Delivering reform in English healthcare: an ideational perspective

A variety of perspectives has been put forward to understand reform across healthcare systems. Recently, some have called for these perspectives to give greater recognition to the role of ideational processes. The purpose of this article is to present an ideational approach to understanding the delivery of healthcare reform. It draws on a case of English healthcare reform – the Next Stage Review led by Lord Darzi – to show how the delivery of its reform proposals was associated with four ideational frames. These frames built on the idea of “progress” in responding to existing problems; the idea of “prevailing policy” in forming part of a bricolage of ideas within institutional contexts; the idea of “prescription” as top-down structural change at odds with local contexts; and the idea of “professional disputes” in challenging the notion of clinical engagement across professional groups. The article discusses the implications of these ideas in furthering our understanding of policy change, conflict and continuity across healthcare settings

Non-state actors in hybrid global climate governance: justice, legitimacy, and effectiveness in a post-Paris era

In this article, we outline the multifaceted roles played by non-state actors within the United Nations Framework Convention on Climate Change and place this within the wider landscape of global climate governance. In doing so, we look at both the formation and aftermath of the 2015 Paris Agreement. We argue that the Paris Agreement cements an architecture of hybrid multilateralism that enables and constrains non-state actor participation in global climate governance. We flesh out the constitutive features of hybrid multilateralism, enumerate the multiple positions non-state actors may employ under these conditions, and contend that non-state actors will play an increasingly important role in the post-Paris era. To substantiate these claims, we assess these shifts and ask how non-state actors may affect the legitimacy, justice, and effectiveness of the Paris Agreement

Implementation of a workplace smoking ban in bars: The limits of local discretion

<p>Abstract</p> <p>Background</p> <p>In January 1998, the California state legislature extended a workplace smoking ban to bars. The purpose of this study was to explore the conditions that facilitate or hinder compliance with a smoking ban in bars.</p> <p>Methods</p> <p>We studied the implementation of the smoking ban in bars by interviewing three sets of policy participants: bar employers responsible for complying with the law; local government officials responsible for enforcing the law; and tobacco control activists who facilitated implementation. We transcribed the interviews and did a qualitative analysis of the text.</p> <p>Results</p> <p>The conditions that facilitated bar owners' compliance with a smoking ban in bars included: if the cost to comply was minimal; if the bars with which they were in competition were in compliance with the smoking ban; and if there was authoritative, consistent, coordinated, and uniform enforcement. Conversely, the conditions that hindered compliance included: if the law had minimal sanctions; if competing bars in the area allowed smoking; and if enforcement was delayed or inadequate.</p> <p>Conclusion</p> <p>Many local enforcers wished to forfeit their local discretion and believed the workplace smoking ban in bars would be best implemented by a state agency. The potential implication of this study is that, given the complex nature of local politics, smoking bans in bars are best implemented at a broader provincial or national level.</p