Beleidsvervreemding in de gezondheidszorg | Amsterdam University Press Journals Online
Volume 28, Issue 3
  • ISSN: 0169-2216
  • E-ISSN: 2468-9424


Policy alienation in the health sector. Professional experiences of midwifes and sonographers

Policy alienation in the health sector. Professional experiences of midwifes and sonographers

A number of developments – such as increased performance measurement and new governmental policies – put pressure on employees working in the public sector. In this article, we examine pressures healthcare professionals experience during the implementation of the 20-weeks ultrasound policy (structural ultrasound policy). We use an interdisciplinary approach. From public administration literature, we draw on the policy alienation concept, which consists of five dimensions: strategic powerlessness, tactical powerlessness, operational powerlessness, societal meaninglessness and client meaninglessness. These are considered as factors that influence the behavioural support for a policy, based on the concept of ‘behavioural support for a change’, drawn from the change management literature. We test this model using survey data collected among 780 Dutch midwives implementing the 20-week ultrasound policy. Both meaninglessness dimensions proved highly significant, whereas strategic and tactic al powerlessness were found not significant. We conclude that clarifying the value of the policy is important in getting professionals to willing implement a policy, whereas their participation on the strategic or tactical levels seems less of a motivational factor. These insights help in understanding why public professionals embrace or resist the implementation of particular policies.


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