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Schober Global Healthcare Consulting, Indianapolis, IN, USA
Keywords
Policy analysisEvaluationOutcomesIndicatorsImpactPolicy analysis is comprised of a technique or process used to determine what a policy will achieve or has achieved relevant to an aspiration or purpose. Analysis can be descriptive in attempting to explain existing policy and its development or prescriptive when the analysis is used in formulating new policies and proposals. Policies that have been developed and implemented should be analyzed periodically for general acceptance and consistency with the current political environment and social and healthcare issues. Review and analysis of policies provide the opportunity for modifications as well as offering a perspective of the world of politics (Dye 2010; Longest 2005; Porche 2012). This chapter explores policy analysis and evaluation focusing on the consideration of what facilitates or impedes formulation and realization of policy. Policy analysis models are discussed. An evaluation process that includes reflexive response and adaptation in development of strategies is proposed. This chapter concludes by urging nurses, especially those leading advanced nursing practice initiatives, to become engaged in interactive policy communication to further ensure evaluation of the impact and outcomes of policy directives.
7.1 Process and Models
Policy analysis consists of a systematic evaluation of the technical and political implications of alternatives proposed to solve public problems (Birkland 2005; Porche 2012). Policy analysis refers to both the process of assessing policies or programs and the product of that analysis using qualitative and quantitative data and a variety of approaches to assess the situation. Results of analysis can facilitate discussion and debate on policy as well as provide evidence for decision-making and/or adaptations.
The context in which an issue arises or policy exists is assessed in the process of policy analysis through interpretative analysis of the policy and an evaluation of the historical context of the policy. This process may produce details regarding the association between current policy along with past and present political, social, and healthcare contexts. If there is a disconnect between current policy and the present context, either a further in-depth policy evaluation may be warranted. The initial policy analysis could simply lead to a recommendation for policy modification.
According to Porche (2012), there are two foci for policy analysis:
Analysis of policy
Analysis for policy
Analysis of policy can be viewed as a retrospective process that explores the purpose of the policy and what comprised and established the policy. This analysis of policy studies how policy evolved onto the policy agenda and the process of formulation of the policy. In contrast, analysis for policy is prospective and explores potential outcomes if a specific policy is developed and implemented (Buse et al. 2005). Policy analysis is dependent upon access to data sources such as valid and reliable documents, interviews, focus groups, and government or agency reports (Porche 2012)
The product of the policy analysis is a clear description of the issue, identification of policy solutions, courses of action with expected outcomes along with a contextual, and comprehensive understanding of the policy. In addition to creating policy or assessing the need for modification of current policy, analysis can be done during all phases of policymaking from agenda setting to policy formulation to implementation (Porche 2012).
However, Birkland (2005) comments that frequently debate on policy is based on anecdotal evidence rather than scientific policy analysis. In comparing these two approaches, anecdotal evidence provides easily understood stories, while scientifically sound evidence from a study is based on factual data. Evidence may contrast with anecdotes or “common wisdom” (p. 11), and even though data are based on scientific findings, it may prove to be unpopular.
The policy feedback theory proposed by Mettler and Sorelle (2014) adds another dimension to the concept of policy analysis. Policy feedback refers to the potential for policies to transform politics and, as a result, influence future development of policy and thus transform the political landscape. The field of policy analysis, which endeavors to predict the most valuable approaches to solving social problems or to evaluate the capacity of existing policies to do so, often focuses on issues of economic value or social well-being. Policy feedback theory proposes to assess how policies affect decisive aspects of governance, such as whether policy promotes public and citizen participation or deters it, whether policy promotes development of powerful interest groups, and how they affect governing capacity. This approach attempts to clarify the impact of policies and assist in avoiding unintended consequences.
Ideally, evaluation and analysis of policy should be based on sophisticated research conducted by objective researchers. In the real world, data are at times difficult to find or do not exist and are too time-consuming to obtain, or results may be withheld due to personal reasons by the researcher (Birkland 2005). Unfortunately, due to diverse interests related to a particular issue such as a controversial topic, empirical results may be labeled as preliminary or inconclusive to impede decision-making. As a consequence the issue disappears from the policy agenda. It is important to bear in mind that even though policy analysis appears sound and logical, by itself, it is unlikely to make a difference in a heated policy debate. Birkland (2005) suggests that ideological agreements on an issue may play a more significant part in making decisions than sound evidence. In spite of this, policy analysis can still be seen to have a role in the policy process if the empirical evidence is accurate and thorough.
7.1.1 Policy Analysis Models
It is not the aim of this publication to provide an in-depth discussion of policy analysis models but to offer an introduction to several examples of approaches that can be considered when thinking about doing a policy analysis. The following sections provide brief synopses of these models.
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