West_whole_thesis.pdf (3.92 MB)
Policy, politics and patients : public policy and radiation therapy services in North West Tasmania
thesisposted on 2023-05-28, 10:19 authored by West, SG
In 2010 the Federal Government made a major funding commitment that enabled a local radiation therapy service to be built in North West Tasmania. This changed the geographic accessibility of radiation therapy services for the region's residents as well as the overall design of cancer services for North West Tasmania. The establishment of this service came about despite the North West's small population, proximity to existing radiation therapy services in the North, long-standing issues with recruitment and retention of specialist health staff, and strong opposition from health professional groups. The aim of this research was therefore to examine how and why public policy responded to the issue of geographic accessibility of radiation therapy services in regional North West Tasmania, with particular regard to the establishment of the North West Regional Cancer Centre. To understand this policy change, a policy analysis framework ‚Äö- the Advocacy Coalition Framework, developed by Paul Sabatier ‚Äö- was utilised and its hypotheses tested against the case study of radiation therapy services in North West Tasmania. The Advocacy Coalition Framework is premised on actors forming coalitions with others based on shared policy beliefs, and it is these coalitions that engage in non-trivial action to influence policy outcomes. The research was based on a descriptive case study using document analysis and semi-structured interviews with key stakeholders and patients and their family. This yielded 137 relevant documents for analysis and interviews with 38 participants. An analysis of documents and interview transcripts was done using the Advocacy Coalition Framework to ascribe beliefs and thereby determine the coalitions involved in the debate over radiation therapy services in North West Tasmania. The findings indicated the clear presence of one coalition, comprising of state health policy actors and health professionals. This coalition shared a core belief of advocating for safety and sustainability of radiation therapy services, with a North West service considered largely unfeasible prior to the 2010 funding commitment. There was no evidence to indicate a second coalition comprising of identifiable actors engaged together in non-trivial action to advocate for a North West service. The findings did indicate a strong role for the media as well as intervention by the Federal Government in an area of State responsibility. The results suggest that political strategy, brought about by internal and external subsystem events, was the impetus for policy change in regard to radiation therapy services in North West Tasmania. It also found that local sentiments and a boundedly rational decision-making process added to this outcome by giving weight to the desire for a local radiation therapy service in policy decision-making rather than alternative means to deliver such a service to the patients in that region. This research was limited by geographical region, looking solely at patients who reside or resided or resided in North West Tasmania at the time of diagnosis. The research also focused on only one diagnosis type ‚Äö- cancer, in its multiple forms ‚Äö- and only on treatment, not prevention, screening or education. The research also related to public policies, without consideration of private and organisational policies that may impact on service delivery or design. The sample for interviews was limited by the opt-in nature of the patient and family recruitment strategy, meaning only those who became aware of the research and wished to participate were able to be recruited. This research applies then critically reviews the Advocacy Coalition Framework. In particular, the Framework considers the policy subsystem to comprise of two or more formal coalitions that vie for policy influence by utilising opportunities and resources. This case study identified only one coalition, and the implementation of a policy change was contrary to the objectives of that single coalition. This challenges the notion that two or more formal coalitions are required to achieve policy change and supports the hypothesis that policy remains unchanged whilst the jursidiction that instigated it remains, unless change is imposed by a hierarchically superior jurisdiction. This thesis extends our understanding of localism and the influence of policy entrepreneurs in effecting policy outcomes, in this case, the introduction of a local radiation therapy service to North West Tasmania.
Rights statementCopyright 2018 the author A paper contained in the appendices relates to discussion of bounded rationality in Chapter 6. The paper: West, S., Shannon, E., Crisp, E., Barnett, T., 2017. A recipe for success: Localism and bounded rationality in lobbying for radiation therapy services in North West Tasmania, Asia Pacific journal of health management, 12(3), 11-15, was published using a Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/)