Developing recommendations to improve the quality of diabetes care in Ireland: a policy analysis

Hdl Handle:
http://hdl.handle.net/10147/328148
Title:
Developing recommendations to improve the quality of diabetes care in Ireland: a policy analysis
Authors:
Mc Hugh, Sheena M; Perry, Ivan J; Bradley, Colin; Brugha, Ruairí
Citation:
McHugh SM et al. Developing recommendations to improve the quality of diabetes care in Ireland: a policy analysis. Health Res Policy Sys. 2014 Sep 18;12(1):53
Issue Date:
18-Sep-2014
URI:
http://dx.doi.org/10.1186/1478-4505-12-53; http://hdl.handle.net/10147/328148
Abstract:
Abstract Background In 2006, the Health Service Executive (HSE) in Ireland established an Expert Advisory Group (EAG) for Diabetes, to act as its main source of operational policy and strategic advice for this chronic condition. The process was heralded as the starting point for the development of formal chronic disease management programmes. Although recommendations were published in 2008, implementation did not proceed as expected. Our aim was to examine the development of recommendations by the EAG as an instrumental case study of the policy formulation process, in the context of a health system undergoing organisational and financial upheaval. Methods This study uses Kingdon’s Multiple Streams Theory to examine the evolution of the EAG recommendations. Semi-structured interviews were conducted with a purposive sample of 15 stakeholders from the advisory group. Interview data were supplemented with documentary analysis of published and unpublished documents. Thematic analysis was guided by the propositions of the Kingdon model. Results In the problem stream, the prioritisation of diabetes within the policy arena was a gradual process resulting from an accumulation of evidence, international comparison, and experience. The policy stream was bolstered by group consensus rather than complete agreement on the best way to manage the condition. The EAG assumed the politics stream was also on course to converge with the other streams, as the group was established by the HSE, which had the remit for policy implementation. However, the politics stream did not converge due to waning support from health service management and changes to the organisational structure and financial capacity of the health system. These changes trumped the EAG process and the policy window remained closed, stalling implementation. Conclusions Our results reflect the dynamic nature of the policy process and the importance of timing. The results highlight the limits of rational policy making in the face of organisational and fiscal upheaval. Diabetes care is coming on to the agenda again in Ireland under the National Clinical Care Programme. This may represent the opening of a new policy window for diabetes services, the challenge will be maintaining momentum and interest in the absence of dedicated resources.
Item Type:
Article
Language:
en
Keywords:
DIABETES MELLITUS

Full metadata record

DC FieldValue Language
dc.contributor.authorMc Hugh, Sheena Men_GB
dc.contributor.authorPerry, Ivan Jen_GB
dc.contributor.authorBradley, Colinen_GB
dc.contributor.authorBrugha, Ruairíen_GB
dc.date.accessioned2014-09-23T10:36:27Z-
dc.date.available2014-09-23T10:36:27Z-
dc.date.issued2014-09-18-
dc.identifier.citationMcHugh SM et al. Developing recommendations to improve the quality of diabetes care in Ireland: a policy analysis. Health Res Policy Sys. 2014 Sep 18;12(1):53en_GB
dc.identifier.urihttp://dx.doi.org/10.1186/1478-4505-12-53-
dc.identifier.urihttp://hdl.handle.net/10147/328148-
dc.description.abstractAbstract Background In 2006, the Health Service Executive (HSE) in Ireland established an Expert Advisory Group (EAG) for Diabetes, to act as its main source of operational policy and strategic advice for this chronic condition. The process was heralded as the starting point for the development of formal chronic disease management programmes. Although recommendations were published in 2008, implementation did not proceed as expected. Our aim was to examine the development of recommendations by the EAG as an instrumental case study of the policy formulation process, in the context of a health system undergoing organisational and financial upheaval. Methods This study uses Kingdon’s Multiple Streams Theory to examine the evolution of the EAG recommendations. Semi-structured interviews were conducted with a purposive sample of 15 stakeholders from the advisory group. Interview data were supplemented with documentary analysis of published and unpublished documents. Thematic analysis was guided by the propositions of the Kingdon model. Results In the problem stream, the prioritisation of diabetes within the policy arena was a gradual process resulting from an accumulation of evidence, international comparison, and experience. The policy stream was bolstered by group consensus rather than complete agreement on the best way to manage the condition. The EAG assumed the politics stream was also on course to converge with the other streams, as the group was established by the HSE, which had the remit for policy implementation. However, the politics stream did not converge due to waning support from health service management and changes to the organisational structure and financial capacity of the health system. These changes trumped the EAG process and the policy window remained closed, stalling implementation. Conclusions Our results reflect the dynamic nature of the policy process and the importance of timing. The results highlight the limits of rational policy making in the face of organisational and fiscal upheaval. Diabetes care is coming on to the agenda again in Ireland under the National Clinical Care Programme. This may represent the opening of a new policy window for diabetes services, the challenge will be maintaining momentum and interest in the absence of dedicated resources.-
dc.language.isoenen
dc.subjectDIABETES MELLITUSen_GB
dc.titleDeveloping recommendations to improve the quality of diabetes care in Ireland: a policy analysisen_GB
dc.typeArticleen
dc.language.rfc3066en-
dc.rights.holderSheena M Mc Hugh et al.; licensee BioMed Central Ltd.-
dc.description.statusPeer Reviewed-
dc.date.updated2014-09-22T19:03:44Z-
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