Role of nursing management in health care policy development

1. 1 Role of nursing management in health care policy development  Dr Frances Hughes, RN, D.Nurs,ONZM Professor & Director of Centre for Mental Health, Research, Policy and Service Development. Faculty of Medical and Health Sciences University of Auckland Adjunct Professor- University of Technology- Sydney

2. 2 What is policy? �Theories and models of policy making provide tools for simplifying the chaotic world of actual policy making� Tenbensel & Gauld (2003, p 24)

3. 3 Outline What is Policy? Making it happen How can nurse leader influence? Group work From talk to action- building the agenda Policy Entrepreneur How can you influence key strategic directions ? Group work

4. 4 Walt�s (1994) Public policy in health is a : �Systematic course of action undertaken by government agencies that not only affects the formal institutions of the health care system by that also has an influence more broadly on the health of community�

5. 5 Policy Process In general the processes can be categorised as a sequence of problem identification, policy formulation, policy adoption, policy implementation, and policy evaluation (Hanley, 2002; Kingdon, 1995; Lindblom, 1987; Weissert & Weissert, 1996; Wieczorek, 1995).

6. 6 Problem identification Problem Identification is crucial to policy formation. This stage involves asking several questions to define the nature of the problem, �What is the scope, duration, history and whom does it affect?, What data is available to describe the issue.. What are the gaps in the data�(Leavitt, Cohen & Mason, 2002, p73).

7. 7 Policy Formation Policy formulation involves the setting of the agenda, and the specification of alternatives from which a choice is to be made.

8. 8 Policy Adoption Policy adoption involves an authoritative choice among those specified alternatives, as in a legislative vote or government decision (Hancock, 1999; Kingdon, 1995; Wieczorek, 1995).

9. 9 Levels of Policy Strategic Big picture, broad policy settings Substantive Sector-and content specific Operational Programme specific and managerial focussed

10. 10 Making it Happen Policy is a course of action. Power enables a group to influence others through political processes. The result is policy If we understand process around policy formation we can target our nursing leadership to influence

11. 11 Group work Who can you influence as a manager and nurse leader?

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13. 13 Traditional Policy Process Three main stages of policy-making Policy design � Activities involve: identify the need for policy, reviewing infor and evidence, historical context, developing policy options, risks, identifying resources needed (eg $s, workforce, timing )etc Policy implementation � Activities involve: engage and manage stakeholders, training staff, set milestones, tragets, accountabilities, marketing the policy Policy maintenance � Activities involve collecting infor. About how policy is working, reviewing resources allocated, reviewing policy effectiveness, etc Traditional model of policy process - sequence of closely inter-related and inter-dependent activitives, which form a cycle, so that you are continually improving the policies. Policy making has a number of key steps, but is rarely a simple process and it rarely proceeds as neatly as this model suggests.Three main stages of policy-making Policy design � Activities involve: identify the need for policy, reviewing infor and evidence, historical context, developing policy options, risks, identifying resources needed (eg $s, workforce, timing )etc Policy implementation � Activities involve: engage and manage stakeholders, training staff, set milestones, tragets, accountabilities, marketing the policy Policy maintenance � Activities involve collecting infor. About how policy is working, reviewing resources allocated, reviewing policy effectiveness, etc Traditional model of policy process - sequence of closely inter-related and inter-dependent activitives, which form a cycle, so that you are continually improving the policies. Policy making has a number of key steps, but is rarely a simple process and it rarely proceeds as neatly as this model suggests.

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16. 16 Building the Policy Agenda Knowledge Development requires critical thinking Between 1995 and 1998, an international panel of expert nurses from nine countries: Brazil, Canada, England, Iceland, Japan, Korea, Netherlands, Thailand, and 23 states in the U.S. participated in a study to examine critical thinking in nursing . Scheffer, B. K., & Rubenfield, M. G. (2000). A consensus statement on critical thinking in nursing. Journal of Nursing Education, 39(8), 52-359

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25. 25 Central to policy making is an individual - who could be you - the Policy Entrepreneur

26. 26 Policy Entrepreneur Kingdon (1995) uses the analogy of a surfer, waiting on the board to catch the wave:

27. 27 Policy entrepreneur �They bring several key resources into the fray: their claims to a hearing, their political connection and negotiating skills, and their sheer persistence. Items� chances of moving up on an agenda are enhanced considerably by the presence of a skilful entrepreneur.�

28. 28 Without the presence of an entrepreneur, the linking of the streams many not come together. Good ideas lie fallow for lack of an advocate. Problems are unsolved for lack of a solution. Political events are not capitalized for the lack of inventive and developed proposals (p.182). Kingdon, 1995

29. 29 Nurses as Policy Entrepreneurs �Surfers� of policy domain - watching the waves and watching the time Exhibit a wide horizon of choice Create agenda items Create linkages & couplings - problems, policy and political streams Engaging and constantly responding to change

30. 30 For most people change is uncomfortable or even threatening. For entrepreneurs change is normal and healthy� they have an uncommon alertness to opportunity and a more creative, risk pattern of response. Hughes, 2003

31. 31 How can you as nurse leaders and managers influence key strategic direction of your service: Individual level Unit/Ward/Team Level Through organised nursing groups/associations List the actions

32. 32 Cohen et al -Progress of nursing through the 4 stages of political development

33. 33 Hughes (2003)

34. 34 Cohen et al -Progress of nursing through the 4 stages of political development

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