Politics of Policy Adoption

Introduction

The Incremental, Mixed Scanning, Garbage Can, and Rational Models are the most applicable decision-making theories. Making decisions concerning public health is a complex process due to the various factors to consider. As a result, healthcare institutions and stakeholders utilize decision-making models to make and influence policies. The article explores how the mentioned models are used in healthcare policymaking.

Theories in Public Health Decision-Making

The Rational decision-making model entails weighing the alternatives to solve an organizational problem. The decision-makers carefully analyze the pros and cons of each alternative to determine their merit. A key weakness of the rationalist approach is the assumption that there is a reliable method to distinguish facts from values and means from ends (Etzioni, 1967). For instance, the construction of a hospital for African Americans was a debatable topic during the Jim Crow era. Building a branch of the Cook County Hospital near African American residents in the South Side created controversy due to the need to distinguish fact from value (Etzioni, 1967). On one hand, it was a fact that the hospital would improve healthcare delivery to the African American community. However, racists questioned the structure’s value because they did not care about African Americans’ welfare (Etzioni, 1967). The controversy questions the thinking process in the Rational Model of decision-making.

Lindblom (2010) shares Etzioni’s (1967) concern as she questions the relationship between the ends and the means in the Rational Model of decision-making (Lindblom, 2010). Lindblom (2010) questions how an administrator can justify the process (means) used to achieve the means if he or she does not have prior objectives or values to judge his/her decisions (Lindblom, 2010). The correct decision depends on the decision-makers’ priorities and values. However, the two elements are undefined, creating bias in decision-making. Despite its weaknesses, the Rational Model is widely used to make decisions in healthcare. Zaahira et al. (2018) document the importance of rational planning in public health (Zaahirah et al., 2018). The authors indicate that the Rational Model enables decision-makers to choose the optimal output option (Zaahirah et al., 2018). An example of the Rational Model in use occurs during budgeting. The authors also discuss Kenya’s Annual Operational Planning (AOP) to demonstrate the role of available resources in selecting the best course of action in public health planning (Zaahirah et al., 2018).

Also, Mixed Scanning is used to make policies in healthcare. The approach entails using fundamental, higher-order policymaking procedures to set basic directions before adopting a social policy. The model provides a realistic definition of stakeholders’ strategy in the field and the best strategy to follow (Etzioni, 1967). A practical application of the Mixed-Scanning Model in healthcare policy occurs in physical therapy. The policymaking process involves several stakeholders, such as legislative bodies (the government), healthcare specialists, and special interest or lobby groups (Sheldon, 2016). For instance, legislative bodies create policies (statutes, laws, and acts) that govern the practice of physical therapists. These rules ensure patient safety during treatment without undermining the role of physical therapists in healthcare (Sheldon, 2016). An example of a policy from Mixed-Scanning is a state agency policy to prevent work-related musculoskeletal disorders. Important factors considered during the policymaking process are political culture, interest group pressures, federal aid, and state resources (Sheldon, 2016). Despite the importance of alternatives, as in the Rational Model, some decisions require input from different stakeholders (federal bodies, healthcare personnel, and special interest groups) with high-level information on the subject matter. Therefore, the Mixed-Scanning Model applies to healthcare policymaking.

Another applicable decision-making model in public health is Incrementalism. The Incremental Planning Theory involves making improvements from previous decisions by making the necessary adjustments. The primary challenge with Incrementalism is that it does not provide a holistic analysis of a problem. Instead, the model focuses on small improvements (Zaahirah et al., 2018). Also, Incrementalism focuses on solving current issues instead of long-term solutions. Such limitations mean the model only works best with limited data, resources, information, and time. The UK applies the Incremental Model to address some primary care issues (Zaahirah et al., 2018). The National Health Service (NHS) implements strategies to make tobacco more expensive, regulates promotion, sets up smoking cessation clinics, and improves awareness about the dangers of tobacco to reduce smoking rates (Zaahirah et al., 2018). Essentially, the Incremental Model is useful in avenues where healthcare policies exist to solve a specific problem. Nonetheless, policymakers continue to implement additional strategies for even better outcomes.

A common theory of organizational decision-making is the Garbage Can Model. The theory postulates that an organization has problematic preferences, unclear technology, and fluid participation (Cohen et al., 1972). Organizations that adopt the Garbage Can Model operate on numerous ill-defined and inconsistent preferences. The organization is more of a loose collection of ideas than a coherent structure (Cohen et al., 1972). Policies are made on a trial-and-error basis and learned from accidents in past experiences. Further, the fluid participation suggests that boundaries, decision-makers, and audiences are constantly changing (Cohen et al., 1972). The lack of congruence in the Garbage Can Model makes it inapplicable to healthcare policymaking.

Conclusion

The Rational, Incremental, and Mixed Sanning Models apply to healthcare policymaking. The Rational model focuses on choosing the best alternative for maximum output, Incrementalism builds on previous experiences to improve policies, and Mixed Scanning uses higher-order procedures from stakeholders to make and influence healthcare policy. However, the inconsistent and problematic nature of the Garbage Can Model makes it inapplicable to healthcare policymaking. Healthcare requires evidence-based strategies from qualified stakeholders, not guesswork, confusion, and inconsistency.

References

Cohen, M. D., March, J. G., & Olsen, J. P. (1972). A Garbage Can Model of Organizational Choice. Administrative Science Quarterly, 17(1), 1-25. Retrieved from https://doi-org.libauth.purdueglobal.edu/10.2307/2392088

Etzioni, A. (1967). Mixed-Scanning: A “Third” Approach to Decision-Making. Public Administration Review, 27(5), 385-392. Retrieved from https://doi-org.libauth.purdueglobal.edu/10.2307/973394

Lindblom, C. E. (2010). The Science of “Muddling” Through. Emergence: Complexity & Organization, 12(1), 70-80.

Sheldon, M. R. (2016). Policymaking theory as an analytical framework in policy analysis: Implications for research design and professional advocacy. Physical Therapy, 96(1), 101-110. Retrieved from https://doi-org.libauth.purdueglobal.edu/10.2522/ptj.20150032

Zaahirah, M., Puvanese, R. S., Faridah, J., Fikri, R., Saba, A., Muhamad, H. J., & Rosliza, A. M. (2018). Planning Theories in Primary Health Care Planning. International Journal of Public Health & Clinical Sciences (IJPHCS), 5(4), 12-28.