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Table 6 Types of policy actors identified in implementation

From: Understanding the implementation of evidence-informed policies and practices from a policy perspective: a critical interpretive synthesis

Actor Sub-type (non-exhaustive) Role description Role in implementation (non-exhaustive) References
Political actors Politicians • Represent citizens (in a democracy) through popular consensus.
• Mandate to create laws and policies with varying levels of authority
• Can be supra-national, national/federal, state/provincial, regional, local/municipal
• Most important level of elected officials is the level where most policy authority rests for area of implementation
• Develop and pass laws/policies (e.g., mandating a particular EIPP)
• Provide leadership and focus
• Source of funding for implementation (organizations, providers, and/or consumer levels)
[34, 36, 41, 50, 54, 61, 63, 65, 80, 82, 83, 94, 95, 101]
Other elected officials • Similar to elected politicians but mandate is limited to a particular policy domain and (often) limited geographic jurisdiction (e.g., sheriff, judge, school board trustee) • If policy authority rests at their level, they may develop and pass laws
• Enforce laws/polices from other levels
• Interpret/adapt laws/policies for their implementation
• Provide leadership and focus
• Source of funding for implementation (organizations, providers, and/or consumer levels)
[54]
Bureaucratic actors Executive departments • Departments or ministries who specialize in a unique area of government responsibility (e.g., health)
• Responsible for carrying out the “vision” of an elected official with leadership for that portfolio (e.g., Minister of Health)
• Not elected nor formally tied to a particular political party
• Support policy development, including implementation considerations
• Operationalize policy/law passed by politicians
• May allocate tasks, responsibilities and define competencies for implementation
• Monitor policy implementation and track outputs or outcomes
• Source of funding for implementation (organizations, providers, and/or consumer levels)
[34, 61, 82, 84, 89]
Boards and agencies of government • Often operate semi-independently from government but are appointed by them
• In most cases, they deal exclusively with one particular sub-field of responsibility in which the demand for public services is especially high (e.g., food inspection agency, state mental health authority)
• Regulation and enforcement
• Interpretation of policies/laws
• Monitor policy implementation and track outputs or outcomes
• May have the ability to apply penalties for non-compliance
• May allocate tasks, responsibilities, and define competencies for implementation
[27, 28, 34, 65, 80, 82]
Self-governing regulatory agencies • Bodies that regulate the conduct of their own members (such as admissions and discipline) and are empowered to do so by the appropriate level of government and their members (e.g., medicine, law)
• Regulators are drawn from the membership
• Can set or change: scope of practice, training, and licensure requirements, or professional liability to support implementation
• Develop/adopt guidelines or standards
• Monitor quality and safety and continued competence of professionals during implementation
[82]
Judicial system • System of courts that provide a formal mechanism for interpretation and application of laws in the name of the state and resolves disputes • Interpret/re-interpret laws through rulings that may affect how they are implemented
• Define/re-define public policies through legal challenges
[40]
Special interests Implementing agencies • Organizations or programs that are responsible for implementing the laws or policies developed (e.g., hospitals, schools, child welfare agencies, industry)
• Location(s) where the majority of the implementation takes place
• Interpretation of policies/laws
• Develop or adapt organizational policies and procedures to support implementation
• Training and support for workforce
• Provide or manage funds to support implementation
• Monitor and evaluate implementation at organizational level
[28, 34, 41, 43, 50, 83, 87, 89, 91, 95, 101]
Street-level bureaucrats • The schools, police and welfare departments, lower courts, legal services offices, and other agencies whose workers interact with and have wide discretion over the dispensation of benefits or the allocation of public sanctions [13]
• Have (1) relatively high degree of discretion and (2) relative autonomy from organizational authority [13]
• Interpretation of policies/laws
• Often the parties responsible for changing their behaviors or practices during implementation
[13, 41, 43]
Insurers • Organizations or government bodies that manage risk by pooling risk across a group of individuals and providing coverage to them for needed services
• Managed care organizations are a specific type of insurer in health care that monitor and control the provision of care in an effort to increase quality through regulating the choices of providers and patients
• Have the ability to change the risk pool by insuring more or fewer people (scope and nature of insurance plan)
• Can adjust the list of covered/reimbursed organizations, providers, services, and products
• Can change billing/reimbursement processes to facilitate implementation
• Engagement and potential influence with political and bureaucratic actors (feedback loops) regarding implementation and scaling
[50, 65, 82]
Donors/foundations • Organizations that raise and allocate funds based on a specific mandate that they identify • Funding and/or in-kind implementation supports (e.g., human resources)
• May have funded an innovation and now have a vested interest in seeing it implemented or scaled (bring leadership and focus, implementation, and scaling expertise)
• Engagement and potential influence with political and bureaucratic actors (feedback loops) to support implementation and scaling
[41, 105]
Government corporations • Organizations or businesses that are run independently from government but are still ultimately accountable to them • Interpretation of policies/laws
• Develop or adapt organizational policies and procedures to support implementation
 
Unions • Organized associations of workers created to promote and protect their interests in the workplace • Negotiate contractual relationships with implementing organizations on behalf of members (can influence the ease of implementation)
• Engagement and potential influence with political and bureaucratic actors (feedback loops) regarding implementation and scaling
[34, 41]
Experts Scientists/researchers • Individuals or research programs that systematically gather, analyze, and use research and other evidence through processes, such as theorizing, synthesizing, and hypothesis testing, to gain and share understanding and knowledge • Share or contribute research expertise concerning the problem, the innovation, the implementation or the evaluation of the implementation effort and any expected outcomes
• Engagement and potential influence with political and bureaucratic actors (feedback loops) to support implementation and scaling
[35, 101]
Field or practice leaders/champions • Individuals who belong to a service providing community and are viewed as leaders or champions of an innovation and its implementation • Share or contribute practice expertise concerning the problem, the innovation, the implementation or the evaluation of the implementation effort and any expected outcomes
• Act as champions for implementation to members of their service providing community and to other policy actors
• Engagement and potential influence with political and bureaucratic actors (feedback loops) to support implementation and scaling
[31, 38, 42]
Patients or persons with lived experience and families/carers • Individuals who bring personal knowledge or experience of a problem, condition, or service and who are the intended beneficiaries or ultimate “targets” of implementation
• Individuals who are family members or carers to individuals who bring personal knowledge or experience of a problem, condition, or service
• Share or contribute lived experience of the problem, the innovation, the implementation or the evaluation of the implementation effort and any expected outcomes [28, 35, 43, 45, 57, 83, 100]
Innovation/developers and disseminators • Organizations, programs or individuals who have developed a process, program, or product to be implemented • Synthesize knowledge about innovation and package it in ways that are “usable”
• Actively seek opportunities for innovation to be adopted in policy and/or practice
• Provide expertise about the innovation during implementation process
• Adapt innovation and materials as needed during implementation process
[52, 101]
Intermediaries and technical assistance providers • Organizations, programs, or individuals that work “in between” policymakers, funders, and front-line implementers, to facilitate effective implementation drawing on expertise in implementation
• Also known as purveyor organizations, backbone organizations, or central bodies charged with coordination
• Translate policy intention for implementing agencies
• Provide technical assistance to implementing agencies (e.g., guidance on implementation process, coaching, decision support, monitoring, and evaluation)
• Provide mechanism for communication between service delivery, policy systems, and innovation developer (if applicable)
[9, 31, 42, 44, 45, 53, 83, 86, 89, 100, 101]
Other Media • Individuals and organizations that communicate information through a variety of channels, including formal media outlets and social media outlets • Monitor implementation and communicate facts or perceptions of the process and outcomes to the public
• Provides feedback loop for political actors, bureaucratic actors, special interests, and experts regarding implementation
[34, 65]