what are the consequences after the policy implementation
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Answer:
Problems of policy implementation in acute care services in the UK
Powell and colleagues (2009) have investigated problems of policy implementation in acute pain services in the UK.
In 1990, the Royal College of Surgeons’ report Pain after Surgery recommended the introduction of an acute pain service to all major surgical hospitals in the UK in order to tackle the long-documented problem of poorly treated postoperative pain. The report was followed by a number of government documents which endorsed and developed the recommendations. By 2002 the majority of hospitals did have an acute pain service in some form, but many services were struggling to embed the necessary improvements in postoperative pain management in routine practice across their hospitals, leading to continuing deficits in basic care.
Through qualitative case study interviews with health professionals and managers working in and around acute pain services in three hospitals, Powell and colleagues identified multiple factors undermining service change around postoperative pain management which they divided into three linked categories.
Issues around the content of the change: what is an acute pain service and why have one here?
Lack of agreement that improvement was necessary
Lack of clarity about the nature of the change and how the proposed new services fitted with existing and related services
Issues around the context of the change: the idiosyncrasies of the local environment
Poor fit with local organisational priorities
Poor fit with local organisational structures (e.g. directorates)
Adverse effects of local organisational histories (e.g. service reorganisations, mergers)
Lack of direct and indirect resources to support the change
Issues around the process of the change: service change challenges professional roles and identities
Divergent views among health professionals about responsibility for this aspect of patient care
Conflict with longstanding professional boundaries and norms
These factors did not just impact as single factors, but also worked in combination and impacted on each other in complex ways. The authors conclude that national policy recommendations about changes in patient care are useful but not enough. Practitioners must also use the growing body of knowledge on health service change to select and tailor appropriate strategies at each organisational level, recognising that the combination of factors that enable development and adoption of new working practices in one setting may not apply in exactly that form elsewhere.