Implementation of health care programmes: development of an operational framework

Abstract

Management’s quest to identify and understand the factors influencing the performance of an organisation has been ubiquitous. The attempt has been to identify what factors influence the conversion of intent into performance ie: the implementation of strategies and policies.

Research on implementation in the fields of Public policy and Strategic management has been fragmented, dominated by formulation issues with limited theory building and empirical testing. It is dispersed and lacks a dominant framework to guide researchers and practice. Thus there arose a need to develop a theory of implementation and use it to develop a framework to help researchers and practicing managers. The objective of this study was to develop a mid range theory of implementation and an operational framework which could help practicing managers in the fields of health care, public policy and strategic management.

The theoretical lenses of resource-based view, resource dependency view along with the resource allocation process were used to address the research problem identified. A processual study was designed in the context of rural health care in India under the public domain and implementation of four national health programmes was studied in the states of Gujarat, Tamil nadu and Kerala. The main contributions based on the findings are:

1. The generation of a tentative exploratory mid range theory of implementation. Overall, the analysis has shown that management of resource dependency is critical for achieving organizational effectiveness. Resource dependency was identified as a function of both quality and quantity of resources required for delivery of mandated services. It necessitated that organization’s have the ability to identify the “Key resources” critical for delivery of such services. This enabled them to position and manages the macro processes which drove the generation, acquisition, distribution and utilization of such resources. It also enabled them to position and ensure functioning of administrative structures at all levels and continuously align these processes in line with changing service requirements. A fully functional “Cognitive architecture” facilitated this process. Ultimately, Managed resource dependency maintained the field unit head’s “Motivation to produce”. This enabled him, through his personal initiative and supervision, to maintain the service deliverer’s “Motivation to produce”. This ensured appropriate resource utilization and purposeful actions at service delivery level. Thus comprehensive execution of the micro processes resulted, leading to effective performance. Overall, the process of implementation was identified to be a function of organizational attention, its direction of macro processes and administration of its micro processes driven by the effort to manage its resource dependency

2. By an effort at integration across disciplines, it significantly developed an operational framework for implementation of strategy or programmes.

3. Building upon the existing concepts in literature, it generated the constructs of “Key resources” “Implementation organization”, “Cognitive architecture” during the process of theory generation.

4. It extends the application of the Resource allocation process to firms in the services sector.

5. It finally establishes the processual character of the implementation process and echoes the persistent call for increase in processual studies of the phenomenon of implementation in the fields of strategic management, policy implementation and programme implementation in the field of health care.