The perinatal regionalization policy: a study in form and development

摘要

The purpose of this research was to demonstrate one way in which the analytical and creative components of policy can complement one another to provide insight for understanding emergent (developmental) and cooperative systems. As a case study, this research examined a perinatal regionalization project--a new health care delivery system--to determine how it might develop from this point in its history, i.e., what form it might take. The key questions were: how do we design a workable and significant system? How much is science; how much art? Given the emergent social nature of the system, a twofold approach was required. The first approach, analytically organized, used multiple perspectives in gathering information for policy planning and implementation. The second approach, process oriented, used a new form of Delphi as a creative, participatory decision technique to design a policy structure. Application of multiple perspectives to a prospective issue, combining them with the participatory approach of the decision Delphi and distinguishing methods appropriate for emergent policy systems were departures from previous research. Data collection involved content analysis, extensive interviewing, and participant observation. Analysis based on three perspectives, technical-rational (T), organizational (O), and personal (P), yielded distinct pictures of the emerging social technology of regionalized perinatal health care delivery. The T perspective emphasized the well-ordered approach to implementation and indicated some areas to reinforce and develop based on measured outcomes. The O perspective emphasized the network of interrelated roles, procedures, and reinforcements (sources of satisfaction). It noted junctures for making inroads into the existing system. The P perspective provided the most immediate grasp of the essential and unique world of the participants. It found that images serve as both compelling visions and forces for change characterized by this non-trivial uniqueness. Delphi found that systems structures can be generated endogenously. Analysis of the three perspectives found that each of the three requires a type of research appropriate to it. In fact, the elusive P perspective can be formulated experientially--a self-reflective type of research--and communicated creatively. Both enhance its value. Analysis also found that while the three are distinct, each adds a dimension to understanding that would be lost without it. They can be integrated as mutual contexts of each other. Analysis found that the form of communication is as important as the form of research. Non-traditional means are more appropriate. Analysis found that design considers form as system self-image, system boundary, and system control. These distinguish the new system from the old. The concept is quite different from implementation as a sequential process in policy.