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Fig. 3 | Implementation Science

Fig. 3

From: Teasing apart “the tangled web” of influence of policy dialogues: lessons from a case study of dialogues about healthcare reform options for Canada

Fig. 3

ac Present potential pathways of influence of policy dialogues on policy-making by illustrating potential links between the various elements of the conceptual framework with policy-making at the agenda setting, formulation and implementation stages of the policy cycle respectively. Note that the suggested pathways do not imply direct causation but are meant to illustrate areas where policy dialogue designers may want to focus efforts to increase likelihood of influence of a given dialogue on policy processes. a Pathways of influence of policy dialogues on agenda setting. Illustrates potential pathways by which the capacities developed at policy dialogues can influence the ideas and interests within the 3-I framework and in turn the capacity to move different policy options onto public policy agendas at the agenda-setting stage of the policy cycle, as well as challenges to the influence of any given dialogue. The features of an effective policy dialogue are shaded ovals at the top of the diagram and the capacities developed from the Boyko framework are shown as boxes marked with an x. Potential linkages between capacities, the 3-I framework elements or the capacity for agenda setting are shown in boxes with upper and lowercase text. The elements of the 3-I framework (uppercase font) are illustrated as a triad of influence on the capacity for agenda setting. For example, with the right mix of features (evidence, participants and environment), policy dialogues can enhance new thinking by seeing and socializing ideas and providing a view of the policy landscape that influence ideas in circulation among policy-makers and stakeholders. Enhanced mutual understanding and relationships can foster a more cohesive policy community and face-to-face communication and strengthen the will to undertake reform among interests. These influences on ideas and interests and realities of the institutional setting, competing ideas and interests will together influence both capacity for agenda setting and which policy options make it onto policy agendas. b Pathways of influence of policy dialogues on policy formulation. Illustrates potential pathways by which the capacities developed at policy dialogues can influence ideas and interests within the 3-I framework and in turn the capacity to formulate policy solutions during the policy formulation stage of the policy cycle. The features of an effective policy dialogue are shaded ovals at the top of the diagram from the Boyko framework. The capacities described in the Boyko framework that are developed through policy dialogues are marked with an x. In addition to the capacities developed in Fig. 3a, a policy dialogue can enhance mutual understanding among dialogue participants that can help in shaping options, reaching a tighter consensus and assisting in setting priorities among options. These in turn can influence ideas and interests, which along with institutions can influence organizational capacity for policy formulation, and the policy options that are ultimately developed, as represented by the oval at the bottom of the figure. c Pathways of influence of policy dialogues on implementation. Illustrates potential pathways by which the capacities developed at policy dialogues can influence the implementation stage of the policy cycle. Constructs from the CFIR framework are represented by unshaded rectangles with flattened corners. For example, characteristics of interventions that influence implementation such as evidence strength, cost, adaptability, relative advantage and design and packaging of options can be shared as part of the evidence presented at the dialogue. Additionally, opinion leaders, implementation leaders and change agents can be engaged at or in follow-up to the dialogue to enhance likelihood of implementation. Building on the pathways of influence shown in Fig. 3a-b, new thinking enhances individual knowledge and beliefs about options that can contribute to organizational knowledge and priority setting, while relationships may lead to peer pressure and/or greater cosmopolitanism that along with enhanced self-efficacy can affect leadership engagement and tension for change within an organization. These factors affect organizational capacity for implementation including planning, reflecting and evaluating processes. External policy and incentives (including ideas, interests and institutions) and organizational capacity together will shape the likelihood and nature of policy implementation

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