Today’s post is by Chloe Duncan from the Public Service Research Group, UNSW Canberra, and it explores how the personal identity and experiences of policy practitioners and service providers can inform their practice in profound ways. Based on PhD research into the implementation of breastfeeding policy in Victoria, it suggests that the ability to draw on multiple perspectives, both professional and personal, can allow policy implementers to overcome significant challenges in their work by devising creative and innovative solutions to problems.
Policymakers and researchers are constantly confronted with the problem of understanding how policy can be more effectively implemented. This is especially the case in contemporary policymaking environments where responsibility for implementation is decentralised and fragmented, and implementation is often led by non-governmental actors. My research into policy implementation in the Victorian breastfeeding sector suggests that the dispersal of responsibility for policy tasks between different types of professionals can actually be a rich source of innovation and creativity. In the Victorian breastfeeding sector, the ability to draw on multiple perspectives, both professional and personal, allowed policy implementers to overcome significant challenges in their work.
In Australia, breastfeeding policy and its implementation is decentralised, dispersed across several levels of governments, and across different sectors. The Commonwealth Department of Health monitors and coordinates implementation activities undertaken by state and territory governments, statutory agencies, health services, industry bodies, professional associations and colleges, community organizations, peak bodies, universities and research centres, businesses and workplaces, and children services.
On top of this, implementers do not implement a single policy, and are instead guided by an amalgam of different documents as the ‘policy’ guiding development of breastfeeding services. Additionally, implementers reported having a lack of funds to implement more effective breastfeeding services, and sometimes a lack of organisational support or interest.
Despite all these obstacles, they were able to develop creative ideas which allowed them to implement new or better breastfeeding services in a fragmented and under-funded service delivery environment. How were they able to do this?
A key part of the puzzle was that successful implementers of breastfeeding were highly motivated individuals, and worked proactively to improve services. When it came to improving services, however, participants in my research described getting ideas about how to go about this from their experiences acting out of several roles at once.
For instance, one participant worked as a paediatric obstetrician, and because of her interest in infant nutrition became interested in breastfeeding. She then trained as a lactation consultant, and her new understanding of the importance of breastfeeding brought her to the conclusion that she should establish a breastmilk bank at the maternity hospital where she worked as a paediatrician. Since then, the draft of the upcoming National Strategyhas recognised milk banks as an important intervention in supporting breastfeeding.
The roles participants shifted between were not always formalised. In describing what had given them their ideas about how to improve breastfeeding services, almost all participants talked about how they had left their jobs to have a baby, and suffered through the difficulties of breastfeeding. Later, when they returned to their jobs, they would look at their role with new eyes. While trying to solve problems on the job, they would look at the tasks they had to perform as if they were a mother using the service. They would think of what they had wanted or needed when they were using breastfeeding services, and while actingas a professional they would thinkas if they were a service user. Participants were able to develop a whole range of new approaches to how they delivered services while juggling multiple perspectives.
One midwife recounted being confronted with a mother struggling to get her baby to latch. This participant had also been trained as a lactation consultant, and so she drew on her skills in that field to help the mother position her baby at the breast. However, she not only drew on her lactation consultancy skills, but also the worldview and specific form of patient focus specific to lactation consultancy. While midwives focus very much on mothers as their patients, with the baby as an important but secondary consideration in their work, lactation consultants focus on the mother-baby dyad – the mother and baby considered as a single unit. Using this different patient focus led the participant to perform tasks to comfort the baby as much as the mother when trying to improve the child’s latch.
A different participant faced the same problem of a baby being unable to latch – but she instead thought back to her own experiences as a mother struggling with breastfeeding. This second participant remembered the intense emotional difficulties associated with being unable to breastfeed, and focused on emotionally supporting her patient. She described her medical role as being much more about “ticking the box” – checking off a list of tasks she had to perform – and she had “absolutely enhanced” her practice by shifting her focus to be more about counselling, listening, questioning, and understanding patients’ emotions. By listening to her patient’s emotional struggles, this participant helped reduce her patient’s stress, which in turn helped her with breastfeeding. These two examples show how the same problem can attract different – but equally successful – solutions to the same problem, depending on implementers’ different perspectives.
Being able to draw on multiple perspectives clearly represents a rich source of creativity in solving policy problems in the Victorian breastfeeding sector. How can people working in other sectors use equivalent techniques to spur innovation – potentially even where they may not themselves work in multiple roles at once?
One answer is that everyone working in policy development and implementation has another perspective to draw on – that of a service user. All of us, every day, use infrastructure and services that exist because of public policies being implemented. One way in which people involved in developing and implementing policy can draw on the creativity inherent in seeing from multiple perspectives is to consider how they felt using policy-driven infrastructure and services – what problems they had, how they were inconvenienced, and how they were helped.
A second way to potentially draw on the creativity inherent in multiple perspectives is to engage with colleagues and stakeholders in a way that really invites their perspectives into our work. For instance, when working with a colleague from another sector or professional group, it could be worthwhile to invite them to consider policy tasks from their perspective. In the first place, a colleague could be asked whether, from their point of view, there is even a problem that requires a solution in policymaking. They could also be asked how they could address the problem; who the primary user or client of services would be; what the value of addressing the problem would be; and so on.
While it’s easy to imagine that the answers to these questions would be answered consistently across different groups, my research indicated that assuming an identity changes how we think about policy problems, including how we can implement programs to fix them. Often these changes in viewpoint are subtle or unconscious, and can’t be accessed without some effort. The effort is worthwhile, however, as shifting between these multiple perspectives may offer the opportunity to develop better ways of implementing public policies, even in constrained and difficult policymaking environments.