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Schober Global Healthcare Consulting, Indianapolis, IN, USA
Keywords
Rational decision-makingIncrementalismDisjointed incrementalismAlternative choicesUnanticipated consequencesAs a concept, rational decision-making can be viewed as a multi-step process, from problem identification through solution, for making logically sound decisions (Porche 2012; Walt 2006). Rational decision-making favors objective data and a formal process over subjectivity and insight, making an assumption that the decision-maker has all relevant data about alternative choices and solutions. This concept also assumes that decision-makers have the time, intellectual ability, and resources to evaluate each choice against others. This chapter discusses the characteristics of a rational approach to policy decision-making and identifies a rational approach model in making policy decisions. The rational approach to making decisions is compared to the theory of step-by-step or incremental decision-making. In addition, disjointed incrementalism is discussed in exploring the perspective of what influence unexpected or unforeseen events may have on the policymaking process.
8.1 Policy-Making: A Rational Process
Is policy-making a rational process? Is strategic planning beneficial? Are communication and collaboration advantageous? How does reality intersect with idealism?
Various perspectives and theories that suggest policies or policy decisions can be made in a rational way have been discussed in earlier chapters. In theory, this view suggests that rational thinking in making policy decisions is the approach policymakers ought to take in making decisions. The rational model of making policy decisions proposes that policymakers go through certain stages logically to achieve the best possible policy decisions. Key points of a rational model include the following assumptions (Kingdon 2003; Walt 2006):
Policymakers can identify or define a specific problem and are able to separate it out from other similar problems (e.g., limited access to healthcare professionals to provide quality primary healthcare services).
Principles that guide policymakers are ranked according to their importance (e.g., providing quality healthcare services may be secondary to providing services at the least cost or more efficiently).
That various alternatives are being considered.
The pros and cons of each alternative are assessed systematically.
Each alternative and its advantage or disadvantage are being compared.
The policymaker chooses the optimal alternative at the least cost.
Assumptions of the rational model imply that the result of this process is a rational decision that most effectively achieves an anticipated conclusion. For various reasons, such a model does not describe reality. Those that question that a rational model accurately describes the policymaking process point out the following (Cairney and Heikkila 2014; Kingdon 2003; Walt 2006):
Policymakers do not always face well-defined problems.
Defining the issue, topic, or problem may be difficult and complicated.
It is unrealistic to think policymakers have the time, imagination, and information to assess the pros and cons of various alternatives.
Unanticipated consequences, by definition, cannot be anticipated.
Policymakers are not objective or value-free. They have preferred ways of thinking or resolving issues.
Past policy heavily influences present policy.
The ability of individuals to process information is more limited than a comprehensive approach would require.
The rational view of policymaking may be an ideal to strive for when providing a theory of the way policymakers ought to act in making decisions. However, the author proposes that the idea of a rational process is unrealistic. While there is little disagreement in identifying different stages of the policy process, there is a great deal of dissension as to how far policymaking follows a rational or logical process from problem identification to evaluation (Kingdon 2003; Walt 2006). Precise and sequential stages do not describe these processes accurately. While there are identifiable processes, they do not necessarily follow one another through time in any ordered pattern.
Policy models or frameworks may give a false impression of rationality by implying that policymaking follows a linear process through chronological phases. This chapter and topics discussed in Chap. 4 propose that policymaking is not a fully rational process. For example, policies may remain intentions that are never put into practice or may be implemented in ways that misrepresent the original intention of the policymakers. A rational approach prescribes how policy ought to be made; however, unexpected and unanticipated events or actions are more likely to define reality and shape the policy process. The next section discusses how incrementalism in relationship to policy development contrasts with the rational model.
8.2 Incrementalism and Policy Decisions
The concept of incrementalism proposes that policy change occurs using small incremental steps rather than a few (extensively planned) large steps (Kingdon 2003; Lindblom 1979; Porche 2012; Walt 2006). This theory suggests that in public policy, the method of change is with many small policy changes enacted over time in order to create a larger broad-based policy change. Walt (2006) suggests that incrementalism is more descriptive of the way policy is actually made as apposed to a rational process. The main assumptions of incrementalism are as follows:
Policymakers usually do not think through or spell out their objectives.
Policymakers identify a small number of alternatives and tend to choose options similar to existing policies.
For each alternative only the most important outcomes are considered.
There is no optimal policy option. There is consensus among policymakers about the decision that was chosen, but it is not necessarily the “best” decision.
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