Modification ofpolicies in the implementation phase occurs in both rulemak-ing and in the operation of policies. Recall from the discussion in Chapters 7 and 8 that policy implementation entails these two distinct and sequentially related sets of activities in which policymakers, and those who would influence their decisions and actions, engage. Feedback from the consequences of formulated and implemented policies can also stimulate the modification of policies in the implementation phase, at both the rulemaking point in the process and in the operation ofpolicies, and often at both points concurrently.
Modification at As noted in Chapter 7, rulemaking is a necessary precursor to the operation Rulemaking and full implementation of new public laws because enacted legislation rarely contains enough explicit and directive language to completely guide implementation of the legislation. Newly enacted policies are often vague on implementation details, usually intentionally so, leaving it to the implementing organizations to promulgate the rules needed to guide the operation of the policies. Beyond this, existing policies are modified most frequently through changes in the rules or regulations used to guide their implementation.
The practice of using rulemaking to modify policies by updating or changing features of their implementation pervades policymaking. As discussed in Chapter 7, rules promulgated by executive branch agencies and departments to guide policy implementation possess the force of law. The rules themselves are policies. As implementation occurs, rulemaking becomes a means to modify policies and their implementation over time. In the process, rulemaking creates new policies. Changed rules are modified policies.
Modification in Policy operation, as discussed in Chapter 8, involves the actual running of Operation the programs embedded in public laws. The operational stage of a policy is primarily a responsibility of the appointees and civil servants who staff the government, particularly those who manage the departments and agencies with policy implementation responsibilities. The managers responsible for operating a public law have significant opportunities to modify the policy— especially in terms of its impact on and consequences for those affected by the law—through the manner in which they manage its operation.
Policies implemented by managers who are committed to the objectives ofthose policies and who have the talent and resources available to vigorously implement them are qualitatively different from policies operated by managers who are not committed to their objectives or who lack adequate talent and resources to achieve full and effective implementation. Modification ofpolicies through changes in the way they are implemented is a routine occurrence in the ongoing policymaking process.
Two principal sources of stimulus for modification exist in the operation of policies: one internal and the other external. Internally, the managers responsible for operating policies approach the task in ways that are similar to the ways of managers in all settings; that is, they seek to control the results of their operations. To accomplish this, they establish standards or operating objectives (e.g., to serve so many clients per day, to process so many reports in a quarter, to distribute benefits to certain categories of beneficiaries, to assess compliance with certain regulations by so many firms); operations ensue; results are monitored; and changes are made in operations, objectives, or both when results do not measure up to the predetermined standards (Longest 2005). Such routine operational modifications are inherent in the implementation phase of any policy. They are part of the daily work that occurs within organizations that implement health policies.
In addition to the internal pressures to modify policy operation, there are external pressures as well. These pressures for change in the operation of a health policy are exerted by the individuals and especially by health-related organizations and interest groups that experience the consequences of implemented policies. As noted above, all of those who feel the consequences of policies are likely to seek to modify them. One avenue open to them, and one of the key points at which they can exert pressure for the modification of policies in their operational stages, is the opportunity to influence the modification of policies through influencing those who manage their operation.
These opportunities for policy modification arise within the working relationships—sometimes close working relationships—that can be developed between those responsible for implementing public policies and those whom their decisions and activities directly affect. The opportunities to build these relationships are supported by a prominent feature of the careers of bureaucrats: longevity (Kingdon 1995). Elected policymakers come and go, but the bureaucracy endures. Leaders of health-related organizations and interest groups can, and many do, build long-standing working relationships with some of the people responsible for implementing the public policies that are of strategic importance to these organizations and groups.
The most solid base for these working relationships is the exchange of useful information and expertise. The leader of a health-related organization or interest group, speaking from an authoritative position with relevant information based on actual operational experience with the implementation of a policy, can influence the policy's further implementation. If the information supports change, especially if it is buttressed with similar information from others who are experiencing the impact of a particular policy, reasonable implementers may well be influenced to make needed changes. This is especially likely if there is a well-established working relationship, one based on mutual respect for the roles of and the challenges facing each party.
Sometimes the relationships between those who feel the consequences ofpolicies, usually operating through their interest groups, and those responsible for implementing policies important to them are expanded to include members of the legislative committees or subcommittees with jurisdiction over the policies. This triad of mutual interests forms what has been termed an "iron triangle," so called because the interests of the three parts of the triangle "dovetail nicely and because they are alleged to be impenetrable from the outside and uncontrollable by president, political appointees, or legislators not on the committees in question" (Kingdon 1995, 33). As discussed in Chapter 3, however, the widely divergent interests ofso many organizations and groups, coupled with their increasing presence in the policymaking arena, have made the formation of solid triangles more difficult and rarer in the health policy domain.
An obvious, and very limiting, problem for those who wish to modify health policies through influencing their operation, as well as the rulemaking that precedes operation, is the sheer enormity of the bureaucracy with which they might need to interact. Consider the enormous number of components of the federal government with relevance to health policy that are involved in rulemaking and policy operation. The number increases when relevant units of state and local government are added. Taken all together, the huge challenge of simply keeping track of where working relationships might be useful as a means of modifying policy through influencing policymakers in the implementation phase—to say nothing of actually developing and maintaining the relationships—begins to come into focus. Obviously, selectivity is necessary in determining which of these relationships might be most strategically important.
Was this article helpful?
Achieve the Fitness and Wellness for You that you have always wanted by learning the facts so you can take the right steps to maximize your health. Learn How to Achieve Real Fitness and Wellness for a Healthy Body, Mind and Spirit to Improve Your Quality of Life in Today's World. Receive Valuable Information to Discover What Really Matters and What Actually Works in Finding Genuine Wholeness for All Aspects of Your Being.