All Vision but No Change?: Determinants of Implementation

Many acclaimed policies in Ireland have failed to deliver on their aspirations, leading some commentators to talk of a problem of implementation. The failure to fully implement some public service policies has led to frustrations on the part of policymakers, service providers and service users alike.
This book reviews the implementation literature from a number of perspectives. There are those who seek to implement policy from the ‘top down’. Others seek to influence the implementation of policy from the ‘bottom up’. Some seek to bring about implementation through change.
The mental health policy 'A Vision for Change' is taken as a case study. The content of reports of an Independent Monitoring Group is analysed. Interviews are undertaken with people associated with implementation of the policy. These include politicians, public servants, mental health professionals, mental health service users and mental health advocates.
The key finding is that two factors were found to be fundamental to successful implementation: (1) authoritative, accountable leadership; and (2) identifying and addressing the main resisters to change. Many other factors were found to be important to some extent.
The book concludes that there is a need to acknowledge issues ‘below the surface’, including beliefs, values and power relationships in implementing policies. Innovation and creativity, along with local leadership, are important but on their own they are not enough to ensure successful implementation.
These findings have relevance for the implementation of nationally designed policies which are intended to be implemented across the country in an even-handed way.