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Divergent notions of “quality” in healthcare policy implementation: a framing perspective

Husayn Marani (Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada) (Women’s College Hospital Research Institute, Women’s College Hospital, Toronto, Canada)
Jenna M. Evans (DeGroote School of Business, McMaster University, Hamilton, Canada)
Karen S. Palmer (Women’s College Hospital Research Institute, Women’s College Hospital, Toronto, Canada) (Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada)
Adalsteinn Brown (Dalla Lana School of Public Health, University of Toronto, Toronto, Canada) (Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada)
Danielle Martin (Women’s College Hospital Research Institute, Women’s College Hospital, Toronto, Canada) (Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada) (Department of Family and Community Medicine, University of Toronto Faculty of Medicine, Toronto, Canada)
Noah M. Ivers (Women’s College Hospital Research Institute, Women’s College Hospital, Toronto, Canada) (Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada) (Department of Family and Community Medicine, University of Toronto Faculty of Medicine, Toronto, Canada)

Journal of Health Organization and Management

ISSN: 1477-7266

Article publication date: 7 January 2021

Issue publication date: 24 February 2022

810

Abstract

Purpose

This paper examines how “quality” was framed in the design and implementation of a policy to reform hospital funding and associated care delivery. The aims of the study were: (1) To describe how government policy-makers who designed the policy and managers and clinicians who implemented the policy framed the concept of “quality” and (2) To explore how frames of quality and the framing process may have influenced policy implementation.

Design/methodology/approach

The authors conducted a secondary analysis of data from a qualitative case study involving semi-structured interviews with 45 purposefully selected key informants involved in the design and implementation of the quality-based procedures policy in Ontario, Canada. The authors used framing theory to inform coding and analysis.

Findings

The authors found that policy designers perpetuated a broader frame of quality than implementers who held more narrow frames of quality. Frame divergence was further characterized by how informants framed the relationship between clinical and financial domains of quality. Several environmental and organizational factors influenced how quality was framed by implementers.

Originality/value

As health systems around the world increasingly implement new models of governance and financing to strengthen quality of care, there is a need to consider how “quality” is framed in the context of these policies and with what effect. This is the first framing analysis of “quality” in health policy.

Keywords

Acknowledgements

The authors are thankful for the Ontario Strategy for Patient Oriented Research Support Unit (OSSU) Impact Award which funded our research. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Citation

Marani, H., Evans, J.M., Palmer, K.S., Brown, A., Martin, D. and Ivers, N.M. (2022), "Divergent notions of “quality” in healthcare policy implementation: a framing perspective", Journal of Health Organization and Management, Vol. 36 No. 1, pp. 87-104. https://doi.org/10.1108/JHOM-09-2020-0370

Publisher

:

Emerald Publishing Limited

Copyright © 2020, Emerald Publishing Limited

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