The Policy Cycle, External Influence and the Role of the Chief Nursing Officer

1. The Policy Cycle, External Influence and the Role of the Chief Nursing Officer Dr. Judith Shamian President and CEO of the Victorian Order of Nurses, Canada Former Chief Nursing Officer for Canada (1999-2004)

2. Role of the CNO • Provides advice to government • Provides access to decision makers • Participates in agenda setting • Retains authority • Is the visible face of nursing for a nation • Is a unifying voice for diverse interests and roles

3. Public Policy & Politics • Policy is focused on content • Politics is focused on process – choosing policy and getting it implemented

4. The Policy Cycle • 4 Major Stages: • Setting the policy agenda • Moving into Action/Legislation • Policy Implementation • Policy Evaluation

5. The Policy Cycle: Stage 1 & 2 – 8 steps Adapted by J. Shamian and ONP, from Tarlov, 1999 Getting to Policy Agenda Values & Beliefs Regulation, Experience & Revision Problem or Issue Emerges Public Policy Deliberation &Adoption Knowledge Development & Research Interest Group Activation Public Awareness Moving into Action Political Engagement

6. 1. Setting the Policy Agenda • Identify problem and bring to the attention of government • Healthy Workplaces for Health Care Workers • Problem identified over 20 years of research • Large body of evidence to support findings • Nursing Health Human Resources researchers played a major role in generating knowledge and disseminating it to policy makers • Currently many policy initiatives underway in Canada

7. Values and Cultural Beliefs • Action on any policy issue must be firmly grounded in a supportable set of values • Dealing with workplace and nursing issues what values are demonstrated by government, employers and others? • Value in the policy context is influenced by public good, needs, demands

8. Healthy Workplace Example • 4 dominant values • Canadians are firmly in support of the Canada Health Act • Nurses are an essential part of the Healthcare delivery system • To offer both access and quality, the health care system needs nurses • The public trusts nurses

9. Emergence of Problem or Issue • Essential for issue to land on fertile soil and be nurtured • Must have urgency • Must be visible and important to others (not just those directly affected)

10. How do we become aware of & define the problems? • Indicators: • routine monitoring, government studies • pervasive, powerful, & necessary • Crises, Disaster, symbol or major event may highlight an indicator • Feedback on certain governmental programs • Values, interests, & ideals influence the problem definition • A lot of marketing involved in this step!

11. Health Workplace Example • Nurses were very vocal in articulating the effects of organizational downsizing on their workloads • In 2000 frustration reached its breaking point and highly visible job action brought publicity to the issue

12. Lomas: “Beyond the sound of one hand clapping” • Why is context important? • We need to understand the context in which issues are brought forward and how they are dealt with.

14. Knowledge and Development of Research • Once issues are clear, research required to back it up • Needs to be accessible and compelling

15. Healthy Workplace Example • Large body of knowledge accumulated over 20 years • Key national reports contributed significantly to developing policy initiatives • Nursing Human Resources Researchers lead the way • Canadian Nursing Advisory Committee Report • Major Government sponsored reports followed • Kirby, Romanow Reports

16. Public Awareness • Creating broad-based awareness of both the issue and the strategy for addressing them • Identify supportive audiences and customize the message • Dissemination through print and broadcast media is important

17. Media: Public Opinion Shapers • More than just the facts…. • Use of editorials, columns, etc – endorsements during elections, parties elected severely affect the type of policies that follow • Use of images • Use of polls

18. SARS • Media images; masks, empty streets, fear • How did Governments deal with it? • Why did it happen the way it did?

19. Political Engagement • Critical for success: • Know the government structure and key members within it • Target those who share interest in the issue • Person-to-person contact important • Customize message • Keep those interested updated on the issue • CNAC Report

20. Lomas: Different decision makers • Legislative • Administrative • Clinical • Industrial

22. Interest Group Activation • Important to exploit every opportunity to repeat message • Build ripples of interest into tidal wave

23. Interest Groups in the Policy Process • Role of Interest Groups: • Articulate and transform political demands into authoritative public policy by influencing the choice of political personnel and processes of public policy making and enforcement • Seek support for demands among other groups • Connect individual to political system via legitimate channels

24. Interest Groups in the Policy Process • Interest or Pressure Groups vary according to: • Organizational cohesion, continuity and size • Knowledge, both substantive and of government • Stability of its membership • Wealth and resources

25. Engaging Key Stakeholders Shaping Policy • MEDIA • extensive newspaper coverage, television, lay magazines, • HEALTH CANADA • Serve on numerous high level committees • Work on health policy issues • Network with HC leadership in Ottawa and across the regions • FACE to FACE • Regional visits • Meet with gov. departments • Meet with health authorities • Meet with boards • Facilitate meetings among sectors • ARTICLES & UPDATES • Regular E-mail newsletter • Share research and relevant information • Source of expertise and advice.

26. Engaging Key Stakeholders Shaping Nursing • FACE to FACE • Regional visits • Conference presentations, workshops • Teaching classes • Meet with nurses at all levels on an ongoing basis • MEDIA • extensive newspaper coverage, television, lay magazines, • ARTICLES & UPDATES • Regular E-mail newsletter • Articles published in professional/academic nursing and health journals • HEALTH CANADA VISITS • Bringing the face of nursing into Health Canada - visiting scholars & other invited guests

27. The ‘Players’ and ‘Webs of Influence’ in the Policy Process: N=1 to N of many • Doern & Phidd (1992) and Howlett and Ramesh (1995) • Interest groups • Political parties, elected officials (cabinet, legislature) • Staff and advisors • Official hearings and procedures • Think tanks and policy research organizations • Universities and disciplinary research organizations • Mass media • Mass books and periodicals • Cultural events • Other decision makers (colleagues, constituents, etc.) • Personal networks • Intergovernmental relationships & power

28. 2. Moving into Action/Legislation • The formal responses to the problem • Has the existing evidence on the benefits of healthy workplaces resulted in effective policy change? • Large body of knowledge on healthy workplaces available for the last 20 years, yet only recently (last 5 years) translating into policy • Nurses have played a key role in generating knowledge and disseminating it to policy makers • The Role of the Office of Nursing Policy of Health Canada

29. Public Policy Deliberation and Adoption • Once issue is on the political agenda, must meet 5 criteria if it is to survive: • Technical feasibility • Value acceptability within the political community • Tolerable cost • Anticipated public agreement • Reasonable chance for elected officials to be receptive to it

30. Healthy Workplace Policy • Workplace health issues now appear on public and government health human resources policy agendas, including the First Ministers’ Meetings (February 2003; September 2004), the Health Council of Canada and in reviews conducted by provinces and territories • The move towards healthy workplaces has been expanded to benefit not only Canada’s nursing workforce, but other health care workers as well. • Canada’s federal, provincial and territorial governments agreed to report to the public on their action plans by December 31, 2005, including targets for training, recruitment and retention and healthy workplaces for health professionals

31. Regulation, Experience, and Revision • Proposed action becomes a formal policy, law or regulation • This becomes cultural value or norm • Program implementation and evaluation generate new info to continue the cycle

32. Healthy Workplaces Policy • There have been significant policy-level improvements • Have these initiatives resulted in healthier workplaces for health care workers? • Over past 2-3 years several studies outlining the progress made at the practice level • Evaluation of the initiatives implemented still required

33. The Policy Cycle • 4 Major Stages: • Setting the policy agenda • Moving into Action/Legislation • Policy Implementation • Policy Evaluation

34. The Policy Cycle • 4 Major Stages: • Setting the policy agenda • Moving into Action/Legislation • Policy Implementation • Policy Evaluation

35. Government Nursing Policy/ Chief Nurse Key Strategy • Build a national policy agenda – adding one block at a time • Disseminate knowledge widely • Engage and interact with broad stakeholders ~ including targeted individuals and groups

36. Government Nursing Policy/ Chief Nurse • Key Attributes • Consistency • Perseverance • Focused • Purposeful • Backward & forward