Week 3 - Assignment: Write a Personal Memo Relating Management and Organizational Behavior to Your Dissertation

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P A R T O N E

The Implementation

Landscape

Reformers are institutional gardeners more than architects and engineers. They reinterpret codes of behavior, impact causal and normative beliefs, foster civic and democratic identities and engagement, develop organized

capabilities, and improve adaptability.1

The great thing about [gardening] is the way something new is always happening . . . Each year there are new varieties to discover in the annual

crop of seed catalogs, new trends to dabble with and new planting schemes to explore. And apart from the dazzling variety of the plants themselves, there are the imponderables of pests, problems and weather that combine to make each season a new gardening adventure. But some things never change—the

basic skills of sowing, planting, and cultivation.2

Sandfort, J., & Moulton, S. (2015). Effective implementation in practice : Integrating public policy and management. ProQuest Ebook Central <a onclick=window.open('http://ebookcentral.proquest.com','_blank') href='http://ebookcentral.proquest.com' target='_blank' style='cursor: pointer;'>http://ebookcentral.proquest.com</a> Created from ncent-ebooks on 2021-10-04 14:41:52.

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In part 1, we describe the landscape of our approach to policy and programimplementation. While we integrate prior approaches to understanding imple- mentation in public contexts, we devote attention to describing an alternative way to view implementation, suggesting criteria for assessing effectiveness, and explaining why things happen the way they do. Chapter 1 presents our definition of effective implementation and key elements in our approach. It is worth noting that this approach is purposefully pragmatic, grounded in academic thinking, but also drawing considerably from experience and reflection. And it is context dependent. Effective implementation cannot be reduced to a generic set of skills that can be applied universally across all settings. Policy-specific expertise is essential, and we introduce case examples that we follow throughout the book to elucidate the dynamics of implementation analysis in specific settings.

Chapter 2 situates our approach within the context of three other traditions of scholarship and practice: political processes and authority, governance and man- agement, and policy and program evaluations. One of our motivations for writing this book is the cognitive dissonance we often feel when engaging scholarship in any one of these areas. On one hand, each directly speaks to the implementation system and its challenges. But on the other hand, each informs only one piece of the implementation puzzle—political and power dynamics, the governance sys- tem, or interventions targeting behavioral change. In our work as practitioners and now scholars, we navigate across these artificial boundaries, borrowing from each the relevant aspects for implementation. We think that this is an important con- tribution for future students and practitioners and therefore share these insights in chapter 2.

Finally, in chapter 3, we apply the concept of strategic action fields to the imple- mentation system as a way to suggest a systematic way to explain what happens in implementation systems. By doing this, we emphasize that these systems are complex, not merely complicated. They cannot be neatly reduced to a set of fac- tors or variables that predict success, but rather must be viewed as dynamic, living social systems. Each level in the implementation system is a strategic action field with a unique social structure and dynamics that shape the core program. The core program is what distinguishes implementation from other change initiatives—it involves establishing viable options, using a logic of change, and selecting a means

2 Effective Implementation in Practice

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for activity coordination. This is a new way of thinking about the implementation system. And like any other new idea, it may take some time to digest the concepts. We continue to weave the concepts presented in this chapter throughout the rest of the book. By its end, we believe this new way of thinking can become second nature and improve your own endeavors as implementation practitioners.

Part One: The Implementation Landscape 3

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c h a p t e r O N EFraming Implementation

By April 2014, Sandra Martinez, manager at Connect with Health Colorado,could finally stop to breathe and reflect on the events of the previous year.1 The federal Affordable Care Act (ACA) was a major change in public policy (see box 1.1), and her organization, a nonprofit formed by the legislature to implement the state’s health care insurance marketplace, was at the center stage of Colorado’s efforts to get the first wave of citizens enrolled. While in late 2013 public and national media attention reached fever pitch when operational challenges threat- ened the federal insurance website marketplace, Colorado was not caught in that controversy. Because it was one of the seventeen states that elected to operate its own insurance exchange, she and other leaders in the state’s public, nonprofit, and private health organizations focused their attention on other important imple- mentation activities. There had been some delays in the state-run enrollment pro- cess, largely because of the state’s effort to sign up as many people as eligible into Medicaid to reduce citizens’ expenses. Yet a sizable number had completed an application, some drawing on the support of navigators contracted to provide indi- vidual support in making insurance selections.

Box 1.1 Overview of National Health Care Reform

Lauded by some as the most significant social welfare law passed in the United States for half a century, the signing of the Patient Protection and Affordable Care Act by President Obama in March 2010 set into motion a complex series of events. Termed “Obamacare” by political adversaries, the law’s goals focused

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(Continued)

on increasing the quality and affordability of health insurance, decreasing the number of uninsured Americans, and reducing health care costs. Implementa- tion of some features began immediately, but political controversy and legal challenges created initial uncertainty for states as they considered how to craft their own health care policy in relation to federal action. When the Supreme Court ruled the act constitutional in June 2012, states began deciding which of the many options offered in the act they would pursue. For example, states had the option of expanding the Medicaid program to provide more afford- able insurance for low-income people, creating health care marketplaces or exchanges to help individuals and small employers purchase private insurance, or making changes to existing state-based health programs. Other states chose to let the federal default options take effect.

Like other states, Colorado had established the Connect with Health exchange as a quasi-governmental agency, governed by a legislatively appointed board representing a range of stakeholders to oversee the program’s direction and ensure public accountability. They had convened working groups to establish the plans and strategies of implementation focused on health care plans, disadvantaged communities, small businesses, and consumer services. Other groups in the state raised funds from private sources to investigate models for consumer support and public education. Martinez, along with some members from these work groups, participated in a number of national events and networks funded by private foundations that brought together state leaders to share the strategies being used to resolve implementation challenges. She found these efforts invaluable; they provided a neutral learning place and valuable information that helped improve decision making.

The need for health care reform in Colorado was high. Compared to other states, a large number of uninsured children and adults either had no health care or paid high out-of-pocket expenses.2 In 2011, the governor had signed into law the state’s policy authorizing Medicaid expansion3 and the development of the insurance exchange. As in other states, eligibility for support was tied to income eligibility: the lowest-income citizens accessed health insurance through expansions in Medicaid, another group was eligible for tax credits to decrease out-of-pocket costs, and others could now access insurance through an unsubsidized marketplace benefiting from group-negotiated insurance terms. But

6 Effective Implementation in Practice

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in May 2013, following the lead of the Colorado Health Foundation, the governor also declared a goal of making the state the healthiest in the nation, raising the urgency and political salience of the issue in the state. Over the previous year, there had been an unprecedented number of public-private initiatives focused on the governor’s goals of promoting prevention and wellness, improving service coordination, and making operational changes in payment and information technology. And while sometimes tensions had erupted between state leaders about the pace and consequence of the changes, the network between major organizations had held together.

The Colorado Department of Health Care Policy and Financing played an important role in the state as the agency that authorized many of the public programs. The department’s managers, such as Maurice Brown, entered into the contracts with the ten insurance plans advertising on the Connect with Health Colorado website. Accountable to the federal Department of Health and Human Services, ACA activities were significantly influenced by the department’s years of experience administering Medicaid, Medicare, and the Children’s Health Insurance Program. The new policy also fit solidly into the organization’s new articulated mission of improving health care access and outcomes for citizens while demonstrating sound stewardship of financial resources. Managers had developed six organizational goals, including strategies to improve services and align communication, technology, and staffing. The overarching intent was to transform the health care system from a traditional fee-for-service model into a regional outcomes-focused coordinated system of care. The ACA programs were included in this larger structure promoted by the department, although compared with his peers, Maurice was more extensively involved with external groups such as Connect with Health, the Colorado Health Foundation, and other implementation working groups because of the policy’s visibility.

While the policy had an impact on many organizations that interacted with citizens—health insurance companies and co-ops, health providers that now pro- cessed bills for fewer uninsured people, mental health practices that now faced economic pressure to join larger groups to ease billing—the agencies providing outreach to disadvantaged groups were particularly important in the first few years because of the law’s goal to enroll the uninsured. Informed by research conducted by a coalition of consumer advocates, the state contracted with public health and community-based agencies to provide exchange navigation, education, and sup- port about the various insurance options. In original discussions, some exchange

Framing Implementation 7

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planners had believed it would operate like the travel website Travelocity, which allows easy comparison among various options. Yet the unveiling of Connect with Health Colorado revealed that enrolling in health care insurance is much more complex than booking an airline flight. At one time there were over sixty-five policies to choose among, and managers like Noah Manning soon discovered that enrollment assistance took considerably more time than what his organization had originally budgeted.

The face-to-face work fell to the cadre of navigators and health advocates who provided enrollment counseling. Yet at the front lines, the dynamics were complex. On the one hand, while navigators such as Cynthia Wang provided information for free to low-income citizens, other certified health advocates received commissions for their services. And consumers’ needs were complex, often requiring individ- ualized assistance. Cynthia had to remind some people to save documentation of expenses to qualify for tax credits at the end of the year. For others, after they had received their insurance cards, she coached them on how to find and use the health care, which many had been putting off for years. Outside of the metropolitan areas, this task was even more challenging because of the limited numbers of clinics and hospitals in many communities. As Cynthia sat with people, she heard each story in turn—the recently laid-off construction worker who couldn’t afford the insur- ance fees, the elderly retail worker whose employer had joined the exchange but offered inadequate coverage for his needs, the disabled veteran who had a difficult time driving the long distances to get her regular checkups.

From each of their positions, Sandra, Maurice, Noah, and Cynthia face cer- tain issues that must be resolved in the process of implementing the ACA. While resolving ideological debates among large institutions might seem quite different from responding to customers’ confusion, these issues are interconnected. One level directly influences the implementation tasks and results at another; the Con- nect with Health Colorado working groups create the plans and online forms that the frontline navigators like Cynthia must fill out. The lessons Noah learned about work flow in outreach agencies are relevant to objectives articulated by the Department of Health Care Policy and Financing. The first policy implementation scholars described this reality as the “complexity of joint action” and, because of it, subtitled their book “why it is amazing that federal programs work at all.”4

In this book focusing on policy and program implementation, we are more optimistic. We believe the more that people like Sandra, Maurice, Noah, and Cynthia recognize their interdependence and have ways for talking about

8 Effective Implementation in Practice

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and analyzing the complex implementation system they are part of, the more likely that policy and program implementation can help deliver desired results. However, this vision depends on implementers recognizing their essential roles in these systems. It requires professionals who will work hard to cultivate the analytical and social skills necessary to understand and intervene in complex systems. It requires courage to acknowledge ambiguity and still take action, particularly seizing opportunities to work across the multiple levels of the system.

In our understanding, implementation is a form of policy practice, distinct from yet influenced by policy debate. It is centrally important to democratic gover- nance. And in its complexity, it can be both fascinating and challenging—solving one problem can reveal another layer needing to be addressed. In this book, we invite you to engage in the endeavor of studying implementation. Be curious about implementation dynamics, develop new conceptual language, and cultivate skills that will help you resolve the implementation quandaries you encounter. Through- out, keep in mind that while your actions are merely one part of the larger system’s dynamics, sometimes small interventions can improve whole system operation. Opportunities present themselves, often in unexpected ways, to better align an implementation system toward improving public value results.

EXPLORING POLICY AND PROGRAM IMPLEMENTATION Implementation issues appear in less-dramatic gestures than the passage of major health care reform. In fact, when any new program or idea for an initiative is shared, practical questions about implementation often follow right behind. How do we take these mandates and make them real in our state? How do we pull together the right people to respond to the large foundation’s request for proposal? When a grant proposal is funded, how do we empower the program managers to develop procedures and training for staff? While we both recognize the urgency of these questions, we also believe that it is important to understand each question in its larger, systemic context. The first step in developing this ability is to internalize helpful lessons from social science that provide new ideas and consistent language for your analysis.

By definition, policy and program implementation is complex. The issues that make their way into the public arena are significant, the solutions illusive. Energy conservation, affordable and adequate housing, educational effectiveness—all are desirable goals that require changes in personal, market, and organizational

Framing Implementation 9

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behavior to attain. Very few policies or programs designed to achieve such goals are self-implementing. And yet the means, the how of developing these solutions, is often quite illusive. Merely acting from organizational or professional interests does little to create integrative solutions that foster collective action across boundaries to advance the common good.

This process is made more challenging because, as in Colorado’s ACA example, much of policy and program implementation devolves from the central government. Around the world, traditional public bureaucracies directly provide fewer services than they used to, depending instead on private organizations under contracts, grants, or subsidies to deliver public services. The diversity of organizations and varied government tools in use raises the substantive importance of improving implementation, but it is not easy. Public sector managers, accustomed to focusing their attention on how best to navigate bureaucratic structures and legislative oversight, must acknowledge how much of policy implementation falls outside the direct control of publicly employed staff. They must cultivate skills of network management, such as facilitation and negotiation, to work effectively in implementation systems. Private business and nonprofit managers, accustomed to acting on narrow conceptions of their organizational bottom line or interests, must recognize the significance of their involvement in public service provision. They must recognize the legitimacy of public accountability and yield some autonomy to be part of larger solutions to public problems. Both must reorient themselves away from organizational interests toward attention to the policy or program target population, to under- standing their behaviors, motivations, and concerns. Teachers, police officers, unemployment insurance clerks and doctors must recognize how their daily decisions—decisions to go beyond the formal requirements of their job in responding to students, citizens, and needy patients—often become the face of public policy.

It is common for public managers, private and nonprofit leaders, and direct service professionals to complain that target groups often do not follow policy or program requirements; they often fail to act in ways that designers intend. This disconnect between systems operation and target group behaviors is a fundamen- tal challenge in most implementation projects. Yet seeking to understand the way such behavior is indeed logical by attending to the actual motivations and real- ities of these target groups is often essential for orienting what implementation improvements should address.

10 Effective Implementation in Practice

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Compared to previous political science and public affairs scholarship, our notion of policy and program implementation grows more directly from sociology and organizational theories. As we discuss in chapter 2, many other scholars anchor implementation on policy intent or the characteristics of a par- ticular legislative statute.5 In this conception, policy implementation is focused on trying to bring the ideas of formal policy into reality. Policy implementation is viewed as the activities carried out by various institutions and implementers in pursuit of adherence to formal public policy and laws. As proponents of a government-centered, top-down approach to implementation, Dan Mazmanian and Paul Sabatier state, “Implementation is the carrying out of a basic policy decision, usually incorporated in a statute but which can also take the form of important executive orders or court decisions.”6 From this understanding, program implementation follows linearly from policy implementation. Imple- menters, county or regional governments or local service organizations, try to interpret and integrate policy directions into their ongoing operations through specific programs; they are a necessary component of policy implementation, operating at a smaller, more localized scale.

But this linear relationship does not hold. Many times national policy is created after the documented impact from programmatic innovation at state or local levels. Kindergarten, electrical smart grid, HIV/AIDS services, and countless other examples evolved in this way. These programmatic ideas can be described, evaluated, assessed by others, and adopted by other states before national legislation is forthcoming. As a result, we join other scholars in challenging how policy implementation is often described in textbooks, as a stage in the policy process that comes after policy adoption.7

Instead, we define effective implementation as deliberate, institutionally sanctioned change motivated by a policy or program oriented toward creating public value results on purpose. When implementation is successful, it becomes incorporated in everyday work and part of standard operating procedures. Effec- tive implementation is deliberate because it involves conscious design, planning, and assessment of what occurs. Effective implementation also is institutionally sanctioned, backed by political authority and a pragmatic understanding of reasonable actions within the operational constraints of the setting. Yet effective implementation is focused on change, introducing new or modifying existing patterns of actions. But many times the process of change proceeds in unexpected ways. There are a number of important indicators of implementation effectiveness.

Framing Implementation 11

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When successful, policy and program implementation creates public value by enabling collective impact beyond the narrow self-interest of any particular actor or institution.8 When policy and program implementation is successful, what once was new and foreign becomes incorporated in everyday work, with the requisite resources necessary to sustain the change in behavior among program implementers. When successful, implementation also helps achieve changes in the target group as imagined by policymakers or program developers.

Rather than assuming a linear relationship between policy and program imple- mentation, we understand implementation as a process of change occurring, sometimes simultaneously and in contrary directions, at different scales within a complex system.9 It happens in a context where often there are already established ways of working. Said another way, it rarely happens on a clean slate. As a result, policy and program implementation requires continuous and intentional learning about changes focused on publicly desired results. And it raises significant ques- tions: What is significant about a context that shapes change? How can changes yield publicly desired outcomes and minimize unintended consequences? How can others be engaged so that what was once new or threatening can be integrated into daily practices and operations? To help us begin to provide answers, we harvest insights from social science theory and research to ground us in concepts important to developing more skill in implementation practice. But there is also mystery in implementation, much like a gardener feels when watching spring flowers emerge from the ground. There is a social dimension to this type of policy practice that operates in unpredictable and sometimes awe-inspiring ways. To be effective, actors must cultivate subtle social skills that engage others in being part of the change.

DEFINING IMPLEMENTATION EFFECTIVENESS To carry out programs successfully, it is essential for implementers to have a clear sense of the results desired to help shape implementation activities. But often it is difficult to narrow down the possible options. One can easily ask, “De- sired results according to whom, and for what purpose?” However, just because desired results are often subjective it does not imply that anything goes. While this is not true for all implementation more generally (such as the implementation of a new technology in a private corporation), policy and program implementation systems normatively should ultimately create public value. It is what justifies the

12 Effective Implementation in Practice

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change that is being attempted—change that tries to counteract the tendency in large systems for inaction and drift.

But pursuing outcomes in line with public value requires explicit consideration of the public consensus regarding how a program ought to be carried out and the desired changes that should result.10 Sometimes this public consensus is docu- mented through democratic processes, in policy or legislative intent. As described in chapter 2, classic implementation scholars described effectiveness as whether the implementation achieved the policy intent. But many times, the formal policy intent is unclear or lacking altogether. When present, policy or program state- ments often identify large-scale desired results. For example, for the ACA, three results were articulated by national law: expanding health coverage to 25 million Americans by 2023, lowering costs and increasing benefits for consumers, and incentivizing quality and innovation in our health care system. While laudable, each is vast and difficult to use to anchor the numerous implementation decisions being carried out in the states and localities. It is well established that in public programs, definitions of effectiveness vary dramatically because of political differ- ences, competing vantage points, and multiple goals.11 Desired results often are left intentionally vague in formal policy statements not only to provide political cover, but also to allow localized interpretations and evaluations of effectiveness. In fact, many scholars note the irony that what is good for implementation—clear assign- ment of responsibilities, specification of change processes, and clear outcomes—is often very bad for politics.12

But public values explicitly extend beyond conventional notions of efficiency and effectiveness.13 One can look to other sources beyond the formal policy to reflect public value consensus regarding a particular program, such as nonprofit membership associations within a certain policy area or accrediting bodies that define quality practices in a field.14 In her research on mortgage lending, Stephanie has often found that institutions in the local community can be a stronger influence on public value outcomes than formal legislative policies.15

And policy field and organizational actors can initiate processes of citizen engagement where members of the public are convened to provide feedback about desired activities and results.16 Indeed, an important first-order task for implementation is to specify the desired outcomes given the formal policies and other assessments of public consensus in a particular policy area.

But what outcomes are important? As others have argued,17 often people inter- ested in public policy tend to ignore administrative and organizational processes

Framing Implementation 13

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and pay little attention to how the operations of programs significantly shape desired outcomes among target groups. In this frame, significant policy outcomes emerge from the alteration of individual, economic, or social factors—and the interventions designed to address these factors—rather than through interactions with the system delivering the policy. However, people interested in organi- zational management often focus their attention on improving the quality of work or attending to staff motivation, and identifying structures that facilitate coordination or manage the complexities of the agency’s environment. To the extent that policy outcomes are considered, it is primarily about performance measurement and assessment of organizational outcomes. The risk, of course, is that management undertaken without awareness of desired changes in the target population may or may not achieve the ultimate policy and program outcomes.

As the title of this book suggests, we strongly believe that effective implemen- tation requires integrating these policy and management mind-sets, leading us to realize that the multiple indicators for defining implementation effectiveness must be acknowledged. A multidimensional notion of effectiveness is also con- sistent with scholars’ recognition that public policies and programs have multiple constituencies, often with their own assessment of what should result.18 It is also consistent with the notion that the manner in which a service is delivered directly shapes how target groups engage with the intervention offered.19 As illustrated in table 1.1, effective policy and program implementation entails changes in both system operations and the target population.

As suggested in our definition of implementation, we are concerned with two types of ultimate outcomes: integration of the change into system operations and

Table 1.1 Indicators of Implementation Effectiveness

Process Quality Results Ultimate Outcomes

Change in systems operations

Quality of program delivery

Integration of program processes into daily operations

Change in target groups

Target group satisfaction and engagement with the program

Desired change in the behaviors or conditions of the target group

14 Effective Implementation in Practice

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desired change in the target group, in either target group behaviors or conditions. When systems change at the policy field, organization, or frontline levels, the new ideas and practices of the policy or program become integrated into standard oper- ating procedures. They are institutionalized, no longer seen as new or “other” but as part of the way work is accomplished. This is one important outcome of imple- mentation. However, a change in the conditions or behaviors of those targeted by the initiative is also essential; most often, the desire for this type of change moti- vated policymakers or program developers in the first place.

In addition to the ultimate change in the system or target population, we also suggest that quality is an integral result, including both the quality of the operational work environment and the quality of interactions with the target population. Sometimes these results are referred to in policy circles as a type of output, but we believe this underscores their significance in implementation practice. For public goods and services, quality is often difficult to measure. It is much easier to assess the quality of a consumer’s hotel experience than to evaluate the quality of nursing home services provided to a patient with Alzheimer’s disease. However, this is the very reason that quality is an important result for assessing the implementation of public services.20 If our only goal for putting grandma in a nursing home is to increase her safety so she is less likely to fall, wander off, or otherwise hurt herself, then it doesn’t matter if this is accomplished through sedatives or repeated interactions with nursing home staff. But most of us also care about the quality of engagement for grandma and hope that she is treated with dignity and respect. Hence, quality matters in implementation; it ensures that we attend as much to the means of public service delivery as the ends.

In policy and program implementation, we also care about not only the quality of the user experience (e.g., grandma in the nursing home), but also the quality of the work environment (e.g., the experiences of the nurse or social worker provid- ing services). Normatively, this is linked to public service values.21 Often public and nonprofit sector workers are paid less than private sector counterparts; yet it is believed the commitment to the public purpose brings intrinsic rather than extrinsic rewards because of their motivation toward the public good. Employee satisfaction and individual mastery also helps realize intrinsic rewards, and research suggests the quality of the work environment affects the extent to which change is successfully integrated within an organization.22 Satisfied employees also improve the quality of citizens’ experiences with the policy and program. Thus, the indicators of implementation effectiveness are not independent factors

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but rather steps that are significant in the ultimate goal of altering the conditions or behavior of groups targeted by the policy or program. We return to these ideas in chapter 8, where we discuss how such indicators of effectiveness provide an anchor to focus your own activities in improving implementation systems.

UNPACKING IMPLEMENTATION SYSTEMS As we will see in chapter 2, implementation is a topic that has eluded simple expla- nations and modeling. In part, this is because of how much variation there is in the substantive concerns of public policy and programs. Implementing health care reform is quite different from implementing new requirements for smart appli- ances that use less electricity; implementing emergency food programs for the needy is quite different from implementing a national security mission. While the specific details of implementation vary widely, some elements are consistent across settings, which form the foundation of a more general understanding of the implementation process. We introduce these concepts here and probe them in more detail in chapters 2 and 3.

First, policy and program implementation occurs at different levels within a system. As with the illustration of Colorado’s health care reform implementation, certain activities occur at the policy field level, where institutions craft and develop understandings and resources about the most effective way of carrying out policy and program objectives. At this level, many organizations are involved, such as government agencies, nonprofit associations, research groups, and foundations. Other types of implementation activities occur within the bounds of organiza- tions. For policy and program implementation, two types of organizations are particularly significant: those, such as the Colorado Department of Health Care Policy and Financing, that authorize policies and programs through administra- tion and those, such as Noah Manning’s exchange navigation agency, that provide direct services. At this level, organizations operationalize the policy or program parameters into daily practice, often in relation to prior organizational experiences or competencies. The final level within the implementation system is the front lines, where the targets of the policy or program interact with the policy system or staff, such as Cynthia Wang. At this level, individual and collective identities are salient as staff and target groups negotiate their understandings and application of general program parameters to particular situations. These levels operate simul- taneously within the same state context, within the same implementation system.

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Sometimes, as is true in many other complex systems dynamics, they operate in competing directions.23

Second, to frame effective implementation practice, we have found it helpful to think of the settings found at these levels as strategic action fields. We find this helpful because while the specific details of people, programs, or power are unique to each context, strategic action field theory helps us recognize and analyze social processes that transcend particular contexts. Actors in a setting have shared knowledge about each other and a general understanding about their purpose, the relationships within it, and the spoken and unspoken rules.24 Said more simply, people in the policy or program area share a common understanding about the task at hand, the relationships they have with each other, and the taken-for-granted assumptions of that setting. In the Colorado health reform illustration, while Sandra Martinez certainly had to address unique challenges and access different resources at the policy field level than Noah Manning or Cynthia Wang did within their organizations or working with clients, each operated within a strategic action field. Within each context, although the particulars differed, the social process of assembling resources and the authority to make change is consistent.

There are common dimensions of strategic action fields that can facilitate a more general understanding of processes across settings and levels in an imple- mentation system. For one, all implementation settings are organized around a core set of program technologies that field members understand are being used. The central question in implementation is: How do we create desired change in the target population? We use the term program technology to refer to the means adopted to make such change. While often technology is understood as the hard- ware and software now shaping so many social interactions, technology has a broader definition within organizational sciences, referring to the full range of activities used to transform inputs into outputs or outcomes.25 Inputs, often con- ceptualized as raw materials, can be people, other living things, material resources, objects, or symbols. Similarly, outputs can take many different forms. Technol- ogy is the full range of activities used to make a change. It is what we do to get the outcomes we want. At its most basic, policy and program implementation is concerned with accomplishing an effective program technology, of develop- ing the means to accomplish desired ends. While there might be challenges about the validity of the means and debates about the ends, actors understand what is going on and what is at stake. Program technology processes are often represented

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through flowcharts, logic models, or process diagrams illustrating how activities are logically aligned into steps.

Second, within implementation contexts, there is always variation in power. In analyzing implementation contexts, we explore a critical question: How are resources and authority distributed and coordinated to induce actors to partic- ipate in the program? Various people and institutions have different abilities to make things happen. Both formal and informal authority structures shape each setting, and people working within it have a general understanding of the power distribution. There are formal manifestations of power, such as rules, contracts, and performance terms, and understanding how these forces directly shape imple- mentation is one part of analysis of strategic action fields.

Third, there are informal influences that shape action, including shared under- standings of what is possible and considered legitimate. Culture is the symbolic dimension of social action, the way a group makes sense of what is taking place. In analyzing implementation settings, we explore the question: How are mean- ing and commitment to the program cultivated? A strong culture creates shared understanding of what to do and how it should be done. It provides a collective interpretation of the problems to be solved, definitions of success and failure along the way, and the value assigned to what results. Getting people to work together toward a common goal is not just about formal inducements such as paychecks and contracts but also about shared commitment (or lack thereof) to the task at hand. By attending to culture in implementation systems, we are explicitly direct- ing our attention to commitment as a powerful motivator. Thus, part of the work of effective implementation is cultivating commitment to the process.

Many strategic action fields exist within the implementation system for a partic- ular policy or program.26 Just as there are multiple fields within Colorado, there are distinct strategic action fields in other states. Neighboring Kansas and Nebraska decided not to develop their own state-based health care marketplace. As a result, the fall 2013 challenges with the federal HealthCare.gov online enrollment were a problem they needed to contend with; in addition, the choices their state lead- ership made by not claiming their state’s expansion to the Medicaid programs changed implementation tasks. But beyond these large-scale decisions, other dis- tinctions are significant for implementation. There are different health systems, large employers, and consumer groups involved in negotiation about the terms of implementation in each state. In Kansas, different service-providing organizations are integrating the new program with their existing operating procedures than in

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Nebraska or Colorado. In each place, community-based navigators and citizens suddenly able to access health insurance for the first time interact with the struc- tures developed at other levels of the implementation system.

So a third assumption of our approach is that while these strategic action fields might be related, they are still bounded as implementation contexts. Conventionally many policy implementation scholars assumed that formal policy parameters create the bounds around which implementation will take place. By contrast, our approach suggests that the strategic action fields operating at each level of the system create the boundaries around implementation—both constraining and enabling what is seen to be possible in the implementation process. Certainly formal policies and legislation are one component of strategic action fields. However, there are other constraints that emerge from other forces. Sometimes they are human factors, for example, in the mind-set of coworkers or organizational decision makers. Yet what is so interesting is that in other strategic action fields, a similar mind-set would not be significant enough to impede change. At other times, these constraints are material resources, such as limited facilities, finances, or information technology systems. But again, it often is not the objective amount of resources that is deterministic but rather the way it is understood and addressed within a particular context. As such, the meaning and significance of important factors in implementation—the understanding of them as constraints or opportunities—emerge from how the strategic action field is bounded.

Finally, our approach implies that to improve implementation practice, one must understand and seek to influence activities happening at different levels throughout the implementation system. In scholarly terminology, this is a prob- lem referred to as collective action. Sociologist Carl May writes, “This problem of collective, coordinated and cooperative social action is the pivot upon which implementation . . . must turn.”27 Collective action—getting groups of individuals at different places in a system to apply themselves to a consistent direction of change—is at the heart of the matter. Implementation requires that actors engage each other in change processes so that ultimately, that which was old becomes established in daily routines. Perhaps it is applying a funding mechanism that creates different incentives for private organizations; creating a new program that better engages participants; or adopting a coaching program that reinforces an evidence-based mental health program. While the specific tactics and activities

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undertaken differ, the process of change requires collective action within and across the strategic action fields found in the whole implementation system.

As we will see in chapter 2, the existing research on policy and program implementation irrefutably documents its complexity. Yet our theoretically and empirically grounded approach helps professionals more effectively understand, navigate, and shape the process. To lay the foundation for a more in-depth exploration of the historical foundation of our approach and the dynamics within strategic action fields, it is useful to first investigate the various levels of scale found in implementation systems, introducing an awareness of implementation practice at these levels. We then conclude this chapter with an overview of two cases that we use throughout the rest of this book to bring the analysis to life.

Understanding Scale We are not the first to suggest the importance of investigating implementation processes at multiple levels.28 Such an approach, though, is particularly important in countries like the United States and in the European Union that have dense pol- icy domains where multiple government, private business, and nonprofit agencies are already engaged in policy formation and public service provision. Rather than naively thinking that a new policy or program idea can be implemented as ini- tially envisioned, our approach invites inquiry, learning about existing conditions within the implementation system, and considering the nature of the implemen- tation challenges one might face. Certain implementation activities occur at the policy field level, and others unfold at the organization or frontline levels; certain types of challenges and possible solutions present themselves as well. Said another way, there are different levels in an implementation system that influence both the scope of problems and solutions, as well as the observed results. Strategic action fields operate at each level, and each requires the cultivation of particular strategic actions at different scales.

The notion of scale here is important. Think about gardening. It is clear that gardeners use different knowledge and tools to address problems, depending on their scale. When wanting to make significant alterations at her home, a gardener will hire a landscape architect to assess the naturally existing contours of the plot, recommend grading, and bring in bulldozers and backhoe loaders to create tiered beds or patios. Together they will look at what is possible given the existing shade trees and buildings, possibly laying brick for a new walkway or retaining wall. But when she wants to actually grow the plants, she needs to change scale and focus on

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the bed in front of her. She must select plants based on what already exists, looking at color and texture, and use a shovel or trowel. She might add some accent rocks or mulch to keep down the weeds, or work to ensure that the bed’s edging doesn’t get too weedy throughout the growing season. Yet the garden is fundamentally composed of plants and blossoms; ensuring their health requires working at yet another scale. Watering cans, pruning shears, antifungal treatments: all become important tools in helping to nurture healthy growth. A master gardener can work at one of these scales, while always remembering that changes at one level affect the other and, ultimately, the final result.

For those not metaphorically inclined, employment and training programs funded by the federal and state government provide a policy example. These programs are often carried out by local nonprofit organizations, accountable to local workforce development boards. Yet what directly shapes these service organizations’ work are both federal rules and historically defined institutional roles within the policy field. Foundation-supported advocacy organizations might host conferences where good ideas can be shared and reinforced for adoption in the field. Particular organizations develop expertise working with certain populations, and some secure philanthropic dollars for low-income worker advancement programs not currently supported in federal or state law. As a result, some organizations develop more holistic service models, while others struggle to deliver basic service. Frontline practices such as competition or service referrals further influence program delivery because they shape both what clients receive and how neighboring nonprofits operate. These factors are all significant in the system and its results.

Policy fields are bounded networks among organizations carrying out a substan- tive policy or program in a particular place. In any jurisdiction, there is a potential pool of organizations composed of public agencies, interest or industry groups, professional associations, nonprofit service providers, or others that might partici- pate in implementation because of their expertise or interests. When an institution actively engages in the policy field, it brings with it money, information, program knowledge, and other resources. These forces flow between organizations and cre- ate a structure that can shift and change as the tasks and issues of implementation shift over time. Thus, while the structure of the field is shaped by the form of public funding and availability of private resources, it is not determined by them. As a strategic action field, policy field structures and processes emerge from the

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interactions of people working within these institutions through their successes, partnerships, and battles over turf.

At the policy field level within implementation systems, certain imple- mentation tasks are carried out. The various actors assemble policy tools and implementation resources that they believe are necessary for carrying out the program technology. Their interactions create the structure of the field. These interactions often involve significant negotiations because field actors come to implementation tasks with distinct understandings of the policy problem and potential solutions. However, it is through these negotiations—and how they reconcile differences in authority, culture, and resources—that the elements of program technology are set.

Many organizations exist within a policy field. Delving into the processes of certain key organizations is critical to understanding and improving policy and program implementation. Some organizations authorize the policy or program. Often this can be a state or regional public agency empowered through legisla- tive authority to administer public programs. But private foundations that invest significant resources into a field can also play the role of authorizer, particularly in fields with limited public investment. Other organizations provide the public service. Their work directly influences the target population: the clients, citizens, or beneficiaries of the program. Although there are distinct roles, both authoriz- ing and service organizations devise the program rules and structures enacted in implementation. They integrate ideas and opportunities from the field, either leveraging or ignoring the constraints and resources present.

At this scale, organizational actors attempt to reconcile the policy or program directives with existing organizational imperatives. They integrate these signals into existing organizational processes and expertise. The way this occurs is directly influenced by the sources of authority and culture within the organization, as well as the resources that exist or can be generated. All are combined to create the enacted program structure, the definitions of activities, and assignment of resources invested to carry out the program.

With our orientation to changes in target group behavior, the front lines of implementation systems are the final scale we see as critical. At this level, the system interacts directly with the target population to carry out the program. It is where larger directives are applied to particular situations. Sometimes the front lines involve face-to-face interactions between staff and the target group: think delivery of education, mental health counseling, or vocational rehabilitation.

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Other times, the system and target group interact through other means, such as online registration for camping or call centers about Medicare claims. The deci- sions made at other levels in the implementation system about the contours of the program technology, as well as the professionalism and norms shared among staff and type of engagement required from the target group, all influence what occurs at this level.

One of the most troubling aspects of how policy and program implementa- tion is often studied is how little attention is paid to understanding target groups’ perspectives and behaviors.29 Although public and private organizations frame problems, develop policies and program ideas, and attempt to implement them, the target group members themselves are often key problem solvers.30 Whether they are drug users, students, ill elderly, or parents, the groups being targeted by the program or policy are the people who need to change in order for the inter- vention to be a success. The front lines are where the program is enacted for target group members. The decisions made by individual staff about how to carry out their work, or the ways in which the computer-based processes are assembled, facilitate or frustrate how target group members experience the public policy or program. At this level, public resources are delivered to real people who bring their own preferences and limitations to the task. They also assess quality and express feedback, either overtly or inadvertently.

Table 1.2 summarizes the key implementation activities accomplished at each level in an implementation system. It highlights the analytical focus, key roles, and types of implementation activities accomplished across any policy or pro- gram content area. In part 2, we explore each of these levels in detail and illustrate the more general concepts through our own analysis of two policy programs with which we are familiar.

Implementation as Policy Practice With the devolution of much policy and program implementation from central government, we believe that people interested in improving policy and program implementation must learn about the various levels within these complex systems. Too often people believe policy activities are restricted to those advancing political positions or organizational interests during policy debates. Yet people with diverse job titles are involved in implementation: executive directors, board members, contract managers, program directors, funders, teachers, counselors, and volun- teers. Whether they recognize it or not, they are all involved in implementation,

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Table 1.2 Multiple Levels of the Implementation System

Level Focus of Analysis at This Level

Key Role at This Level

Work Accomplished at This Level

Policy field Bounded networks among organizations carrying out a substantive policy and program area in a particular place

Assemble policy tools and implementation resources; create field structure

Problems and solutions are negotiated; authority and resources are mobilized; coordinating structures are selected

Organization Authorizing and service orga- nizations that devise the program rules and structure

Integrate program with existing orga- nizational processes; create program structure

Program is operationalized with defined activities; resources are secured and assigned to deliver program

Front lines Workers or interfaces that directly interact with the target population to carry out the program

Enact program for target group; facilitate target group inter- actions with program

Resources and services are delivered; assessments of quality occur

and they all have a role in policy practice. In this book, we are inviting people in these diverse roles (or those aspiring to assume these types of roles in the future) to embrace, as one part of their professional identity, their abilities to affect policy outcomes through implementation.

In table 1.3 we summarize principles to keep in mind as you build your aware- ness of your own implementation practice and cultivate its effectiveness. It begins by understanding the larger systemic context of your work. Implementation activ- ities are diverse: working with a network of agencies, replicating a new mental health service model, crafting new training programs for public health workers, or

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Table 1.3 Principles for Cultivating Effective Implementation Practice

Know the context where you can affect change: the participants and resources, sources of power, and cultural values.

Unpack the core program (viable options, logic of change, and coordination), and identify changes to bring about public value results.

Confront the technical and adaptive challenges necessary to create change, applying analytical inquiry and social skill.

monitoring factories’ compliance with heath standards. Effective implementation requires people with many more diverse skills and orientations. As we will see, there are many different positions within implementation systems, many distinct actors playing different roles. Knowledge of the policy or program area and the target population attempting to be reached is essential. But so are tactical and man- agerial skills that allow one—regardless of official position—to mobilize resources and make change.

We have seen many managers, leaders, and staff spending considerable time complaining about conditions in the implementation system about which they can do little. State administrators blame the competing priorities of service providing organizations; frontline workers blame economic factors or lack of political support for their endeavor. They try to apply a tool that is inappropriate for the implementation problem they are confronting. We see these actors as suffering from scale error, a term from developmental psychology. In exper- iments, children introduced to a tool, such as a hammer, will try to use that same tool even when the physical task is altered. Much like these children, policy and program implementers regularly try to use tools that are familiar or ones they have seen other colleagues deploy regardless of the particular needs of the situation at hand. Improving implementation requires recognition and prevention of scale error.

As we walk through our multilevel understanding of implementation systems, we will dive into the social dynamics of each setting, emphasizing the unique elements of each strategic action field. This is because implementation practice occurs in a particular setting, often where you work or find yourself in the system. What needs to occur to implement the ACA at Connect with Health Colorado is

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different from careful explanations frontline staff must do with people signing up for their health insurance for the first time. Integrating the legislative priorities of the ACA into the strategic planning process of the Department of Health Care Policy and Financing is substantively different from the task of creating feasible staff assignments for exchange navigators in the service agency. Implementers must focus on improving implementation appropriate to the scale at which they work.

Significant impact can come from people who can operate effectively across levels and settings. These professionals are strategic in negotiating the power dynamics in the Department of Health Care Policy and Financing so that con- sistent rules and reporting requirements can be passed to service organizations. They position themselves as expert frontline workers who can provide formal testimony or informal information about frontline interactions with new insurers to the Connect with Health advisory committees. So while we focus on improving your understanding of differentiated levels within complex systems, we do not mean to imply that these levels are isolated from each other. As we will discuss in chapter 3, they are embedded and the boundaries between them are porous.

Second, our approach in this book bucks popular trends in management for a one-size-fits-all approach that tries to simplify the tasks, diverting attention away from the complex social processes at the heart of implementation, with the promiseofmoresimplisticquickfixes.Onemanagementtrend,calledresults-based accountabilityor“newpublicmanagement,”advocatesnotattendingtoimplemen- tation details at all. Significantly influenced by a private sector business orientation to financial results, advocates of this approach direct policymakers to merely spec- ify results and trust that others will figure out the means. In this view, a shared focus on results will cause various implementers to select the appropriate tech- nology needed to achieve the results—the details will work themselves out. While we certainly agree that performance measures and results-based management can be useful tools for improving implementation practice, many studies now doc- ument that they alone do not ensure effective change; measures can be merely used symbolically.31 Other visible policy initiatives, such as the No Child Left Behind education reform, document that not understanding the means by which results are being pursued or providing inadequate resources to do so will create many unintended and detrimental consequences for implementation systems.32

Understanding the means through which desired change is attempted in the target population – what we call the “core program”—and tending to the unintended

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consequences to bring about public value results is the central work of implemen- tation.

The third principle for effective implementation practice requires confronting both technical and adaptive challenges, using inquiry into what is known and subtle social skill to engage others in determining what is not known. In some policy domains, there is a countervailing trend to results-based accountability that focuses on selecting program technology grounded in research evidence, evidence-based programs, or empirically supported treatments. In fact, as we will describe in the next chapter, a whole field of research called implementation science focuses on improving adoption and diffusion of such interventions by generating evidence about what activities have an impact on outcomes. Similarly, there has been a rise of small-scale randomized control trials to perfect tech- nology in pursuit of cost-effective interventions. Federal and state governments are enthusiastically investing in research that makes such microadjustments in program technology to explore the impact on results and how to apply these findings in other settings.

We certainly support the use of research-based evidence to inform implemen- tation activities; it is a large part of what motivates this book. However, we think it is shortsighted to reduce the application to merely perfecting program technology. Significant evidence documents that adoption of evidence-based interventions or behaviorally sound wording is not automatic. What is picked up is often a result of the skill of social actors within the particular setting, working with the power and values present to introduce technological elements that are viable while engag- ing others in participating in the suggested solution. In this book, we integrate research that helps us make sense of this process, attending to the social dynamics that occur in the strategic action fields that comprise implementation systems.

In coming to understand implementation as pragmatic policy practice, we have been influenced by many people who share our concern with professional prob- lem solving. Nobel laureate Herbert A. Simon’s Science of the Artificial established the idea that professions (in fields such as architecture, engineering, and manage- ment) share an essential trait: problem solving, or what he described as converting existing conditions into preferred ones. Eugene Bardach spent years at the Gold- man School of Public Policy at the University of California Berkeley exploring how effective leaders develop practices that are influenced both by their context and what they are trying to accomplish.33 Donald Schön, a professor at MIT, con- ducted extensive studies showing how practitioners think in action.34 These three

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scholars share a common insight that we fully embrace here: professional effective- ness involves being able to describe a specific context, understand why it comes to operate that way, and act purposively using technical and social knowledge to solve problems. A multilevel framework for implementation analysis helps one to describe the context. Theories of social process, like strategic action fields, allow one to analytically explain what is occurring, and see patterns and underlying mechanisms that transcend the particular situation. When brought into use in a particular setting, this type of analysis opens the way for more skillful resolu- tion of complex challenges. Said another way, it helps you understand who acts where, doing what, and how, and suggests what you might do to change those circumstances.

BRINGING THE ANALYSIS TO LIFE Implementation practice is fundamentally about attending to details—about get- ting them right in order to make the change in your context. To help inspire your own analysis and illustrate our general concepts, we focus on particular illustra- tions of program implementation throughout part 2 of this book. We selected these examples because they are ones we know well from our own areas of exper- tise and experience. Both of us have worked at the frontline, organizational, and policy field levels of these implementation systems; our tacit knowledge of these levels helps us understand important implementation details. But, significantly, these examples are smaller initiatives than the monumental ACA. They evolved out of collective efforts to respond to public problems.

We suggest that the best way to learn to do implementation analysis is to pick a policy or program area of your own. It can be a large federal policy like the ACA or something more modest such as a targeted program or state-based initiative. Applying the steps in our analysis to an actual case will illuminate the poten- tial for this analysis to point the way to more effective and strategic practice; the appendixes at the end of this book provide tools that allow you to easily translate the ideas of this analysis and apply them to your own cases.

The Hardest Hit Fund (HHF) was a program undertaken to respond to the fore- closure crisis of the Great Recession, an outgrowth of the Troubled Asset Relief Program (TARP). As box 1.2 describes, it concentrated on assistance to eighteen states particularly hard hit by the crisis, enabling them to offer mortgage assis- tance to unemployed or underemployed homeowners at risk of foreclosure. It is

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a redistributive program, reallocating resources from the government to assist homeowners in need.35 The Quality Rating and Improvement System (QRS) is a program designed to improve early childhood education settings. As box 1.3 describes, rather than being initiated by the federal government, the program idea has spread from its initial development in Oklahoma in 1998 to forty-three states currently running pilot, regional, or statewide programs, with another six in plan- ning stages.36 QRS is a regulatory program, using a voluntary process to assess early childhood setting quality so as to improve services and provide information to parents.

Box 1.2 Introduction to the Hardest Hit Fund Program

The US financial crisis of 2007–2008 has been labeled the worst financial crisis since the Great Depression of the 1930s.a The crisis resulted in failures or near failures of some of the largest financial institutions in the country and led to record levels of unemployment and foreclosures for individual households.b The federal government stepped in with various initiatives to stem the potential collapse of financial markets, stabilize housing markets, and boost the economy. One of these initiatives was the Troubled Asset Relief Program, also known as TARP, administered by the US Department of Treasury.c The Hardest Hit Fund (HHF) program was one of the foreclosure prevention initiatives under TARP.

The HHF initiative was in part a response to previous federal foreclosure ini- tiatives that fell short of expectations. While prior programs provided federal funding for mortgage assistance, the funds flowed through private lenders that determined borrower eligibility. Among other barriers, capacity and compliance issues with private lenders limited the success of these programs. The HHF pro- gram provided a new vehicle, state housing finance agencies (HFAs), to deliver assistance directly to homeowners.

Beginning in 2010, the US Department of Treasury allocated federal funds to states deemed to be hardest hit by the foreclosure crisis through the HHF program. Eighteen eligible states, including Ohio, received a total allocation of $7.6 billion under the HHF initiative.d The program required states to tar- get funds to unemployed or underemployed homeowners, thereby serving a growing (critical) population of potentially distressed homeowners.e In each state, HFAs worked within federal guidelines to tailor their programs to the needs of homeowners in their individual states. While states had discretion in how they designed their programs, most structured their programs to provide mortgage assistance to homeowners through participating private lenders. Ohio

(continued)

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(Continued)

was awarded $570.4 million under HHF, the third largest allocation among the eighteen states.

a. Miguel Almunia, Agustin Benetrix, Barry Eichengreen, Kevin H. O’Rourke, and Gisela Rua, “From Great Depression to Great Credit Crisis: Similarities, Differences and Lessons,” Economic Policy 25, no. 62 (2010): 219–65.

b. Michael D. Hurd and Susann Rohwedder, Effects of the Financial Crisis and Great Reces- sion on American Households (Washington, DC: National Bureau of Economic Research, 2010).

c. For more information, see the most recent financial report on TARP: http://www .treasury.gov/initiatives/financial-stability/reports/Documents/AFR_FY2013_TARP-12– 11–13_Final.pdf.

d. Much of the background information about the program is from the information on the program website: http://www.treasury.gov/initiatives/financial-stability/TARP- Programs/housing/hhf/Pages/default.aspx.

e. SIGTARP report 2012: http://www.sigtarp.gov/audit%20reports/sigtarp_hhf_audit.pdf.

Box 1.3 Introduction to the Quality Rating and Improvement

Systems Program

Quality Rating and Improvement Systems (QRS) are programs adopted by states to bolster the quality of early childhood programs and improve parental access to high-quality services for their children. The supply of quality early childhood education is not provided by typical market dynamics, rather public provision of service is targeted through subsidies for low-income parents and their children. The QRS program provides parents with information about the early childhood education services and creates incentives for service providers to improve their quality through tying access to quality improvements or subsidy payments to higher ratings. Stated another way, it is a systemic approach to assess, improve, and communicate the level of quality in early childhood education programs. As such it is part of creating, as one report noted, “a decision support data system”a

for early childhood education and is a programmatic strategy for solving a long-standing problem of market misalignment in early childhood education.

Early childhood education is largely a state-based public service. While private national accreditation and national Head Start program rules exist to define quality settings, the majority of settings are not covered by these requirements. State governments also have licensing systems, which establish

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the basic floor of health and safety for regulated settings.b QRSs are a means for states to assess setting quality, tie public investments to incentivizing quality improvement, and offer parents a way to access information about quality ratings of early education settings.

Between 1998 and 2005, ten states adopted the program and fourteen oth- ers, including Minnesota, embarked on planning. Virtually all offer QRS as a vol- untary system for providers, and in those settings, about 30 percent of providers participate.c As of 2010, twenty-six states had implemented QRS, with others under development.d As is true for most other state-based education programs, there is significant variation in implementation across the states.

a. Kathryn Tout and K. Maxwell, “Quality Rating and Improvement Systems: Achieving the Promise for Programs, Parents, Children and Early Childhood Systems,” The Quest for Quality: Promising Innovations for Early Childhood Programs, ed. P. W. Wesley and V. Buysse (Baltimore, MD: Brookes Publishing, 2010).

b. A portion of the early childhood education market is provided by legally unregulated providers, such as family, friends, and neighbors, who care for small numbers of chil- dren. If the children’s parents are eligible for subsidies, these providers are able to receive public funds.

c. Kathryn Tout, personal communication (November 2, 2013). d. An assessment done in February 2014 by the QRIS National Learning Network revealed

that forty-five states and territories implemented a statewide, regional, or pilot QRS program, with an additional eight in planning stages. Only Missouri was not pursuing a program.

These two illustrative cases vary on a number of dimensions (see table 1.4): they were initiated at different times and have distinct scopes, they are different policy types and have distinct target populations, and each has distinct desired results. Yet as we will show in part 2, they allow us to discuss the details of imple- mentation in practice and demonstrate how a consistent analytical framework can help uncover the dynamics that are at the heart of the implementation process. The cases help us illustrate how the general dynamics of strategic action fields operate and how a multilevel implementation analysis can proceed. We share them here to show how to undertake such analysis in your own policy or program area, to improve your understanding of implementation and identify points of interven- tion in your particular system.

We have taken this practical, applied approach because, as practitioners and scholars, we know only too well how difficult it is to understand and act strate- gically to improve policy and program implementation. We also are inspired to pursue this type of engaged scholarship by colleagues who have worked on these

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Table 1.4 Comparison of Illustrative Cases

Hardest Hit Fund (HHF)

Quality Rating and Improvement System (QRS)

Policy domain Housing Early childhood education

Initiation Federal government in response to housing crisis (2010)

State government and diffusion of idea (starting in 1998)

Scope Eighteen states Approximately forty-three states

Policy type Income transfer Regulatory

Targets Unemployed and underemployed homeowners

Early child education providers, parents

Service organizations

Nonprofit housing counseling agencies, lenders

Nonprofits supporting quality enhancement in early childhood education sites

Frontline staff Housing counselors Coaches

Desired outcomes Homeowner stability (decrease in foreclosures)

Promotion of quality early childhood settings and enhanced information to consumers

important topics for a long time. As Lawrence O’Toole noted, “To establish as a goal that the field of . . . implementation should be able to assist practitioners does not oblige researchers to develop a single predictive theory which will then be employed by actors in the policy implementation process . . . Just as with other varieties of social science, implementation research can serve practical purposes by highlighting a problem, sensitizing others to it, and calling attention to consis- tently important clusters of variables and relationships.”37 This, then, is our intent.

To cultivate effective implementation we want to shine light on the problems confronted in the execution of implementation and sensitize others to them. We begin by recounting, in chapter 2, the three perspectives scholars have taken

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to understanding policy and program implementation in the past half-century. Then, in chapter 3, we integrate these perspectives, bringing into focus our approach that explores the social dynamics surrounding the program at the heart of an implementation process. By unpacking the dynamics of strategic action fields found throughout implementation systems, we provide language and concepts that bolster our analysis of the complex process.

In part 2, we explore how implementation works at various levels in an imple- mentation system, providing helpful ways to describe key factors at each level and tools that can be used with others to appreciate the significant elements of implementation decided at that level. In part 3, we begin by illustrating a multi- level implementation analysis through the Hardest Hit Fund and early childhood Quality Rating and Improvement System programs. In this way, you will better understand how to analyze the structure and processes of implementation systems in your own situations.

We finish, in chapter 8, by laying out a practical approach to improving imple- mentation that is possible with a thorough understanding of the system. We also provide helpful tools for improving implementation conditions in your own con- text. Rather than promoting the notion that implementation conditions should be predicted and controlled, our approach focuses on reflection and analysis to enable more strategic action in particular contexts. Thus, rather than providing a ten-step guide, we enable our readers to see things more clearly and equip them with helpful resources to cultivate their own gardens where public policy and pro- gram implementation occurs.

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c h a p t e r T W OConventional Perspectives

on Policy and Program Implementation

In this book, we offer a new way to think about implementation, but theimplementation challenges we explore are not new. For decades, policymakers, practitioners, and scholars have wrestled with the complexities of policy and program implementation and have offered various ways of making sense of what they observe. Significant contributions have been made along the way, helping to reveal the elements that make up the broader implementation system. Understandably these contributions tend to be made from the perspective and background of the observer. Those with a background in politics or political science tend to approach implementation challenges by thinking about the sources and structures of political authority that may lead to intended—and unintended—outcomes. By contrast, those with a management or administration mind-set tend to see implementation challenges through the lens of governance and coordination. Finally, those with training in clinical settings or behavioral sciences tend to focus on the intervention itself and the characteristics of the treatment more likely to lead to successful implementation.

These are not mutually exclusive perspectives; often observers from each of the three perspectives tip their hats to the other elements. Yet it is sometimes difficult to see the proverbial forest when focusing so intently on individual trees. One of our primary aims in this book is to provide a fuller picture of the forest within which implementation challenges emerge. This aim requires us to be pragmatic—moving across schools of thought and units of analysis

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without getting bogged down in any one particular way of thinking. We will turn to this integration in our discussion of strategic action fields in chapter 3, but before pushing forward, it is helpful to review the insights that have evolved over time within each perspective. We expect that some of our readers will be more familiar with one perspective or another and may find the review within their perspective to be a bit superficial. Our aim is not to provide a comprehensive literature review of implementation-relevant scholarship within each perspective, but rather to introduce readers to all three perspectives to help ground our integration and application, thereby motivating our approach toward integration.

In the sections that follow, we group prior scholarship into three categories: political processes and authority, governance and management, and policy and program evaluations. Yet they don’t operate in isolation; research focused on political processes contributes to understandings of governance and vice versa. However, there are general emphases and foci within each perspective that are distinct. Table 2.1 summarizes some of the key attributes of each perspective. We briefly review the development of each perspective and highlight some of the literature that has shaped its evolution.

Table 2.1 Three Traditional Perspectives on Implementation

Perspective Unit of Analysis

Dominant Disciplines

Focus of Implementation

Political processes and authority

Public policies or policy problem areas

Political science Power dynamics: top-down authority; bottom-up influences

Governance and management

Organizations or networks

Public administration; organizational science

Coordination: multilevel; multiactor; governance tools

Policy and program evaluations

Interventions Economics and behavioral sciences

Change processes: impact analysis; innovation diffusion; behavioral change

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POLITICAL PROCESSES AND AUTHORITY In the 1960s, political scientist David Easton called attention to implementation as an important, distinct component of the larger policy system—the “throughput” between inputs and outputs.1 His contributions pushed political scientists to move beyond a focus on particular political actions, such as the passage of a piece of legislation by Congress or executive orders issued by the president, toward a focus on policy outcomes that result from the broader political system—conceptualized as a series of stages rather than a one-time event.2 Classic textbooks on the policy process built on this work and proposed more formal, discrete stages, including problem identification, agenda setting, adoption, implementation, and policy evaluation.3 This perspective spawned a body of literature focused explicitly on policy implementation, initially favoring a linear top-down model of political control, followed by more organic bottom-up approaches, and finally integrative frameworks. The central thread through each of these approaches is the emphasis on political control, power, and authority that contribute to implementation success or failure.

Top-Down Authority Initial studies of implementation assumed that the appropriate lever of change to improve policy outcomes was the design of the policy itself. Failures in implemen- tation occurred because the policy put in place through legislation or executive orders either lacked sufficient clarity or did not match the context or policy problem it was intended to address. The first generation of implementation research in this vein was predominantly case studies of implementation failures evolving out of frustrations with the Great Society programs of the 1960s and 1970s. The 1973 book by Pressman and Wildavsky, Implementation: How Great Expectations in Washington Are Dashed in Oakland or Why It’s Amazing That Federal Programs Work at All, is the classic study often credited with launching this stream of research.4

In their book, Pressman and Wildavsky unpack the apparent failure of a fed- eral economic development initiative targeting resources to boost the economy and minority employment in Oakland, California. Their main premise is that the inability of the federal initiative to reach its intended goals was due to the discon- nection of policy design and policy implementation. They counter the notion that policy designs are prescriptive plans that simply need to be executed; rather, they espouse that policies are hypotheses based on a theory about a chain of causation

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between “initial conditions” and “predicted consequences.” Sometimes the chain is relatively simple, but more often the chain is complex, with numerous links that need to be in place to achieve the intended outcomes. Implementation is about forging the links in the causal chain; if the intended outcome is not real- ized, it could be that the links were not feasible to create or that the theory of change was incorrect in the first place. Essentially, perceived failures in policy may occur because of faulty policy design in crafting the theory of change—a mismatch between means and ends.

Applied to the economic development programs, Pressman and Wildavsky purport that policy actors in Washington, DC, crafted an initiative to boost the economy based on a theory of change that did not reflect reality or what was actually feasible to bring about change in the city of Oakland. They lay out the complexity of the hypothesis underlying the federal policy: if the federal government provides more than $20 million in funding through a new entity, the Economic Development Administration, to private businesses in Oakland and the funded businesses agree to hire minorities after spending the money at some point in the future, then new jobs will be created that will hire minorities, thereby reducing minority unemployment in the region. According to Pressman and Wildavsky, this policy design was based on too many indirect assumptions. To be successful, the policy needed to target resources in a more direct way toward the intended problem. Rather than subsidizing the general capital development of businesses, hoping they would hire minority personnel, the policy could have been designed to offer companies direct wage subsidies after they had hired minority personnel. In this way, the policy design could circumvent some of the difficulties of implementation by reducing the necessary causal linkages.

Pressman and Wildavsky’s analysis has been criticized for being too rational and placing too much responsibility on implementation at the top during the design phase of the policy process.5 However, in subsequent editions of their book, they clarify that they were in fact responding against the rational planning-and-control model of implementation. They were challenging that policy design should not be treated as a separate process, divorced from imple- mentation, but rather that implementation is an evolutionary and adaptive process stemming from and building on the initial policy intent. Nonetheless, they continued to assert the importance of formal policy; they saw their approach as distinct from subsequent theorists who focused on interactions on the ground without substantial attention to the intended policy outcomes. Perhaps their key

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insight relates to the complexity of joint action—that the multitude of actors with different missions and time lines create implementation challenges. They stress that joint action is more difficult if the program or policy is complex, requiring multiple decision points to transform inputs into outcomes. In other words, the underlying core program and assumptions are critical to implementation success, a premise we agree with and discuss in more detail in chapter 3.

Following Pressman and Wildavsky, a strain of research continued to focus on policy design. Some offered more prescriptive recommendations, admonishing policymakers to take responsibility to set the stage or “fix the game” for success.6

Other researchers began to move away from case studies and prescriptions toward empirical models and the identification of variables that affect implementation success—still from a top-down perspective.7 For example, in the 1980s, Daniel Mazmanian and Paul Sabatier sought to identify important variables that influ- ence the achievement of legal objectives throughout the implementation process. Their resulting model had seventeen important variables, categorized into three groups, measuring the tractability of the problem, the ability of the policy statute to structure implementation, and nonstatutory factors affecting implementation.8 In general, the implementation studies in this approach—whether prescriptive case studies or empirical models—emphasize identifying levers of change in a mecha- nistic way that can be manipulated by policymakers to improve implementation and policy outcomes. The illustrations of machine-like contraptions on the cover and throughout Pressman and Wildavsky’s book offer a case in point.

Bottom-Up Authority As might be expected, other scholars pushed back against the top-down approach, emphasizing that it was not technically feasible or politically viable for policymak- ers to comprehensively structure implementation.9 For example, RAND policy analyst Paul Berman observed wide variation in the same policy being carried out in different local environments. According to Berman, it is the interaction of policy with its implementation setting that creates implementation challenges. He concluded that policy designs were required that could be adapted to local conditions to prevent policy failure, particularly for unclear technologies.10 These “bottom-up” scholars often called for a mapping of the local implementation context and relationships between actors that could then describe the incentive structures and behaviors on the ground. For example, European scholar Benny Hjern and his colleagues coined the term implementation structures to represent

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the self-organized, interconnected clusters of government agencies, organizations, and private businesses that carry out policies and programs at the local level.11

Rather than focusing on a single policy, Hjern’s approach was to start with a policy problem, identifying the multiple institutions and policies that affect the problem. Whereas the top-down approach was deductive, offering formal models and specifying variables that could predict implementation outcomes, the bottom-up approach was more inductive, identifying conditions on the ground to inform a descriptive (rather than predictive) account of the implementation process.

However, it is not just the institutions in the local implementation environ- ment that matter, but also the individuals carrying out policies within institutions. Perhaps one of the best-known scholars to make this point is political scientist Michael Lipsky, who wrote the 1980 book Street Level Bureaucracy: Dilemmas on the Individual in Public Services. We will revisit Lipsky’s seminal contributions in chapter 6, but some background is helpful here. Lipsky offered a sympathetic explanation for the actions of “street-level bureaucrats,” the people who work on the front lines of public service provision. Whether they were police officers, social workers, teachers, or lawyers, these frontline agents often faced criticism for mak- ing decisions about individual cases that at times appeared capricious and insensi- tive to client needs. According to Lipsky, the solution is not to reduce the discretion of frontline workers, which is often infeasible and even undesirable. Instead, effec- tive implementation requires attention to the experiences of frontline workers and adequate support to equip them to facilitate the desired policy outcomes. Other scholars have reached similar conclusions, stressing the need to engage street-level workers in the policy design process, empowering them to create the conditions that will lead to successful outcomes.12 We agree, and highlight the front line as one of the three critical levels in our multilevel model of implementation.

Implied in Lipsky’s analysis is the idea that behaviors and behavioral responses matter as much as or more than formal rules and procedures. This important assumption also underlies the work of Richard Elmore, who introduced the concept of backward mapping to understand implementation outcomes.13 Unlike some of the other early approaches, Elmore’s backward mapping offers a tool that can be used to unpack implementation and inform policy design rather than a theory to predict implementation outcomes. His approach considers the behaviors of the target population and their likely responses to the initiatives being implemented. It also takes seriously the behaviors of the street-level workers

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administering the program and how incentive structures might affect interactions between workers and the target population. Rather than a top-down approach to designing policy, Elmore suggests that policy instruments should be selected based on the behaviors to be changed at the lowest levels and the necessary incentive structures to bring about that change. This focus mirrors the behavioral economics approach that we think is essential to improving implementation practice, and we discuss it later in this chapter and throughout this book.

Integration and Frameworks By the late 1980s, political scientists had identified a plethora of variables and contextual factors that might affect implementation outcomes; however, there was no comprehensive theoretical approach, perspective, or framework by which to make sense of them.14 The title of a 1986 article by scholar Malcolm Goggin described the situation as the “Too Few Cases/Too Many Variables Problem in Implementation Research.”15 Rather than identifying new factors that might affect implementation outcomes, these scholars and others offered theoretical perspectives and frameworks toward integration.16 For example, Goggin put forth a behavioral theory of implementation, focusing on the form and content of the policy, the capacity of implementing organizations, and the skills of people responsible for implementation. Under the behavioral theory, the primary measure of success for implementation is the integration of the new policy into the standard operating practices and procedures of implementing organizations and individuals. Later Goggin and his colleagues extended the theoretical approach to include an explicit focus on intergovernmental communications in the implementation process, unpacking the transmission of messages between the federal level (often in the form of policies) and local-level implementers.17

Another important theoretical contribution from political science that inte- grates implementation is the advocacy coalition framework (ACF), initially put forth by Paul Sabatier in the 1980s and generating a large body of research that continues today.18 The ACF combines Sabatier and Mazmanian’s prior emphasis on legal instruments that constrain behavior, but with particular attention to the context of implementation and actors at various levels of the policy process. One of the unique aspects of the ACF is the focus on the system affecting the policy problem over a substantial period of time—in cycles of ten years or more. Another is the focus on coalitions of “subsystem actors” that form over time in response to a problem, with different coalitions representing the varied

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belief systems operating in the policy environment. According to the ACF, these coalitions offer a more appropriate focus than institutions for understanding political dynamics and authority in implementation analysis. Actors who share common beliefs about the policy problem, its causes and the preferred solutions, coordinate together to advocate for their positions in a policy field over time. Multiple coalitions not only compete for power and dominance but also engage in policy-oriented learning, where coalition members gather information and analysis that helps support their beliefs and policy positions. Changing the outcomes of a policy subsystem, including those associated with implementation, thus entails shifting the beliefs or power dynamics of the dominant coalitions.19

While it offers a big-picture perspective for making sense of policy changes observed over time, the ACF has been criticized for providing limited insights for day-to-day implementation—failing to describe how policy changes result- ing from coalition beliefs are carried out at the operational level or how implementation dynamics feed back into subsequent policy-oriented learning.20

We agree with these limitations. However, we appreciate the ACF’s attention to power dynamics within a policy subsystem and the coalitions that form and learning that occurs around particular belief systems to reinforce or challenge existing practices. Power dynamics, belief systems, and policy learning at the field level, but also at the organizational and frontline levels, are important components of our approach in this book.

Whereas the ACF offers a framework that is characterized by attributes of the policy environment, other scholars have offered frameworks that are character- ized by attributes of the policies themselves. For example, beginning in the late 1980s and early 1990s, Patricia Ingraham, Helen Ingram, Anne Schneider, and other scholars began to call for a shift in perspective away from implementation generically toward understanding specific policy characteristics that might shape implementation and design choices.21 Rather than treating all policies as equal, these scholars noted that some policies lend themselves more readily to easy implementation, whereas others have considerable diversity of stakeholders and complexity that might prevent strict policy design. Motivated by this perspective, Richard Matland proposed a framework for conditions affecting implementa- tion success.22 Depending on the levels of ambiguity and conflict, success for some policies would be more readily achieved through a top-down fidelity to the policy design—with the most important factors being those that would affect such adherence, and success for other policies would necessarily evolve

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through a more bottom-up implementation process—with the most important factors being the conditions on the ground that might affect policy learning and improvement.

Matland’s framework, along with other implementation frameworks stemming from political science, offers a potentially useful heuristic to describe how policy environmentsandpoliciesthemselvesmayvaryinsystematicways.However,most of these frameworks reflect a mechanistic view of implementation, seeking to find the right levers that can be adjusted at the top (policy design) or bottom (imple- mentation settings) to improve outcomes. And with the exception of the ACF, the unit of analysis tends to be a single, clearly identified policy. In reality, implemen- tation challenges are likely affected by more than one formal policy—and each policy may differ substantially. Even within the same policy, there may be varia- tion at different levels of government and across implementation sites. The next perspective reviewed here, governance and management, is in a sense a reaction against this policy-centric view of implementation, favoring instead a focus on the structure and coordination of the broader implementation system.

GOVERNANCE AND MANAGEMENT While the study of policy implementation was relatively new to political science in the 1960s, the study of implementation systems more broadly can be traced back to the beginnings of public administration. In his 1887 essay, “The State of Public Administration,” Woodrow Wilson suggested that it was “becoming more diffi- cult to run a constitution than to write one” and that serious focus needed to be placed on administration, as distinct from politics.23 This was reinforced by Frank Goodnow’s classic text in 1900, Politics and Administration. Their primary objec- tive was to call attention to the study of administration and management and the need to acknowledge the complexities of carrying out policies in public agencies. In this regard, they drew a line between political processes needed to pass legis- lation and the administrative processes necessary to make government function. While some scholars critiqued Wilson and Goodnow as promoting an artificial dichotomy between policy and administration,24 others suggested that if taken in historical context, they were primarily advocating the study of administration as distinct, but not separate, from the study of politics.25 Indeed, the study of public administration and management has a robust and growing scholarship, a review of which is beyond the scope of this book.26

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The focus of public administration is not explicitly on implementation; how- ever, the study of the coordination systems to carry out government actions is inextricably linked to implementation challenges. One of the predominant themes in this perspective today is the multiactor, multilevel nature of the system in which policy and management take place. Governance is an umbrella term that scholars have used to describe this broader system.27 Since the mid-1970s, when Harland Cleveland coined the governance terminology, researchers have grappled with how to describe and make sense of systems of “interlaced webs of tension in which control is loose, power diffused, and centers of decision plural.”28 Whereas tra- ditional studies of public administration and political science tend to focus on governmental actors and political factors that affect outcomes, the study of gov- ernance implies a more comprehensive approach that includes nongovernmental actors and other factors that interact in a decentralized, often networked structure.

While governance includes much more than implementation, the concepts of multilevel and multiactor systems of action are fundamental to understanding implementation. Some scholars, such as Michael Hill and Peter Hupe, place the study of implementation within the governance framework.29 Yet the challenge with a governance approach is that it is defined too broadly to be of much use—it has become everything and the “kitchen sink.” The term is used to refer to organizational structure, managerial approaches, systems of incentives, market-based approaches, citizen participation, public sector performance, glob- alization, contracting out and devolution, corporate transparency, international independence, or a new approach to managerialism.30 While research in each of these areas is critical to informing implementation, we join other scholars to assert that there is still a significant need to focus on implementation—that which occurs at the intersection between these governance and management practices, and policy-related inputs and outcomes.31 We highlight some of the themes from governance research that have importance for understanding implementation.

Multilevel To help make sense of the complexity of governance systems, many scholars have situated the diverse public (and private) actors and sources of authority for decisions in hierarchical, multilevel frameworks.32 This is not a new concept; for decades, sociologists and institutional scholars have described organizations in a similar fashion, with each individual organization (or organized group of actors) nested within a broader organizational or institutional field.33 From a

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public administration perspective, this sort of multilevel framework provides a way to think about how policy decisions made in the federal government resonate down to lower levels of state agencies, service providers, and eventually target populations receiving services.

Perhaps one of the best examples of this approach is the “logic of governance” framework articulated by public affairs scholars Lawrence Lynn, Carolyn Hein- rich, and Carolyn Hill. For them, the central question of governance is, “How can public sector regimes, agencies, programs, and activities be organized and managed to achieve public purposes?”34 The logic of governance framework hierarchically links the preferences of citizens, enacted laws and rules of pol- icymakers, and decisions of bureaucratic agencies to outputs and outcomes. They describe a hierarchy of relationships found in modern governance between institutions, management, and operations.35 While the levels of relationships are situated hierarchically, the system incorporates feedback mechanisms, where outputs and outcomes observed by citizens in turn affect preferences, and thus political choices at the top.

One of the important contributions of this framework is that it describes public policy outputs and outcomes as a function of formal and informal authority, including both legislation and rules as well as agency discretion and the actions of frontline workers. They correctly observe that researchers often model policy out- comes or outputs as a function of formal policy, ignoring many of the potentially important managerial and operational factors, many of which are particularly critical for implementation. In contrast, public management scholars tend to concentrate on the managerial and operational levels, which often overlook some important policy variables. However, by situating implementation questions within a multilevel logic, there is a general recognition that institutional factors at higher levels also affect the outputs and outcomes that are of importance to implementation.

This framework has spurred a robust body of research that approaches pol- icy problems more comprehensively. For example, Ken Meier, Laurence O’Toole, and colleagues have conceptualized outcomes for school districts as being affected by four governance levels: the school board setting general policy, the superin- tendent who is responsible for overall management, the principals and central office administrators who manage the day-to-day affairs of the school, and teach- ers carrying out programs at the street level.36 Others have applied the gover- nance logic to health care delivery outputs and outcomes with three levels: the

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institutional level of Medicare and Medicaid policy, the public management level with physicians who have managerial responsibilities, and the service delivery level incorporating nurses’ beliefs and values.37

While multilevel governance research is not specifically limited to analyses of implementation, it is easy to see why implementation questions might fit well within this sort of structure. In a sense, the multilevel framework provides an alternative to the stages heuristic of the policy process—where implementation is viewed as a stage after policy formulation and adoption. The multilevel framework does not require discrete stages but rather allows for nesting of “lower levels” that include implementation within higher levels of policymaking. Still, the division between levels can sometimes be arbitrary—like the divisions between stages—and thus it is important to think of this sort of logic as a heuristic device rather than a predictive theory.38

Others also have conceptualized policy systems following a multilevel approach. Most notably, the institutional analysis and development (IAD) frame- work developed by political scientists Elinor and Vincent Ostrom offers relevance for implementation.39 The IAD framework helps make sense of the policy process by identifying the underlying institutions operating at multiple levels that govern decisions and thus affect policy outcomes.40 In the IAD framework, collective decisions regarding policy problems are made and carried out in an “action arena.” Decisions made in action arenas are affected by institutions, collective characteristics, and environmental factors. For the purposes of policy analysis and design, specific attention is paid to role of institutions, which they characterize as rules, norms, and shared strategies that constrain and enable collective action taken by individuals within the action arena. Similar to the logic of governance framework’s operational, managerial, and institutional levels, the IAD framework has three levels of institutions that affect outcomes within any given action arena: operational, collective choice, and constitutional.41

Scholars have borrowed from both the logic of governance and IAD frame- works to make sense of implementation questions. For example, Michael Hill and Peter Hupe have proposed a “multiple governance framework” that combines the IAD framework’s constitutive, directional (collective-choice), and operational levels, with actions taking place at three scales: system, organizational, and individual.42 According to Hill and Hupe, implementation takes place at the operational governance level—what they suggest is the focus of implementation

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analysis. While the operational governance level is the focus of implementation, the operational level is nested within the other levels, and thus actions taken at the higher levels affect implementation.

One of the benefits of viewing implementation as part of a multilevel frame- work is that it forces the analyst to think about the level (or scale) on which action is taking place and to think about how other levels of action might also influence the outcomes of interest. A limitation of this approach is that it can again lead to the kind of isolation of implementation that was endemic to the stages approach to the policy process, particularly if implementation is restricted to occurring only at a specific level (e.g., the level of operational governance). To help address this poten- tial limitation, we recognize in our approach that implementation occurs across multiple levels connected in a larger system rather than segregating it to lower lev- els of governance. We view all implementation action as occurring within policy fields, organizations, and the frontline levels within an implementation system.

Multiactor Networks While multilevel frameworks provide one way to portray the interactions of par- ticipants involved in governance, multiple actors are also implicitly or explicitly embedded in interorganizational networks. Networks can be defined as “multiple organizations that are legally autonomous,” linked through relationships “based on cooperation and coordination.”43 There are at least two fundamental contribu- tions of conceptualizing governance from a network perspective. First, network terminology provides a way to describe governance structures, shifting the unit of analysis away from a single organization toward a set of actors with various roles and responsibilities. In this regard, simply mapping the different organizations involved in a particular policy area can help illuminate the relationships and link- ages necessary to create policy or program change. This is similar to how Benny Hjern and his colleagues mapped various organizations involved in the imple- mentation process on the ground to identify the “implementation structures,” as described earlier.44

In sociology, an entire methodology, social network analysis, equips analysts with tools and terminology to map networks of individuals or organizations and their relationships.45 It allows researchers to visualize the structural relationships (ties) between organizations, identifying network characteristics such as clusters of organizations, overall network density, and the centrality of key organizations.

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Rather than viewing each organization engaged in policy implementation as an isolated, independent decision maker, mapping the network structure informs how an organization’s relative position within a network influences the decisions it makes.

In addition, networks provide a way to describe the coordination of actors operating in a given situation, often juxtaposed against market mechanisms or hierarchical controls. In markets, exchange benefits are understood, legal sanc- tions can be evoked, and trust is not necessary. Prices simplify relationships by mediating between supply and demand. In hierarchies, interactions are structured by the nature of employment and, specifically, the authority provided through organizational position and past actions. In networks, however, transactions are reciprocal and relationships are the main modes of communication. It is always possible for people or institutions to exit, so priority lies in achieving mutual ben- efit. Since the 1980s, social scientists, including many public affairs researchers, have investigated the characteristics of networks in this light.46

A growing body of literature in public affairs applies the network perspective to help make sense of multiactor, multisector governance. The majority of these studies are descriptive, generating best practices for public officials and managers. For example, public management scholars often distinguish network or collabo- rative management from traditional bureaucratic management.47 Many papers describe the requisite skills of network managers, such as activating resources, arranging structures, guiding interactions, and focusing on goals,48 recognizing that the means for doing such things may differ when people are focused on interactions among network members or the entire network structure. In their extensive studies of local economic development, Robert Agranoff and Michael McGuire highlight a range of collaborative activities undertaken by local public officials to glean information, make adjustments in policy mandates, develop strategy, exchange resources, and engage in project-based work.49 Not surpris- ingly, they discovered that the use of such practices varies by city, depending on the economic development needs and capacities of the local actors engaged.

Another way to think about differences in networks is to examine the pur- pose for which the network has evolved. For example, scholars Brint Milward and Keith Provan draw from nearly three decades of research on public networks to identify four primary types of networks engaged in public service activities: ser- vice implementation networks, information diffusion networks, problem-solving networks, and community capacity-building networks. These network purposes

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are not mutually exclusive; however, effective strategies for network coordination depend in part on the network purpose at hand. For example, service provision networks may require formal funding contracts and coordination agreements in place to govern participant interactions, whereas more organic information diffu- sion networks may lack formal agreements and rely more heavily on the voluntary participation of member organizations.

Not only are there differences by purpose, but networks also exhibit different structures. Considerable public affairs research employs social network analysis techniques to help describe the structures of public networks.50 One of the most substantial contributions in this regard is Milward and Provan’s study of mental health networks beginning in the 1990s.51 Motivated by the deinstitutionalization and decentralization of services provided to the mentally ill, they sought to exam- ine how differences in coordination of various agencies engaged in providing diverse services to clients—from counseling and medical assistance to housing and employment—might affect client outcomes. They collected extensive data from agencies, clients, and their caregivers in four cities across the United States, each with unique service network structures. The network structure in Tucson, Arizona, was highly decentralized, with funding flowing from a nonprofit in the city to other recipients providing diverse services. In contrast, the network structure in Providence, Rhode Island, was centralized and bureaucratic, with one central agency receiving all funding and providing services directly to clients, controlling referrals and services offered by other community agencies. Which network structure would be better for implementation? For client outcomes? Interestingly, Milward and Provan found that while the participating agencies reported higher satisfaction with the decentralized network structure (as was present in Tucson, Arizona), the clients and their caregivers reported higher satisfaction and better mental health outcomes with the centralized network structure. Why? Milward and Provan suggest that the clear roles and relationships between different organizations in the centralized structure, as well as the stability of the formalized model, provided more predictability and reliability for clients, thus enhancing their experience and outcomes.52

Ideas generated from the network perspective are particularly important for understanding policy and program implementation. One of the early critiques of implementation scholarship was that it often ignored the multiactor reality of implementation and assumed a single implementing organization with clear lines of operational authority and institutional boundaries.53 Even with national

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legislation, where executive agencies are often tasked with carrying out a specific policy, multiple actors are frequently implicated. Researchers Thad Hall and Larry O’Toole make this point through an analysis of the implementation structures arranged by national legislation at two very different times (1965–1966 and 1993–1994). They find that in both time periods, nearly thirty years apart, legislation formally stipulated multiactor arrangements for implementation more than 80 percent of the time. In the more recent period, 55 percent of these configurations were intergovernmental, 27.5 percent included private business, and 10 percent included nonprofit organizations. They further classified the types of coordinated activities required by legislation and found that nearly one in four required joint or pooled production of the service underlying the legislation, while about one-third required sequential production and another one-third required reciprocal production. They key lesson here is that while we know that informal implementation often implicates multiple actors (as described previ- ously by Benny Hjern and his colleagues), even in formal legislation, multiactor networks are implicated for producing the core program defined by policy.

Governance Tools A final theme in governance research that has importance for implementation is the focus on coordinating mechanisms, or policy tools. Policy tools have been defined as “an identifiable method through which collective action is structured to address a policy problem.”54 In 1981, Lester Salamon called for a movement of attention away from agencies and programs involved in policy design or implementation to a focus on the distinct tools that are used to achieve public objectives.55 Other scholars at the time echoed this movement as a necessity of decentralized government action. For example, in 1990, policy design scholars Helen Ingram and Anne Schneider asserted that core elements of policy included objectives, agents responsible for carrying out objectives, and target populations—linked together by policy tools, rules, and theories. In their conceptualization, policy tools are instruments that “are intended to motivate implementing agencies and target populations to make decisions and take actions consistent with policy objectives.”56

Policy tools include grants, contracts, regulatory mechanisms, and other formal instructions intended to coordinate and guide the behavior of imple- menters and clients targeted for services. This underlies one of the foundations of governance—that authority is not centralized in government hierarchies but

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is dispersed through decentralized governing mechanisms.57 These different structures for expending public resources likely have different implications for creating and managing policy change. One of the purported benefits of the tools approach is that while there are numerous federal and state programs, there is a more limited set of underlying tools employed across diverse programs.58

Thus, developing a typology or classification system for common tools can help analysts and managers identify the reoccurring implementation challenges and factors that are likely to be important. We revisit the tools approach in chapter 4 when we discuss coordinating mechanisms in the policy field. However, it is important to consider the ways in which it has been used to help understand policy implementation, as well as the limitations of this approach.

Research employing a tools perspective tends to focus on the outcomes asso- ciated with a particular government tool, addressing questions about efficiency, equity, manageability, and legitimacy.59 For example, research about grants tends to focus at the macrolevel, considering the prevalence of grant-in-aid from the federal to state and local governments and its consequence.60 Research about con- tracts is often concerned with how these tools alter market-based dynamics or are affected by political concerns.61 There is also extensive exploration of how con- tracting has altered public management; rather than managing service providers, public managers now focus more exclusively on developing contracts, moni- toring service levels, and assessing performance rather than managing service provision.62 Extensive research about vouchers explores implementation in par- ticular policy domains, such as health, education, or housing, and the impact on market concerns, such as consumer incentives and restrictions of choice.63

On the plus side, an analytical focus on policy tools more appropriately captures the reality of public service provision today and the structures by which public authority and resources are used to deliver public programs. And research on these instruments demonstrates there are often different implementation considerations when political authority and resources are structured in a certain way. Direct subsidies distributed to end users require different administrative structures and technological processes than contracts awarded to nonprofit organizations to carry out a service program.

Understanding the different policy tools in use in a particular implementation context is certainly an important part of understanding implementation dynam- ics. In fact, we suggest that an inventory of tools in use in a particular policy field is an important step in understanding the current conditions, something we

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discuss in more detail in chapter 4. However, focusing on policy tools alone is insufficient to truly grasp implementation dynamics and improve implementa- tion outcomes. While it is helpful heuristically to identify the commonalities and differences between different types of policy tools, in reality, it is often insuffi- cient to sort specific programs that way. Policy and program implementation in a particular area often leverages multiple policy tools simultaneously to coordi- nate activities. And rather than a rational process of defining the policy problem and selecting the tool to fit the problem, policy tools tend to develop and evolve throughout the implementation process, often in response to political pressures and existing practices.

In practice, government tools come to resemble hybrids of the ideal-type policy tools described in the literature. For example, in the Hardest Hit Fund case we describe in detail throughout the book, competitive federal block grants were awarded to state agencies that provided services directly to homeowners in need, distributed grants to local nonprofits, contracted with private companies to develop intake infrastructure, and financed subsidies to homeowners—where the ultimate recipient of the funding was a private mortgage company. It is difficult to compare the policy tools in use in this particular program to the use of similar policy tools in other programs. What matters for implementation outcomes are not primarily the individual tools but the interactions of the multiple tools in use and the capacities and structures in place at the multiple levels of the implementation system.

POLICY AND PROGRAM EVALUATION A third perspective of implementation shifts the focus away from the political processes or the governance system toward the characteristics of the intervention itself. We group together three distinct but complementary movements under the heading of “policy and program evaluation.” Unlike the other two perspectives that grew largely out of academic disciplines, policy and program evaluation grew from practice and the desire to demonstrate the impact of social programming and government-funded policy interventions.

In the United States, the first federally required and funded program evalu- ation was initiated in 1962 alongside the launch of a new juvenile delinquency intervention. President Lyndon B. Johnson’s Great Society programs of the 1960s and subsequent War on Poverty interventions were designed to be more

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systematically evaluated than prior government interventions, with the hope that rational analysis would provide objective evidence of what works beyond political jockeying. Social scientists were contracted to conduct large-scale evaluations of programs ranging from preschool under Head Start to housing assistance. Feder- ally funded social experiments were undertaken in an effort to identify the causal impact of a particular initiative. For example, under the Moving to Opportunity (MTO) demonstration, poor people were randomly assigned housing vouchers to pay for an apartment in the open market rather than being assigned to live in public housing developments. By evaluating MTO, policymakers could learn about the impact of choice-based vouchers versus concentrated public housing on outcomes such as poverty, education, and even health.64

Many of the early evaluations of the antipoverty programs yielded depressing results. Head Start programs did not lead to the education outcomes that were intended, community action agencies made little impact on eradicating homeless- ness, and even the MTO demonstration yielded mixed findings.65 However, while lack of findings fueled conservative critiques of social programs, null findings did not end evaluation research. Rather, the field of systematic program evaluation was born and developed to support the use of applied social science in policymak- ing and assessment. Along with this came the focused interest in implementation and the growth of implementation studies reviewed earlier. But to a large extent, implementation analysis largely was separate from program evaluation, and eval- uation funding often did not include implementation analysis. In the late 1980s, Harvard professor and experienced evaluator Carol Weiss called for more inte- gration of implementation insights into evaluations and policy analyses, which we view as a continuing need today and in part the charge of this book.66

In the sections that follow, we review three approaches in policy and program evaluation: policy analysis, implementation science, and behavioral economics. Most of our readers are probably most familiar with policy analysis, which is more closely intertwined with political science and public administration. However, there have been important movements outside the conventional approaches that contribute to understanding implementation as part of a broader evalua- tion framework. Within health sciences and clinical practice, implementation scientists seek to understand how new practices and innovations can become embedded in standard operating procedures. Behavioral economists combine insights from psychology and economics to understand human biases and motivations that contribute to (or detract from) implementation effectiveness.

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All three of these approaches share a central focus on the characteristics of the “treatment,” or intervention itself.

Policy Analysis In 1951, political scientist Harold Lasswell called for a “policy orientation” to help address some of the most vexing social problems of the time.67 On the heels of World War II and the Great Depression, traditional studies of political science were not well equipped to inform government’s responses to the most fundamen- tal problems of society, including national security and unemployment. According to Lasswell, a policy orientation would combine knowledge of the policy process with contextual understanding of specific policies and underlying problems. By employing scientific methods and theoretically based models, policy science could produce useful knowledge to improve policies and thereby better address public problems.

While questions relevant to policy implementation had been previously explored in other fields, the Great Society programs and growth of government interventions in the 1960s and 1970s spawned increasing attention on the study of policy explicitly. Policy analyses were launched in an effort to document the effec- tiveness (or ineffectiveness) of government interventions to secure (or eliminate) continued funding. In the process of conducting policy analyses, scholars realized that solutions needed to be implemented and thus investigated how such imple- mentation occurred.68 This shift both altered the unit of analysis and signified an important normative change. Conventional public administration was criticized for focusing on bureau politics and process without offering much relevance to public service delivery being carried out by different instruments and through an array of institutions.69 Political scientists also weathered their share of critique from the emerging policy scholars. Sequential linear approaches that depicted implementation as merely a phase in the policy process were challenged.70

And the appropriateness of rational systems models for policy decision making was questioned, such as the planning, programming, and budgeting system introduced in the Department of Defense in the 1960s.71 As traditional public administration, political science, and econometric approaches were questioned, new schools of public policy and public affairs were launched in many major universities with new attention to policy and program implementation.72

Trained policy analysts began to occupy major positions in government in the 1970s, with offices of policy analysis created within departments at the federal

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and state levels.73 Independent think tanks were formed to serve as evaluation and analysis contractors to government, employing cadres of policy analysts trained in economics and statistics. As with program evaluation more generally, randomized controlled trials and experimentation have often been upheld as the gold standard in policy analysis research. However, there tends to be recognition that the sort of experimentation that is feasible in the real-world policy environment is much different from the type of experimentation that would take place in a laboratory setting. For policy analysis, there is a preference for field experiments and what leading policy scholar Alice Rivlin terms “random innovation,” whereby innova- tions are introduced systematically over time, perhaps within random subsets of the population.74

The initial promise was that policy analysis would directly inform govern- ment decision making by providing objective evidence to cut through political struggles.75 However, it was soon realized that there is no single source of objective evidence and that politics is always part of decision making. In a classic textbook on policy evaluation, scholars David Braybrooke and Charles Lindbom positioned policy analysis as a part of the social process of political decision making, taking place in an incremental and exploratory fashion rather than as a definitive tool to determine political decisions.76 Policy analysis is as much an art as it is a science. In his book paradoxically titled Speaking Truth to Power, Aaron Wildavsky cautions that there is no single truth to be uncovered through analysis and that the highest form of policy analysis is to use “intellect to aid interactions between people,” to help promote discussion and deliberation on the problems to be solved and potential alternatives.77

Viewing policy analysis as part of a social process requires an understanding of implementation dynamics. Unfortunately, most of the evaluation models and econometric methods employed in policy analyses favor simplicity and precision at the cost of contextual integration.78 For example, there tends to be a dominance of welfare economics, which uses microeconomic techniques at the individual level to evaluate well-being at the societal level in policy analyses of government programs. On the one hand, this offers a way to think about and monetize com- plex social problems, and thus evaluate the impact of specific interventions. On the other hand, there are many components of social problems that escape easy measurement, thus potentially compromising the validity of analytical findings. A number of critics of the technocratic approach to policy analysis have encour- aged a more qualitative, reflective approach.79 Sometimes these softer analytical

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techniques make their way into practice; however, most policy analyses today still tend to favor econometric models and experimental methods in an attempt to quantify policy impact.

On the plus side, by focusing on policy impact, policy analysis tends to call attention to the target population and potential shifts in the behavior and outcomes of the targeted recipients of programs. However, rather than operationalizing implementation as a process that takes place within a broader governance system, policy analysts tend to treat implementation factors as variables that can be identified and therefore taken into account in policy design or controlled for after the fact to achieve desired outcomes.80 In our approach, we emphasize the importance of behavioral change in the target population as the end outcome, similar to policy analysts. However, as described in chapter 1, we also emphasize the importance of creating change in the implementation system as an equally important outcome for sustainable results. Identifying changes in operating systems is the dominant focus in the implementation science approach.

Implementation Science A parallel yet independent trend in the study of implementation is the blossoming of implementation science in other research fields.81 Although it is not explicitly linked to public policy, implementation scientists in fields such as medicine and community psychology develop models and methods to study the implementa- tion of specific interventions and programs. These interventions are often funded, carried out, or authorized by public agencies and policies. In 2006, a scholarly journal, Implementation Science, was established to provide a publishing venue for this research. In the introductory volume, the editors clarified the intent: “Im- plementation research is the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine prac- tice, and, hence, to improve the quality and effectiveness of health services and care.”82 Since then, the approach increasingly has been seen in education and other human services fields, such as early childhood development, youth development, and employment.

Most broadly, implementation science posits that creating evidence-based interventions will affect results only if there is research examining imple- mentation processes. The research tradition underpinning implementation science originates from medicine, where there was concern with promoting evidence-informed care at scale. As a result, implementation science scholars

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often anchored their approach to lessons about innovation diffusion and dissemination. In 1995, Everett Rogers, a rural sociologist, developed diffusion theory to explain how innovative ideas spread among farmers, largely through imitation.83 This foundational, often cited theory suggests that innovations that present clear advantages (in effectiveness or cost savings) are more easily adopted or implemented. Those that align with the values or needs of the implementing group, are easily understood and visible, have low risk, and are brought in for time-limited experimentation or adaption are more seamlessly adopted in new settings.84 This frame of innovation diffusion highlights the significance of behav- ioral change in individuals and organizations as a key part of implementation processes more clearly than much of the earlier research we have discussed.

In this field, the innovations are empirically supported interventions—what are referred to with many signifiers, including evidence-informed practice (EIP), evidence-based practice (EBP), empirically supported treatments (EST), and empir- ically supported interventions (ESIs). While increased internal validity for program evaluation is now achievable through a range of research approaches, the research designs do little to help investigators identify what elements of an intervention are causal. What really creates the effect? What is the factor that drives positive results when they are documented? And how do we scale these factors to realize this effect in other settings? Implementation science emerged to discover answers to these questions. Most often the work focuses on what it takes to inspire the people who deliver services, such as the doctors, nurses, teachers, or counselors, to embrace the evidence from program evaluations. Yet there is no magic bul- let. Research clearly documents challenges in persuading these people to embrace evidence-based interventions and abandon the service models they are familiar and comfortable with.85 Much like the implementation studies focused on polit- ical process and authority, there is a fundamental quandary: how to best realize the potential suggested by diffusion theory to promote successful interventions by convincing implementing actors working in existing systems.

Carl May and colleagues are focused on building a grounded theory to provide answers to this quandary. They investigate what promotes the take-up of new ideas in complex interventions, particularly increasing staff interest in integrating the novel into practice.86 Like other implementation science scholars, they begin with an interest in medical interventions. Yet their normalization process theory focuses on better describing how practices are made coherent and meaningful to clinicians, how this inspires commitment, how specific actions are

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adapted and contextualized, and how activities continue to be actively appraised. Fundamentally they are interested in the social organization of work or how changes become normalized, transformed into everyday tasks that are sustained by implementers. By drawing attention to key capabilities and capacities, their work is focused on promoting more skillful implementation practice. We return to these ideas in part 3.

The growth of implementation science studies taking place has led to a call for integrative frameworks, not unlike the frameworks developed by policy implementation scholars.87 For example, Trisha Greenhalgh and colleagues synthesized nearly five hundred published sources across thirteen health care fields to develop a model that predicts successful innovation implementation in health care. Their model identified more than fifty seemingly important variables to predict implementation success.88 In its complexity, this effort resembles the multivariate models created by Mazmanian and Sabatier and other top-down implementation scholars already discussed to be similarly focused on predicting results.

In fact, a 2012 review in the American Journal of Preventative Medicine identified sixty-one models available for researchers exploring dissemination and implementation.89 Virtually all of the models focus on identifying determinants of implementation behavior in relation to the core intervention.90 Ironically, the effect seems to hinge on how the efforts are implemented. There are no magic tactics for changing service providers’ behavior. This finding highlights a challenge with the implementation science reductionist analysis: researchers equate strategies to overcome implementation barriers to those helping doctors tailor clinical treatment for medical diagnosis.91 As a result, scholars promote standardized assessment tools for program managers interested in objectively assessing their organizational capacity to successfully implement a new program or intervention. Duncan Meyers and colleagues attempt to integrate twenty-five implementation frameworks that ostensibly focus on the how-to of implemen- tation to create what they term the “quality implementation framework” with an accompanying standardized rating tool.92 In this effort, the implementation process is represented in fourteen steps to be used across settings. Beginning with assessing initial conditions and creating structures for implementation, to pro- viding ongoing support and learning from experience, this framework—although built to align with the research findings—strongly resembles conventional strategic planning models.

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In this expanding area of research, scant attention is paid to the policy environment. While it is repeatedly recognized as significant in both initial program delivery and dissemination of evidence-based interventions, only a small proportion of the models and frameworks incorporated policy activities.93

While significant attention is focused on developing and sharing consistent measures of implementation, policy context is often seen as merely a few control variables. In the widely used CFIR (Consolidated Framework for Implementation Research), the policy environment is conceptualized as the “outer setting,” highlighting that the technological intervention itself is what is most important in implementation activity.94 Among health implementation studies published in the past ten years, fully one-quarter employ an experimental design that by definition is focused on internal reliability rather than external generalizability relevant to policy concerns.95

On the positive side, implementation science takes seriously the need to account for factors associated with innovation diffusion and dissemination when introducing a new intervention or making changes to an existing program. Too often, however, the approach starts from a blank slate or list of factors without a systematic way to make sense of the implementation system. By drawing from insights from multiple perspectives, our approach in this book allows us to position insights about innovation diffusion within a complex system. Rather than creating tools intent on trying to reduce implementation complexity, we think it is more practically useful and intellectually hopeful to generate ways of systematically investigating the complexity of implementation systems. Part of the complexity is the nature of human behavior—inherent in both the target population and the system engaged in implementation. To shed light on the human side of policy interventions and implementation, we find some insights in recent scholarship from psychologists and behavioral economists.

Behavioral Economics A final current trend in our review of relevant scholarship is the use of behavioral sciences, particularly psychology and behavioral economics, to inform policy design and implementation.96 Often the outcomes of policies and programs involve targeting the behavior of individuals. However, the natural or impulsive behaviors of individuals do not always fit with the assumptions of policymakers and program managers. Together, psychologists and behavioral economists identify and analyze such biases and heuristics that shape individual behaviors.

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The insights revealed help inform how users experience programs, allowing implementers to design interventions that increase take-up and maximize behavioral change, often at less cost.

This less invasive behavioral approach to creating positive change has been popularized by the best-selling book Nudge, written by economist Richard Thaler and law professor Cass Sunstein.97 Their book opens with a fictitious story about Carolyn, the director of food services for a large public school system. Carolyn identified a creative way to encourage children to eat healthier by simply restructuring the food line in the school cafeterias. By putting the healthier foods first, she can increase the likelihood that children in her school system eat better. Thaler and Sunstein refer to Carolyn as a “choice architect.” Choice architects are people who create the environment in which others make decisions. Simple changes, or “nudges,” can profoundly affect the behaviors of participants, such as children making healthier food choices because of a food presentation in the lunch line. Borrowing from their terminology, policy and program implementers can most certainly be defined as choice architects. Whether they intend to or not, implementers make decisions every day that constrain or shape the experiences of participants.

Despite its recent increase in popularity, behavioral economics is not new. Insights regarding the take-up of public benefit programs or food choices in the lunchroom are supported by decades of research from psychology about the limitations of individual decision making. Behavioral scientists and economists have challenged the assumptions of the purely rational decision maker for decades. Nobel laureate Herbert Simon articulated this critique in the 1940s with his conceptualization of bounded rationality.98 In the 1970s, psychologists launched a new branch of behavioral decision-making research demonstrating the limits of human rationality and the power of social and contextual factors over human behavior. These limits were demonstrated most profoundly with the infamous experiments of psychologist Stanley Milgram in the 1960s. Following the Holocaust, Milgram sought to understand how Nazi soldiers could commit such horrific acts of torture against other human beings. Through laboratory experiments, he found that human subjects were willing to inflict what appeared to be high levels of painful electric shocks on other subjects when commanded to do so by the head researcher. His experiments revealed the social power of obedience to orders, even when it required inflicting irrational pain and suffering on other human beings.99

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Aside from obedience to social orders, further research in this area sought to identify perhaps more subtle factors limiting human decision making. Psychologists Amos Tversky and Daniel Kahneman led the research in the 1970s with a series of articles outlining common heuristics and biases constraining decisions and the conditions under which such constraints are more likely to come into play.100 In their 1974 article in the journal Science, they demonstrate that people are more likely to fall back on heuristics, such as recalling recent similar experiences, when they face an unfamiliar situation. Relying on heuristics might help individuals make decisions in these situations, but they may also lead to less-rational decisions than individuals would have made if they fully understood the context.

By identifying common heuristics and biases at play, researchers argue that such less-than-optimal decisions can be predicted and perhaps even corrected. Psychologists’ work in this area drew the attention of other social scientists, partic- ularly economists whose theories are based on individuals’ interest in maximizing their own economic position. Understood this way, the behavioral insights from psychology are not at odds with economic theories and models but complement them, helping to explain and predict observed behaviors.101

Behavioral insights improve not only research but also implementation. Policies and programs can be designed and implemented in such a way that they recognize and even leverage common heuristics and biases to be more effective. Over the past few decades, dozens of studies have been conducted to identify these behavioral factors and test the effectiveness of different types of behaviorally based interventions on outcomes ranging from individual savings behaviors to corporate environmental practices. Typically these interventions are tested through randomized controlled trials, where some users are randomly selected to receive the new intervention and others receive the status quo.

One common example is testing of interventions that change the default options in a particular policy context. For example, in the area of organ donation, researchers have observed that the proportion of the population consenting to donate their organs on death varies greatly by country, with only 12 percent consenting in Germany compared to 42 percent consenting in the United States and a whopping 99 percent consenting in Austria.102 Through surveys and lab experiments, researchers have found that one of the primary differences in consent rates is the way in which citizens were presented with the decision.103

Specifically, if the default in a particular country (such as Austria) was to be

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automatically registered as a donor and the person had to explicitly opt out to not be registered, the registration rates were very high compared with a country like the United States, where citizens are typically given the option to opt in and become a donor when registering for a driver’s license. Other researchers have extended this observation to test default options in other contexts, such as automatic enrollment for employee retirement savings.104

Behavioral economics is not just a trendy subject being discussed by researchers. Policymakers and foundation executives in the United States and abroad are beginning to emphasize the importance of incorporating behavioral aspects in policy and program decisions, engaging the expertise of behav- ioral scientists.105 Typically economists have played a dominant role in advising policy decisions. For economists, government intervention is typically viewed as justified when markets fail to provide important services or do so in a way that is inefficient or ineffective. They help inform conditions under which information asymmetries between consumers and suppliers might create the need for disclosure on products or even signed releases acknowledging risk before making a purchase. However, a behavioral understanding of decision making demonstrates that not only is much information often imperfect, but it is also difficult to present information in a way that is unbiased. The font size on a disclosure or the phrasing of the costs and benefits as a loss or a gain can substantially affect the choices people make. To the extent that “mistakes” made regarding these choices have societal consequences, behavioral insights can help enable policy design and implementation effectiveness. To inform our purpose here, we will revisit some of the findings of this research—particularly some of the most common behavioral limitations and tested interventions— in part 3.

While policymakers and public officials across the globe are increasingly embracing the insights of behavioral economics, some are less optimistic about the potential for this movement to lead to better societal outcomes. The primary concern is that policymakers and program managers are people too—affected by some of the same biases as the target population. What makes implementers better decision makers than the target population that they are trying to serve? One well-known economist suggests that the realization that there are flaws in how humans make decisions should make us more hesitant for government to intervene, to try to manipulate human behavior in less easily observed ways.106

Because it is often more difficult to observe behaviorally targeted interventions,

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such as subtle changes to wording in messaging campaigns or mandatory disclosures, public accountability may actually be reduced.

However, others will contend that for public interventions to be effective, they need to be able to match the messaging and sophistication used by the private sector to target consumers. Private firms have leveraged these sorts of insights for years in marketing campaigns and product messaging. As we discuss in chapter 6, rarely will a private firm develop a new product or services without testing the user perceptions and experiences. And smart firms know that they can exploit behavioral biases to increase profitability. Of course, the same incentives that lead firms to apply behavioral insights for profitability can have positive societal consequences.107 For example, a private insurance firm interested in increasing the contributions of employees to their retirement savings might leverage behavioral insights to make it easier for people to save more; this helps the firm, but it also addresses the policy issue of undersaving for retirement. Sometimes, however, public and private interests conflict. It is possible, of course, that policies or programs designed to increase the positive behaviors of individuals could be undermined by marketing campaigns that play on their vices. It is important for implementers to be aware of the potential for signals to conflict.

Whether intentional or unintentional, there are components of policies and programs that evoke particular behavioral responses and affect policy outcomes. A simple opt-out check box for organ donation at the bureau of vehicle registration will lead more people to register as donors than an opt-in check box. It may be by chance that the implementer initially designed the form with an opt-in rather than opt-out. Nonetheless, this design dramatically affects the policy outcome. The question for policy and program implementation is whether we identify that these effects exist and use that information to improve the intended outcomes of the program or policy. This is a subject to which we return in chapter 8.

While behavioral economics contributes significantly to the way we think about program components, there are limits to a strict adoption of this approach to improve implementation. Most of the interventions designed using behavioral insights are tested through randomized controlled trials. Just as is true in imple- mentation science research in health care, this approach allows an evaluator to zero in on the effect of the intervention without worrying about all of the other factors that could influence intervention effectiveness. However, testing interventions in controlled settings does not take into account the contextual factors that often are difficult, and perhaps undesirable, to control in the real world.108 Furthermore,

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behavioral economics rarely accounts for the significance of the institutions that will ultimately carry out the interventions and bring them to scale.109 Too often the hopes for an intervention to be designed, tested, and then replicated en masse in the real world are dashed when the complexities outside of the laboratory come into play.

CONCLUSION This chapter provides a broad landscape of prior perspectives that inform policy and program implementation. Understandably researchers and practitioners with different backgrounds tend to focus on different aspects of the implementation system. Traditional policy implementation scholarship has been predominantly associated with political science, categorizing implementation as a stage in the pro- cess of policymaking. Classic studies of policy implementation tend to take either a top-down or bottom-up approach. From a top-down approach, implementation is viewed as directed by legislation and political officials and recommendations for improvement begin with policy design at the top. Those taking a bottom-up approach acknowledge the organic nature of the implementation system operating on the ground and recommend strategies to provide discretion to microimple- menters. In the end, the classic literature provides a list of factors that can influence implementation outcomes, paying particular attention to political authority and power dynamics. But this scholarship struggles to make sense of this complexity to improve implementation results. Several frameworks have been proposed to orga- nize the complexity, but these frameworks serve more as heuristics for research than practical ways to make sense of and manage within the complexity that is policy and program implementation to desired ends.

Rather than being situated abstractly within the policy process, alternative per- spectives are grounded in either the governance system or the interventions being carried out. In public administration and management, the study of multilevel, multiactor governance has become the dominant approach. There is much to learn from this approach, particularly when thinking about the structure of implemen- tation settings and the ways in which activities are coordinated between diverse actors. However, by focusing on the system, this approach tends to downplay the importance of the intervention being implemented. Instead, the intervention is often left to technical policy experts.

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By contrast, the third perspective reviewed here is grounded firmly in the inter- ventions underlying policies or programs. Beginning with policy analyses of the Great Society programs in the 1960s, the key objective guiding this perspective is to evaluate the impact of given interventions on desired outcomes. Researchers and practitioners in this perspective often start with technical policy or program expertise. Policy analysts tend to favor cost-benefit analysis and econometric mod- els that can be used to support or refute specific policy proposals. Implementation scientists seek to identify the ideal intervention that can be easily replicated across settings. Evidence-based practices become the gold standard, creating a prolifer- ation of program evaluations testing the effectiveness of specific interventions in one particular context but offering little generalizability to a broader understand- ing of implementation effectiveness. Behavior economists zero in at an even more granular level, at the interactions between target participants and specific inter- ventions. They also prefer randomized controlled trials to identify behaviorally informed modifications to existing interventions. While their work calls attention to the importance of user experiences and interactions with the intervention, it tends to brush aside the importance of the implementation settings that are so critical to bringing new policy or program ideas into reality.

While we borrow and integrate learnings from all three perspectives, our commitment to developing a practically relevant approach to supporting more skillful implementation practice causes us to part ways with these traditions. As described in chapter 3, rather than understanding implementation as activities undertaken in regard to a particular intervention, our approach conceptual- izes implementation as interactions within various strategic action fields in a multilayered system. Thinking about implementation as taking place within strategic action fields allows us to take into account politics and power dynamics, multilevel governance, and important attributes of the core intervention. Rather than starting from the question of what works, this approach explores how programs work110 and considers opportunities to make improvements to the system that support achievements of desirable results.

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c h a p t e r T H R E EA New Perspective for

Implementation Strategic Action Fields

As our review of prior perspectives has made clear, there are many approaches to describe and analyze policy and program implementation. Without a doubt, implementing program change is difficult because of the many players and the inevitable significant limitations in available resources. Yet within these constraints, those charged with managing public and nonprofit organizations, carrying out public policy, and developing innovative solutions do make progress on implementing such changes. Unfortunately, most of the literature does little to provide such professionals with a way to talk about the challenges they encounter, analyze the barriers, or develop more skillful responses to those conditions.

When we set out to write this book on implementation, we realized that one of the primary factors contributing to the gap between research and practice is the artificial division created in the current study of public affairs. As described in chapter 2, political scientists tend to focus on political authority and politics, management or administration scholars focus on coordination and governance, and other behavioral science specialists focus on the intervention or treatment. These divisions between the policy context, institutions, and interventions might be useful to organize scholarship; however, such divisions do not exist in the real world of practice.

The analytical approach we describe is relevant for either understanding imple- mentation dynamics after they have occurred or assessing new initiatives that must be planned. We aim here to help those doing such work (or those who aspire to!) more clearly understand the implementation dynamics where policy solutions

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and systems’ response intersect. Rarely are implementation systems built from the ground up with new institutions, agencies, and staff; instead, they almost always require working with existing entities or established market patterns. As a result, it requires convincing people that the change envisioned by policy or program parameters is justifiable to achieve different results.

While we are informed by the traditions of implementation scholarship, we are explicitly turning to new theoretical frameworks and pushing for a deeper level of integration and application. Our thinking about how to proceed is informed by an array of developments in the natural and social sciences. Most broadly, from the natural sciences, we can learn much from the operation of complex, adap- tive systems.1 In complex systems, factors are interrelated in nonlinear ways and it is difficult to anticipate the consequences of particular strategies or action. Our emphasis on complexity contrasts with prior studies that view implementation as complicated but predictable, categorizing successful implementation strategies a priori based on characteristics of the policy environment or intervention.2 In complex systems, rather than identifying all possible factors that might predict implementation outcomes, the focus shifts toward understanding system dynam- ics and equipping managers with the skills needed to probe and respond to them.

When thinking about the complexity of the system, we have found it helpful to view implementation from the perspective of multiple levels, bringing essen- tial parts of the system into focus for detailed exploration. As in an environmental ecosystem, the different levels of the implementation process at the policy field, organization, and front lines are not independent of one another but are embedded and interrelated. In part 2, we spend considerable time exploring the multiple lev- els within these complex systems where particularly important decisions often get decided. It is important to probe and understand dynamics at each scale. However, we cannot forget that they are intimately connected. Activities and constraints in the policy field ripple down and affect the organization and front lines. And inno- vations at the front lines or organizational levels emanate out to affect ideas in the policy field.

Analyzing implementation requires special emphasis on the intervention or core program. Across all levels of the system, the core program defines what is being done to whom under what conditions. Except in completely routinized and centralized implementation systems, the programmatic details are shaped by social dynamics in the policy field, organization, and front lines. Understanding

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implementation hinges on paying particular attention to the core program and how it develops and changes at different levels in the implementation system.

In practice, the importance of the program is so self-evident that it is often not even acknowledged. Professionals engaged in implementation often seek to increase their knowledge of the substantive content of the intervention and the characteristics of the target groups—they compare different models of mental health interventions and what research reveals about changes in emotional and social functioning; they assess educational curricula and consider how to intervene in children’s lives characterized by many factors that predict their academic challenges; they review the engineering of energy transmission lines to improve throughput and output. Even if they work at different scales in an implementation, at different levels, and in various organizations, professionals who care about implementation care about programmatic elements.

One of the challenges in taking a more complex approach to understanding implementation is that it may begin to appear as if everything matters and there- fore nothing is important. This was a problem with some of the earlier imple- mentation studies that provided lists of literally hundreds of variables that might affect implementation outcomes.3 Rather than equipping implementers with tools to increase implementation effectiveness, we end up overwhelmed and immobi- lized, with paralysis by analysis. Fortunately, we think that there is a practical way to think about the parts of the implementation system that can help prevent this sort of “everything and the kitchen sink” pitfall: strategic action fields.

INTRODUCING STRATEGIC ACTION FIELDS Borrowing from sociology and organizational theory, we can think of each level within the implementation system—the policy field, individual organizations, and the front lines within organizations—as a unique institutional setting or strate- gic action field.4 Strategic action fields are settings where collective action takes place; participants working together in that context have a general understanding about their purpose, their relationships, and the spoken and unspoken rules that guide their actions.5 While different activities take place at distinct levels and pol- icy areas, participants, resources, and program technologies are present in each implementation setting. In fact, as strategic action fields, each setting within the implementation system has a unique social structure that enables participants to work together toward a common purpose. By definition, social structures provide

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frameworks around how participants interact and make decisions within their group and create a boundary around what takes place.6

It is perhaps helpful to think back to the gardening and ecosystem metaphor to illustrate our meaning. Within the same ecosystem, multiple habitats exist simultaneously on different scales. Each habitat could be described in terms of plant and animal life, natural resources, and climate. Rather than existing independently, each habitat is embedded within a larger ecosystem—a forest, for example. While each habitat is affected by and affects the overall characteristics of the forest, each could also be described as its own subsystem; the plant and animal life, resources, and climate can be described and compared. Near a stream, the habitat may be very different from that found in a cave even when they are in the same forest. Importantly, the subsystem around the stream or cave has a natural boundary that in part determines what takes place within it.

Although people construct them, strategic action fields are like these habi- tats. At each level of the implementation system, there are social structures, for- mal and informal, that act as permeable boundaries, limiting the alternatives that actors within the setting consider when they are making decisions. These social structures could include formal regulations, funder expectations, or even norms about what is viewed as an acceptable practice. Rather than being predetermined, social structures emerge from the choices and dynamics among people as they work on shared concerns. Although in a strict sense, social structure is “made up” by people, it is very real, shaping the minds and actions of people who work within it. The social structure often creates the very terms that must be navi- gated to make change. As such, it is both a blessing and a curse. On the plus side, people have limited capacity and ability to consider all possible alternatives—the social structure operating at each level of an implementation system makes more manageable the number of participants involved, the ideas considered, and the resources deployed to tackle a specific problem. On the negative side, the social structures may constrain peoples’ abilities to develop the most creative or innova- tive solution to the problem at hand. There is often some degree of what scholars call path dependence, where the same idea or resource is applied repetitively even if it is no longer effective.

Analyzing implementation to improve process and results requires unpacking the social dynamics and constraints operating at each level of the system. If we develop clearer descriptive analytics—just as we have developed ways of under- standing that rocks are different from plant matter and that rocks in streams play

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