Street-level bureaucracy: an underused theoretical model for general practice?

Cooper, Max; Sornalingam, Sangeetha; O’Donnell, Catherine

doi:10.3399/bjgp15x685921

Cited by 47 publications

(49 citation statements)

References 7 publications

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“…A focus on discretion has emerged as a prominent discourse in health and social care scholarship: student nurses (Hughes and Condon ), experienced Health Visitors (Bergen and White ), social workers (Evans , Scourfield ) and primary care physicians (Cooper et al . ) have all been shown to use discretion to reconcile professional values with institutional constraints and limited resources.…”

Section: Introductionmentioning

confidence: 99%

“…Drawing on the work of Lipsky (1980), this body of research explores the ways that public employees use, implement and subvert policy directives in response to day-to-day pressures of working in a resource-limited environment (Erasmus 2014, Hughes andCondon 2016). A focus on discretion has emerged as a prominent discourse in health and social care scholarship: student nurses (Hughes and Condon 2016), experienced Health Visitors (Bergen and White 2005), social workers (Evans 2010, Scourfield 2015 and primary care physicians (Cooper et al 2015) have all been shown to use discretion to reconcile professional values with institutional constraints and limited resources.…”

Section: Introductionmentioning

confidence: 99%

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Home level bureaucracy: moving beyond the ‘street’ to uncover the ways that place shapes the ways that community public health nurses implement domestic abuse policy

Cuthill

Johnston

2019

Sociology Health & Illness

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Street‐level bureaucracy is an increasingly useful way to understand how strategic policy is implemented in day‐to‐day practice. This approach has uncovered the ways that individual health and social care practitioners work within institutional constraints to influence policy implementation at the micro‐level. Nonetheless, despite the diversity of settings where these street‐level bureaucrats (SLBs) work, little attention has been focused on the impact of place on policy delivery. This paper draws on empirical research to examine the ways that delivering government domestic abuse policy in the intimate space of the family home shapes the delivery of strategic policy in the everyday. Drawing on qualitative research with Health Visitors (HVs) in the UK in 2016, the study findings illuminate the ways that the material, socio‐spatial and idealised boundaries of the family home shape the implementation of policy. Key themes in the HV's narratives emerged as they described themselves as both a danger and in danger in the family home. In challenging the ontological security of the home (Giddens 1990) – privacy, security and control are key concepts here – HVs described how they shape their actions to achieve policy outcomes while simultaneously managing threats to the home, to professional identity and to self.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Home level bureaucracy: moving beyond the ‘street’ to uncover the ways that place shapes the ways that community public health nurses implement domestic abuse policy

Cuthill

Johnston

2019

Sociology Health & Illness

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“…The critical role of these frontline workers mirrors that of other professionals, such as police officers and teachers, who are at the vanguard of policy implementation in their fields, and have been dubbed "street-level bureaucrats. " [30][31][32][33][34] Many of these voices had not been previously captured, nor their expertise acknowledged.…”

Section: Discussionmentioning

confidence: 99%

Improving Medicaid Access in Times of Health Policy Change: Solutions from Focus Groups with Frontline Enrollment Workers

Raymond‐Flesch¹,

Lucia²,

Jacobs³

et al. 2019

Journal of Health Care for the Poor and Underserved

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Enrollment navigators and government-employed Medicaid workers were an important element in the Affordable Care Act's (ACA) initial enrollment success. The Centers for Medicare and Medicaid Services eliminated 41% of funding for 2017 navigator programs and 90% of funding for outreach, arguing less investment was needed. Given that many remain uninsured, it is critical to identify effective enrollment practices. This study characterizes barriers and enrollment strategies from the perspective of California's Medicaid government and community-based enrollment workers (n=101 in eight focus groups). Participants identified a need for communication with policymakers, the state exchange, and each other regarding changing enrollment processes. Solutions include increased contact between enrollment workers to share strategies and policy updates regarding application processing, uniform policy interpretation, and details of ACA-related immigration law. Given efforts to weaken the ACA, it is critical to engage frontline workers in problem solving to streamline enrollment strategies, particularly for vulnerable populations.

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“…The limited research on policy impact on neonatal death highlights the challenges of inadequate research in Ghana context. Of critical importance to policy, continuity is the need to assess policy gains overtime after policy implementation [ 48 , 46 ].…”

Section: Methodological Literaturementioning

confidence: 99%

“…Lipsky opined that in policy implementation, the lower level employee is faced with challenges and exercises discretions. He maintained that the employee is the last link to policy formulation and should not be left out in developing workable policies [ 44 , 45 ] and that, the lower-level employee which he termed the Street-Level Bureaucrat, is the one with the actual implementation role of public policy [ 48 , 46 ].…”

Section: Conceptualizationmentioning

confidence: 99%

Impact of free maternal health care policy on maternal health care utilization and perinatal mortality in Ghana: protocol design for historical cohort study

et al. 2020

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Background Ghana introduced what has come to be known as the 'Free’ Maternal Health Care Policy (FMHCP) in 2008 via the free registration of pregnant women to the National Health Insurance Scheme to access healthcare free of charge. The policy targeted every pregnant woman in Ghana with a full benefits package covering comprehensive maternal healthcare. Purpose This study seeks to measure the contribution of the FMHCP to maternal healthcare utilization; antenatal care uptake, and facility delivery and determine the utilization impact on stillbirth, perinatal, and neonatal deaths using quasi-experimental methods. The study will also contextualize the findings against funding constraints and operational bottlenecks surrounding the policy operations in the Upper East Region of Ghana. Methods This study adopts a mixed-method design to estimate the treatment effect using variables generated from historical data of Ghana and Kenya Demographic and Health Survey data sets of 2008/2014, as treatment and comparison groups respectively. As DHS uses complex design, weighting will be applied to the data sets to cater for clustering and stratification at all stages of the analysis by setting the data in STATA and prefix Stata commands with ‘svy’. Thus, the policy impact will be determined using quasi-experimental designs; propensity score matching, and difference-in-differences methods. Prevalence, mean difference, and test of association between outcome and exposure variables will be achieved using the Rao Scot Chi-square. Confounding variables will be adjusted for using Poisson and multiple logistics regression models. Statistical results will be reported in proportions, regression coefficient, and risk ratios. This study then employs intrinsic-case study technique to explore the current operations of the ‘free’ policy in Ghana, using qualitative methods to obtain primary data from the Upper East Region of Ghana for an in-depth analysis. Discussion The study discussions will show the contributions of the ‘free’ policy towards maternal healthcare utilization and its performance towards stillbirth, perinatal and neonatal healthcare outcomes. The discussions will also centre on policy designs and implementation in resource constraints settings showing how SDG3 can be achievement or otherwise. Effectiveness of policy proxy and gains in the context of social health insurance within a broader concept of population health and economic burden will also be conferred. Protocol approval This study protocol is registered for implementation by the Ghana Health Service Ethical Review Committee, number: GHS-ERC 002/04/19.

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Street-level bureaucracy: an underused theoretical model for general practice?

Cited by 47 publications

References 7 publications

Home level bureaucracy: moving beyond the ‘street’ to uncover the ways that place shapes the ways that community public health nurses implement domestic abuse policy

Home level bureaucracy: moving beyond the ‘street’ to uncover the ways that place shapes the ways that community public health nurses implement domestic abuse policy

Improving Medicaid Access in Times of Health Policy Change: Solutions from Focus Groups with Frontline Enrollment Workers

Impact of free maternal health care policy on maternal health care utilization and perinatal mortality in Ghana: protocol design for historical cohort study

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