Work

Conditions shaping policy enactment: Insights from evaluators at the bottom of the implementation staircase

Year: 2025

Type: article

Abstract: The current study advances understanding of policy enactment by conceptualizing the conditions influencing policy implementation in healthcare. A qualitative interview study examines how micro-level evaluators experience enacting macro-level policy, leveraging the implementation staircase model (Reynolds & Saunders, 1987). Three key themes emerged: alignment divide, value and impact, and policy leadership, summarizing nine conditions for policy enactment. Data were collected from semi-structured interviews (n = 8), document reviews (n = 6), and researcher reflections. Findings suggest that the evaluators' position at the lower levels of the implementation staircase amplifies the gap between policy and practice. Results highlight the crucial role of relationships between top and bottom layers of the staircase in influencing policy enactment. • Nine conditions influencing policy enactment by evaluators at the micro-level are identified. • The Implementation Staircase Model is expanded to reflect evaluator expertise and policy roles. • Evaluators bypass middle levels of the staircase, reshaping traditional policy enactment dynamics. • Practical solutions are offered to bridge policy-practice gaps in healthcare institutions. • Qualitative insights from interviews (n = 8) and document review (n = 6) inform policy improvements.

Source: Evaluation and Program Planning

DOI: 10.1016/j.evalprogplan.2025.102601

Author: Krista Brower

Institution: Lancaster University

Language: English

Topic: Health Policy Implementation Science

Subfield: General Health Professions

Field: Health Professions

Domain: Health Sciences

SDGs: Good health and well-being, Reduced inequalities

Open Access status: hybrid

Estimated APC paid: $3,370