Policies are not implemented just because they exist on paper. When implemented, they often confound the expectations of policy makers and take forms different from the visions outlined in policy documents. This is because policy implementation processes are dynamic.
Rarely do they follow the often-hoped-for, bureaucratic logic of moving inexorably down public sector hierarchies in which the role of some is to formulate and others simply to implement. Instead, the direction of a policy is shaped by the context in which it is introduced, the relationships required to implement it and the stakeholders whose paths it crosses.
This is shown by in-depth case studies of policy implementation in two South African district hospitals. The research sought to document key influences over policy implementation, including the exercise of power by managers and frontline implementers and institutional factors such as managerial trust and organisational culture.
In unpacking these implementation influences, it focused on two examples of policy implementation practice: the Patients’ Rights Charter (PRC), which guides the relationship between patients and providers, and the Uniform Patient Fee Schedule (UPFS), which regulates the payment of user fees and the granting of exemptions at public hospitals.
CREHS policy brief, October 2009, 4 pp.