Translating policy guidelines: a multiple case study of disease prevention in Sweden.

IF 2.7 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Mattias Elg, Elin Wihlborg, Malin Wiger
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引用次数: 0

Abstract

Background: There is a growing need for new knowledge about healthcare policy implementation that is relevant to both researchers and practitioners. Many policy initiatives fail due to insufficient coordination between different system levels and conflicting agendas among various actors. This paper aims to propose and illustrate an analytical framework using a multilevel-multilogic framework. This framework helps reveal the combined challenges encountered when implementing policies within public healthcare systems.

Methods: A multiple case study was conducted, focusing on the implementation of disease prevention guidelines in four Swedish healthcare regions. These regions were purposefully selected to represent diverse contexts and conditions that could influence policy translation. A total of 28 respondents across the four regions were interviewed, representing different system levels and institutional logics. The qualitative analysis identified connections between actors, settings, and policies, and explored how policy translation varied-from strong to weak, or even interrupted-as it moved from policy development to clinical practice.

Results: We developed a theoretical and empirical understanding of policy translation processes, tracking how evidence-based national guidelines for disease prevention methods (DPMs) moved through regional administrative systems into clinical practice. The analysis focused on four main themes: the gradual translation and reinterpretation of policy objectives, the impact of shifting policy priorities, the facilitating role of technology in translation processes, and the ways policy became embedded into everyday clinical routines.

Conclusions: Policy guidelines are implemented through a stepwise translation process, first being adopted and adapted within healthcare administrative systems via political and administrative activities, and then integrated into clinical practice. Within the multilevel-multilogic framework, each system level or logic has the potential to adapt, alter, delay, or even block the intended policy. Actions taken early in the translation process significantly affect the outcomes of subsequent stages.

翻译政策准则:瑞典疾病预防的多个案例研究。
背景:对医疗保健政策实施的新知识的需求日益增长,这与研究人员和从业人员都相关。许多政策举措的失败是由于不同系统级别之间的协调不足和不同行动者之间的议程冲突。本文旨在提出并说明一个使用多层多逻辑框架的分析框架。该框架有助于揭示在公共医疗保健系统内实施政策时遇到的综合挑战。方法:进行了多例研究,重点是在四个瑞典卫生保健地区实施疾病预防指南。有目的地选择这些地区来代表可能影响政策翻译的不同背景和条件。四个地区共有28位受访者接受了采访,他们代表了不同的制度水平和制度逻辑。定性分析确定了行为者、环境和政策之间的联系,并探讨了政策转化在从政策制定到临床实践的过程中是如何变化的——从强到弱,甚至是中断的。结果:我们对政策转化过程进行了理论和实证理解,跟踪了循证国家疾病预防方法指南(dpm)如何通过区域行政系统进入临床实践。分析集中在四个主要主题:政策目标的逐步翻译和重新解释,政策优先事项转移的影响,技术在翻译过程中的促进作用,以及政策融入日常临床程序的方式。结论:政策指导方针是通过逐步翻译过程实施的,首先通过政治和行政活动在医疗管理系统中被采用和调整,然后融入临床实践。在多层-多层逻辑框架中,每个系统层或逻辑都有可能调整、更改、延迟甚至阻止预期的策略。在翻译过程的早期采取的行动会显著影响后续阶段的结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMC Health Services Research
BMC Health Services Research 医学-卫生保健
CiteScore
4.40
自引率
7.10%
发文量
1372
审稿时长
6 months
期刊介绍: BMC Health Services Research is an open access, peer-reviewed journal that considers articles on all aspects of health services research, including delivery of care, management of health services, assessment of healthcare needs, measurement of outcomes, allocation of healthcare resources, evaluation of different health markets and health services organizations, international comparative analysis of health systems, health economics and the impact of health policies and regulations.
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