There is sound evidence reporting that health inequities are globally prevalent and persistent inequities in health have resulted in repeated calls for more innovative approach towards development of healthcare policies through action on economic and social determinant of health in order to create conducting conditions for improved wellbeing, health and equity. The purpose of healthcare policy and procedures is to support standardization of routine operations and activities. According to Malone (2020) it is crucial to provide clarity while dealing with activities and issues which are vital for health and safety, regulatory requirements and legal liabilities. Policies in healthcare are of great importance as they provide a set of general plan of action which can be implemented to guide desired outcome, and is fundamental in decision making.
Sakellarides, Escoval, Barbosa, Isabel, Santos & Miranda (2019) mentioned that the underlying aim of the healthcare policy is to help employees understand their responsibilities and role within the organization and in an healthcare environment such policies set the foundation of cost effective and safe quality care. The importance of such policies is especially pertinent in case of aged care, considering the needs and fragility of their situation which increases the chance of errors. Here, the term aged refers to individuals over 65 years of age. This paper aims to critically discuss the development and implementation of health care policies, especially in case of aged care policy. In order to do, the paper focuses on the Aged Care Quality and Safety Commission’s complaints policy and illustrates the practical application of the policy development process and discusses the importance of the policy on the health of the policy target group. Moreover, the paper employs the Australian policy cycle for the analysis of policy.
The policy under consideration is the Aged Care Quality and Safety Commission’s complaints policy. This policy deals with the approach towards the management of complaints from external stakeholders regarding the services and practices. The aim of the policy is to resolve complaints about the fair practice in an efficient and effective manner (Sinclair, Field, Blake & Radoslovich, 2019). In addition to this, the policy supports and affirms recipient’s right to care, service providers, their representatives and non-government and government agencies and the members of public to complaint against the services and practices of the commission.
The said policy applies to every service delivered by the commission to external stakeholders by staff whether on contract, seconded or temporary arrangement and externally contracted assessors. However, this policy does not deal with the fees and charges, regulatory decisions and internal staff grievance and public interest disclosures about staff (Sinclair, Field, Blake & Radoslovich, 2019).
One of the main reasons for selecting this policy is the inherent importance of the policy regarding the complaints procedure. Such policies need to be patient focused and should investigate the complaints effectively and efficiently. Despite of all the efforts made by the staff members, there will be complaints made by patients at some point. In order to reduce the apprehension and anxiety for both staff and patients it is vital to have a proper procedure in place for handling complaints (Bomhoff & Friele, 2017). Not only does this facilitates a better care delivery but also provides the institution opportunities to improve its procedures.
A policy cycle is a heuristic, or guide, for development of policies and as Lingard (2016) mentioned, it brings a rhythm and system to a world which, otherwise, might appear unordered and chaotic. The policy cycle was initially proposed in by Lasswell and was later adopted by others. Bridgman and Davis formulated the Australian policy cycle in 2004 which basically conceptualized the process for developing public policies (Howlett, McConnell & Perl, 2017).
The Australian model for policy development is a useful reference model for identifying the distinct part of policy development (Prpic, Taeihagh & Melton, 2017). Moreover, it is also instructive for policy developers to understand the approach and expectations taken by their peers in the public service for the same. The model includes eight distinct steps, namely, issues identification, policy analysis, policy instrument development, consultation, coordination, decision, implementation and evaluation. Daniell, Morton & Insua (2016) stated that in the said model presents a basic framework which can be used by policy makers to undertake the thinking of and planning of the required policy. Furthermore, some steps can be skipped, compressed or reversed in practice, according to the context within which the policy is being developed. In addition to this, policy makers can also a completely different approach, but the main advantage of using this model is that it provides a starting point for the policy development, especially in the absence of any formal procedure for policy development.
For better or worse, politics, plays a prominent role in health affairs mainly due to the fact that health is inherently a political issue (Trein, 2017). Author further mentioned that public health usually involves actions from government to get results that individuals are unable or unlikely to produce on their own, such as health promotion or disease and injury prevention. Vollard & Martinsen (2017) argues that a political community emphasizes a common bond among community members and organized society protects the welfare, security and common goods of health, while its subordinate members engage in the welfare of the community.
Moreover, despite the fact that this perspective is against the fundamental emphasis on economic individualism and property rights, Millar, Jian, Mannion & Miller (2016) suggests that there are many reasons due to which health of general public and individuals is a political issue. For instance, the authors mentioned that institutional and individual action more often than not produce spillover effects and some of them are beneficial while others are not. In order to compensate for such externalities political decisions are required to impose restraints on commercial interest and individual liberties. Moreover, protection of public health entails moral judgment which acquires legitimacy through political resolution and debate. In respect on the policy development model under consideration, Pedersen & Kjaer (2017) discovered that political engagement in the policy development changes throughout the process and from policy to policy according to the priorities of the government which makes articulating a consistent approach for policy development quite difficult. This difficulty is illustrated in the report of the Auditor-General which mentioned that the overly of complex accountability and reporting requirements led to different complaints management arrangements across State and Territory Offices (STOs) (Chiapperino & Tengland, 2016).
Moreover, Delgadillo, Asaria, Ali & Gibody (2016) claimed that the common need for policy makers to respond to tight deadlines and political demands often results to an inability to adhere to the structured process. This in turn results in pre-canned or rushed policies which lack public consultation or due process. Therefore, in this manner, the said policy cycle model does not prepare policy makers in a pragmatic manner for the gravities to respond to the actualities of the policy making process in the public sector. The model was also criticized by Perry, Lomax, Taylor, Howson & McCurdy (2019) for not having much consideration towards demonstrating that the following the suggesting prescriptions leads to better results or that they are derived from practice. According to the author, health conditions turn into political problems when individuals recognize that their personal desire and needs are the same as other and through emergence of social movements, public opinions, voting or interest group mobilization they can make public officials pay attention to them. Considering the issues with aged care, social interest groups through public opinion and demonstrations force healthcare institutions to resolve their concerns which encourages government to implement a proper policy in place for addressing such problems (Sheikh et al., 2017).
In addition to this, Sepper & Roberts (2017) development of policies is quite heavily influenced by political agendas and political players which is not addressed by the Australian policy cycle. Although some policies are given to public sector for development and implementation, but most of the time policies are directed by strong political involvement with the ultimate outcomes of the development under guidance of Ministers for considerations. Moreover, the policy can also be taken to Cabinet for final modification. This suggests that even the most logical, highly researched, evidence based and widely consulted policy position can be overruled by government. The policy cycle does not prepare policy developers on how to manage this process. Fierlbeck (2016) even suggested that the most crucial aspects of a successful policy lie outside the range of Australian policy cycle, in the navigation and mapping of the public and stakeholder management, myriad political agendas and other areas of policy that compete for limited resources and prioritization.
In terms of the ethical and legal dilemmas, Resnik, MacDougall & Smith (2018) reported that traditionally, healthcare ethics primarily oriented towards individual doctors and patients, concentrating on justification for treatment decisions, their rights and their actions. This means that traditionally, ethical arguments mainly dealt with this particular professional group and assumed that doctor and patients are the only participants of the ethical considerations. Therefore the relationship between patient and doctor were approached on a case by case basis with the assistance of ethics consultation service. Cummins (2018) continued the argument and suggested that because of this main emphasis on an individual agency, ethical considerations in healthcare fails to recognize the effect of the underlying culture of the organization on the healthcare delivery. Moreover, Yung & Yu (2016) stated that this emphasis of traditional ethics on patient/doctor relationship is being supported by the contemporary health care policy development approaches. According to authors, nowadays, policy developers have to address the role of healthcare organizations, and the way moral disagreements regarding controversial medical practices. Therefore, policy developers have to understand and address not merely clinical ethics, but also ethical behaviors, problems and obligations of healthcare organizations.
One of the main aspects of policy development which grapples with ethical and legal issues is related to individual decision making. Wachs (2017) mentioned that since policies guide the process, they have to address the morally controversial problems of individual decision making which has long been discussed in ethics literature. There is a widespread consensus in society that individual adult with capacity to make decisions have the right to guide their healthcare delivery even if it is injurious to their health. This belief is based on the integrity of patient and his or her rights to make decisions that are autonomous in nature. This conflict often leads to interruptions in the relationship of the hospital and patient (Yu, 2016).
Apart from this policy writers also have to address the morally controversial practices in such a manner which meets the substantive and additional procedures and requirements (Martin, 2018). In addition to this, Fischer (2019) claimed that nutrition related public health intervention can also be challenging for policy makers to deal with, especially in the case of aged care, since such interventions can take several different forms and their goals, scope and nature can vary considerably. Also, such interventions tend to occur in different contexts, at different levels and with the collaboration of different stakeholders. Therefore, ethical and legal issues related to nutrition related public health intervention vary and cannot be generalized or equated with a specific activity.
Furthermore, another form of ethical considerations and dilemmas are related to the scarcity of resources. As Wachs (2017) mentioned, public finance always has to grapple with the relative scarcity of resources which presents a dilemma for public officials to ascertain which area of the healthcare should be prioritized. Policy writers also have to ensure ethical evaluation of policy as policies can develop in order to address a specific problem which pre-exists or to deal with a probable issue. Either way, ethical analysis needs to be undertaken to critique or and to evaluate the policies and their respective goals. Yung & Yu (2016) supported this reasoning and suggested that ethical transparency in defining and identifying goals is valuable as it facilitates the clarification of what or who must be sacrificed to realize said goals. In the absence of such ethical measures it is possible for policies to have an opposite effect and adversely impact the welfare of affected personnel (Resnik, MacDougall & Smith, 2018).
Therefore it can be said that the relationship between policy development and ethics is complex. While developing a policy which will eventually affect the health of a large population, one also needs to ensure that the drive behind the development and implementation of policy is not shaped by economic or political agendas. Ethicists can also play the role of an honest broker by facilitating the identification of the values and voices of both, who are present and those who are not. Fischer (2019) further suggested that while there are dangers in mixing ethics and policy, such dangers are outweighed by the dangers of not engaging in the same. Although there is no need for some major role of ethicists in the development of healthcare policies, but at the same time they should not be absent form the discourse.
It has been identified that the sustainable development goal of the United Nations 2030 is to enhance the health ration of people throughout the world without any inequality. Improving health as well as reducing health inequity is very important for the United Nation to fulfill their sustainability goal in the year 2030 (Ekmekci, 2017). Multiple sustainable development goals play a crucial role in determinant he health. If the government is able to achieve these goals then it will directly or indirectly impact the health and wellbeing of individuals without any discrimination. It has been discovered that in order to improve, child development, decent work, social protection and fair employment plays a significant role in affecting the wellbeing and health of an individual (Bazyar, Yazdi-Feyzabadi, Rahimi & Rashidian, 2020).
If the government wants to implement its policies more effectively and efficiently it has to make that all the people are treated as one, because of they are not treated as one the polices will shatter. These policies might seems very insignificant but it can surely help the under privileged people of the society. It has been identified that these particular policies have a positive impact on an individual. These policies have come in as a ray of hope for the people that were treated as an outcast (Quilty et al., 2019). The main reason why these policies are effective is because of the fact, that these policies have helped the disadvantaged groups of society to stand, neck to neck with the people who once looked down upon them. These polices have impacted the society positively, because of which the discrimination faced by these particular groups have dropped down significantly, giving them a right to enjoy the same privilege that might have been enjoyed by their different peers or other people of the society. The biggest change these policies have made for the underprivileged group of the society is that they can enjoy the feeling of belonging (Riosmena, Kuhn & Jochem, 2017).
The united nation sustainable goal of 2030 majorly focuses on the health and wellbeing of all the individuals throughout the world. If the United nation is achieve this particular goal than it is pretty sure that they indifference that has been faced by some of the groups can be easily minimized. In the previous years the under privileged people had to face a lot of hardships due to which they were deprived of their common rights, some of the famous examples can be determined from the colonial era, or when the black people in United states were treated as slaves (Fletcher, 2019). During those hard times there were no policies regarding, health, age or even social problems that might be incorporated and help the safeguard the humanity that was lacking in that particular era. However, with the advent of the new Era and the formation of the United Nations things have changed drastically and every person is treated equally (Gaffney, Rast & Hogg. 2018). Although, it will still take some time to implement the said polices completely, but it is quite sure that the when the United Nations is able to spread equality throughout the world, everything will change for good.
In conclusion, healthcare policy strives to help employees understand their responsibilities and role within the organization and in an healthcare environment such policies set the foundation of cost effective and safe quality care. Such policies are especially pertinent in case of aged care, considering the needs and fragility of their situation which increases the chance of errors. Moreover, the analysis of the Aged Care Quality and Safety Commission’s complaints policy in respect of the Australian policy cycle suggests that most crucial aspects of a successful policy lie outside the range of Australian policy cycle, in the navigation and mapping of the public and stakeholder management, myriad political agendas and other areas of policy that compete for limited resources and prioritization. In addition to this, relationship between policy development and ethics is complex.
While developing a policy which will eventually affect the health of a large population, one also needs to ensure that the drive behind the development and implementation of policy is not shaped by economic or political agendas. Although there is no need for some major role of ethicists in the development of healthcare policies, but at the same time they should not be absent from the discourse. In addition to this, sound development and implementation of public policies can ensure that disadvantaged groups of society can stand, neck to neck with the people who once looked down upon them. These polices can impact the society positively, because of which the discrimination faced by these particular groups have dropped down significantly, giving them a right to enjoy the same privilege that might have been enjoyed by their different peers or other people of the society.
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