and 2005) primarily of VCC health care managers, the impact of implementation is measured by prioritisation structures, processes and decisions. Survey response rates were low. Results were used as qualitative data, internally compared, and interpreted as: a) responses reflected mainly “early adopters’” opinions; b) priority setting is an ambiguous concept; c) indicating limited overall implementation; d) reinterpretation of the prioritisation task occurred over time among respondents; and, e) this group took increasingly personal responsibility as stakeholders in priority setting. Paper II reports a case study intervention of explicit, departmental level priority setting with the aim of improving cost-effectiveness in in vitro fertilization resource use and a rationing of services perceived legitimate by all stakeholders. The intervention combined priority setting and structured quality improvement techniques. Results were: a) improved operational efficiency of diagnostic procedures that allowed resources to be reallocated to treatment; and b) patients were prioritized and treatment resources were rationed based on evidence of treatment effect among subgroups. Evaluation showed that the procedure met stated criteria for legitimacy. In Paper III, a full-format test of the macro level prioritisation process is described and evaluated by participants with the help of surveys after each completed stage. Participants report the need for improvement of elements in the overall process and of procedural specifics. However, overall there was a strong commitment to the initiative and satisfaction with the process and the resulting decisions. In Paper IV, procedural specifics of the prioritisation process are evaluated. They are also compared to the Program Budgeting and Marginal Analysis (PBMA) framework when used for macro level purposes. Procedures provided intended results such as vertical and horizontal priority setting and a consistent process. However, economic targets were not fully achieved in any of the stages. Conclusions include that health care management systems are not prepared for priority setting and need profound restructuring and that the prioritisation process described in Papers III and IV was successful because: a) the process satisfied politicians’ directives; b) participants were satisfied with the procedures and perceived the subsequent reallocation decisions as legitimate; and, c) methods resulted in the intended outcome. Factors suggested as the basis of success include: long-term overall preparations; broad and deep participation; a readiness for change among participants; a stage for horizontal priority setting that added to the quality, feasibility and perceived validity of the knowledge base; a strong process leadership; and politicians determined to protect the process from opportunistic disturbances.

No / This paper presents findings from a study of 55 cases of decision implementation. The research identifies a number of features that characterize the way implementation is managed which appear to enhance the chance of success. Analysis reveals patterns in the data indicating that these features fall into two groupings, giving rise to two distinct approaches to implementation management. These are termed the Experience-based approach and the Readiness-based approach from the initial conditions which give rise to each. Although following either approach may enhance decision performance, the greatest success is associated with a dual approach. Implementations that follow neither are generally less successful. A theory of implementation management is postulated, comprising a Planned Option and a Prioritized Option.

Thesis (M.S.); Submitted to Iowa State Univ., Ames, IA (US); 12 Dec 2003. / Published through the Information Bridge: DOE Scientific and Technical Information. "IS-T 2608" Maria Ambert Sanchez. 12/12/2003. Report is also available in paper and microfiche from NTIS.

Educators in the basic education system are facing extreme challenges in assessing learners in general and in implementing assessment policy in particular. These challenges influence the pass rate, particularly in grade 12. The validity of the evidence of the learners’ performance depends on the quality and type of assessment tasks administered to those learners. Therefore, it was critical that those aspects, which pose challenges in the management of the assessment policy within the education system, be addressed by developing policies which would assist educators in managing assessment at school, since assessment forms an integral part of teaching and learning. Support programmes on policy implementation had to be developed for learners and for the training of educators, the implementation of which should improve the pass rate. These programmes had to include the conditions and roles of provincial and district education officers. A South African policy development model had to be developed to address the unique situation of developing such programmes. The introduction of the National Curriculum Statement (NCS) and the National Protocol on Recording and Reporting (NPRR) were some of the measures aimed at improving learner performance and assisting educators in implementing and managing assessment which is in line with national policy. An exploratory study, aimed at providing a broad framework on policy analysis, was used with the view to understand how the NCS and National Protocol for Recording and Reporting are managed. A proportional representative sample of 25% of the schools from the six clusters in the Mopani district formed part of this study. To ensure that the historically white, urban and rural schools were represented, an incidental biased sampling method was used. Data obtained from the questionnaire indicates that educators have knowledge of the various policies, acts and guidelines which should be used in assessing learners. However, some data indicates that some educators know about the existence of such policies, acts and guidelines but do not have knowledge of the content thereof. Data obtained from the interviews indicates that educators either know the content of policies or are only aware of them. Therefore, the lack of knowledge of policy content which regulates the practice of a policy has an influence on the teaching and assessing of learners. / Thesis (PhD)--University of Pretoria, 2011. / School of Public Management and Administration (SPMA) / unrestricted