It has consistently been documented in many countries and sectors that there are difficulties in implementing public policy effectively. A priori, the Australian health care system is no exception to this general proposition. While governments issue directives with particular goals in mind these goals are not always met, because of the modifications, interpretations or lack of uptake by targeted populations. However it is not clear the extent to which these difficulties occur in the public hospital sector, and we lack clear empirical data on this phenomenon. This thesis investigates the effects of a state government directive on the development and implementation of elective admission policies in New South Wales public hospitals. It did this by three separate but related studies that examined the impact of the directive at the hospitals??? management and staff levels. The first two studies were quantitative and qualitative surveys of hospital managers and admission staff. The management survey aimed to ascertain the extent to which managers responded to the directive in terms of developing and implementing hospital policies. The staff survey sought to investigate staff awareness and knowledge of the developed policies. The third study was a qualitative analysis of the policy contents to determine the extent to which they reflected the aims and objectives of the government directive guidelines. All three studies found a general lack of relevance and applicability of the government directive and its guidelines to individual hospital organisations. The manager survey showed a disconnection between the central government office responsible for implementing the directive and hospital managers??? perspectives. This was apparent by the lack of response to the directive by many hospitals and the fact that managers often passed on the task of implementing the directive and its guidelines to other hospital staff. The findings of the qualitative analysis of policies showed evidence of hospital strategies to manage pressures created by the directive. These difficulties were corroborated by the surveyed staff that reported difficulties in translating the directive???s requirements (as reflected by the hospital policy), into the reality of their daily work; a lack of organisational commitment to policy enforcement; and a suspicion regarding the directive???s political motives. The findings of this thesis show that, as with other public service sectors effective policy implementation in the public hospital arena is problematic, with government agendas frequently not aligned with the requirements of stakeholders, and inadequate understanding of implementation barriers. Recommendations are made regarding methods to improve the synchronicity of political directives with organisational realties in the public hospital sector.
| Identifer | oai:union.ndltd.org:ADTP/242522 |
| Date | January 2006 |
| Creators | Wolk, Jael, Public Health & Community Medicine, Faculty of Medicine, UNSW |
| Publisher | Awarded by:University of New South Wales. School of Public Health and Community Medicine |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | Copyright Jael Wolk, http://unsworks.unsw.edu.au/copyright |
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