Implementation of Information Technology in U.S. Healthcare System

Implementation of Information Technology in U.S. Healthcare System

Introduction

The first major analysis of policy implementation as a focus for public administration was Jeffrey Pressman and Aaron Wildavsky's 1973 study, Implementation: How Great Expectations in Washington Are Dashed in Oakland. Many authors have offered definitions of policy implementation, which focus on the gap between policy intent and policy outcomes. O'Toole's (1995) definition is a good example stating that policy implementation refers to the connection between the expression of governmental intention and results. Policy implementation studies accept that the formal adoption of a policy goal does not necessarily provide direction on what should be done to achieve that goal. Mazmanian and Sabatier (1983) remarked that knowing the policy objectives gives only a general hint of what will actually be done by the agency responsible for carrying out the program and how successful it will be at winning the cooperation and compliance of the persons affected by it.

The field of implementation is traditionally divided into three generations and, perhaps, an emerging fourth generation. The first generation began with Pressman and Wildavsky in 1973. They found that the complexity of multiple layers of government and its agencies is a central obstacle to policy implementation. Interaction and coordination is difficult with potential roadblocks, turf battles and clashing management styles and resources. However, they hinted that systematic understanding of cause and effect might be possible (Currie, 1996).

The Second Generation Studies sought to overcome some of the deficiencies of the First Generation Studies such as constraints of time and space and the inability to generalize to more programs than the one under study. The Second Generation Studies shifted from focusing on a specific policy to the construction of more general theories of policy implementation. Bardach (1977) in The Implementation Game used the metaphor of games to focus analysts'attention on the participants in the process, the stakes that were at risk, the rules and tactics as well as the strategies and resources each member brought to the table. Bardach argued that there are four basic adverse effects during policy implementation,

The diversion of resources,

The deflection of policy goals,

Resistance to control, and

The dissipation of personal and political energy.

He categorized his games according to these adverse effects. For example, the budget game had the adverse effect of diverting resources or piling on which inhibited goal achievement by using new programs as Trojan horses for an agency's preferred goals.

Micro Perspective of Policy Implementation

The micro perspective looks at structural and cultural aspects of the implementing agencies within a local setting such as a municipality, governmental agency or private provider that delivers services within a locality. This local environment is a collection of governmental and civic agencies but also is influenced heavily by local citizen opinion. Whether or not local citizens have embraced a policy will determine its implementation and individual localities may differ on whether a policy is beneficial or detrimental within a smaller, narrow geographic ...