Between crisis and reform: developing a causal mechanism of Indonesian healthcare reform with process tracing

This article explains the failure of two long‐term care (LTC) reforms attempted between 2005 and 2019 in Poland, and driven by policy entrepreneurs—individuals with a personal understanding of the challenges faced by LTC and determined to initiate policy change in the domain. The article inductively identifies the ‘outsider policy entrepreneur’ mechanism of policy reform. LTC in Poland is a negative case (or breakdown) of this mechanism, which occurs when a policy entrepreneur has enough political influence to initiate a formal reform proposal, but not enough to convince decision‐makers to adopt it. The article combines an examination of the role of policy entrepreneurs in social policy change with an analysis of their interactions with domestic and foreign epistemic communities. Through showing how ‘foreign’ policy models are used by policy entrepreneurs to pursue domestic reform, the study contributes to the literature on transnational policy diffusion/transfer. The analysis is based on document analysis and 16 semi‐directed expert interviews, which were used to process trace the explained outcome (failed reforms). The article concludes that the mechanism failures were due to the fact that involved policy entrepreneurs did not convince decision‐makers of the need to reform LTC. Specifically, the contribution identifies two features of the political context in illiberal post‐transition polities that interrupt the persuasion efforts of outsider policy entrepreneurs—the impossibility of inter‐partisan cooperation and continuity, and the declining role of Western policy models as catalysts for change.

ABSTRACTThis article maps the methodological debate on process tracing and discusses the diverse variants of process tracing in order to highlight the commonalities beyond diversity and disagreements. Today most authors agree that process tracing is aimed at unpacking causal and temporal mechanisms. The article distinguishes two main types of use for process tracing. Some are more inductive, aimed at theory building (i.e. at uncovering and specifying causal mechanisms) while others are more deductive, aimed at theory testing (and refining). The paper summarizes the main added value and drawbacks of process tracing. It ends by providing ten guidelines for when and how to apply process tracing.

El siguiente artículo proporciona una revisión bastante detallada en lengua española del método de rastreo de procesos para su aplicabilidad en las áreas de la Ciencia Política y las Relaciones Internacionales a partir de la revisión de la bibliografía científica más relevante que ha sido escrito en su mayoría en inglés. El trabajo inicia con la conceptualización del método del process tracing a partir de la revisión de sus principales definiciones diferenciándolas de otro tipo de debates metodológicos. Posteriormente, profundiza en las diferentes variantes que se pueden asumir conforme a los objetivos y preguntas de investigación dentro del método. La base fundamental de este artículo se encuentra en la comprensión del mecanismo causal, las variantes teóricas y empíricas conforme a los objetivos y preguntas de investigación, las pruebas de evidencia y las entradas deductivas e inductivas. Adicionalmente, el artículo aborda a partir del enfoque social constructivista el rastreo de procesos, en donde, se resalta el uso de las entrevistas especializadas como una técnica para reconstruir el proceso por medio de fuentes primarias. Finalmente, el artículo concluye extrapolando las lecciones más relevantes que el uso de este método nos puede dejar.

Nurses challenging to terminate irrelevant treatment prior to end of life patient

PurposeThis paper examines cases of multiculturalism in Singapore and Malaysia. Through causal sociocultural mechanisms, the authors observe how two countries in proximity, with shared histories and demographic profiles, achieve differing outcomes in regard to social cohesion and competitiveness.Design/methodology/approachThe paper employs case-centric process tracing (CPT) to build a “plausible” explanation of causal mechanisms that can contribute to social cohesion and competitiveness. The authors adopt a common analytical framework to distil the nuances of generalizability and a cross-case analysis in order to ascertain factors that enable multiculturalism.FindingsDifferent causal mechanisms result in diverging outcomes in the two countries. In managing multiculturalism, Singapore has pursued policy actions emphasizing “integration and pragmatism,” while Malaysia has followed a model of “separation and preferentialism.” Judging by a selected number of established indicators, Singapore's multiculturalism outcomes seem more successful than that of Malaysia in respect to areas of national competitiveness and interethnic tolerance.Practical implicationsThis paper sheds insights on the policy actions that promoted multicultural integration. The process tracing approach is found to be a useful tool in helping policymakers understand how intrinsic mechanisms can contribute to more/less desirable socioeconomic outcomes.Originality/valueTogether with the evidence using the CPT approach, the paper draws attention to multiculturalism evolving through distinctive sets of public policy. The authors ultimately suggest that such policies can be paralleled to the function played by institutions in leading to “varieties of capitalism” and have an impact on achieving cohesive and competitive societies.

This paper examines what factors are associated with the 2015 pension reform of Korean civil servant as social innovation. We explore what lessons we can learn from the pension reform in terms of the Advocacy Coalition Framework (ACF) model. The ACF model allows us to identify how the substantial reform is, relying on policy knowledge and entrepreneurs, possible in terms of political and social consensus. It also clearly demonstrates the possibility of systematic pension reform at an appropriate level through social learning and policy learning. Through the ACF model, we review how South Korea’s civil servant pension reform act occurred at the end of May 2015. The temporal scope covers from 2009 latest reform, and the 2014’s President administrative policy speech that had strongly been showed her will to reform the pension issue to the end of May 2015 when the reform bill enacted. We investigate each advocacy coalition in order to elucidate the actors that constitute the two coalition groups and to scrutinize whether a policy broker had existed in the process. We also attempt to find the relatively stable parameters and external events that affected the reform and also the belief system that shared by two advocacy coalition group. The result clearly shows that the two coalition groups shared their normative beliefs ultimately, for example, the need to change the current civil servant’s pension system, but, the gap in the numerical change in the policy core belief and secondary belief between the two actors had seemed to be excessively large and uncompromising. A policy broker who can coordinate the interests and interests of stakeholder groups over the government pension reform proposal was desperately needed. Negotiation and leadership of the policy entrepreneurs led to a settlement of the government pension reform proposal at the end of May 2015. Their entrepreneurial activities led to an appropriate level of social consensus on the sustainable reform of pension system through policy knowledge and learning. Further research is required to explore how models of socially innovative forms of governance are created in various pension reforms across various countries. It is also required to examine how policy entrepreneurs use policy knowledge and information for a successful institutional reform through social innovation across various countries.

Process tracing (PT) is a case study method that enables scholars to study how causal processes (also known as causal mechanisms) play out in real-world cases. Despite the increasing popularity of the method in international studies, there is still considerable disagreement among scholars about how to understand the process actually being traced and how these processes can be studied empirically. This article tries to bring clarity to these disagreements by arguing that there is not one correct variant of PT, but instead several distinct variants of PT methods that differ based on the positions scholars take on what is being traced and how it can be traced. First, some scholars work with simple, abstract (minimalist) process theories, whereas others disaggregate process theories into parts composed of actors engaging in activities. Second, some scholars contend that inferences that assess the difference that a process makes for outcomes can only be made through controlled comparisons of cases. Others posit that we should study processes through the empirical traces left by their operation within cases. Finally, there are scholars who contend that causal processes in international studies involve social actors, meaning that more interpretive methods should be combined with more traditional PT. The article illustrates how different variants of PT have been used in published work within international studies, followed by a discussion of key challenges with using PT methods.

Comparative Methods and Process Tracing

This article examines the role of policy entrepreneurs in countering regulatory capture, a phenomenon whereby regulatory bodies influenced by industry lobbying often prioritize private over public interests. The study employs an abductive process‐tracing approach to investigate the 2013 drug pricing reform in Morocco, illustrating how substantial policy shifts can occur even in authoritarian contexts susceptible to regulatory capture. The findings underscore the pivotal role of Houcine El Ouardi, the former Minister of Health, whose strategic leadership exemplified policy entrepreneurship. His capacity to navigate and surmount industry resistance was instrumental to the reform's success, culminating in a significant reduction in drug prices. This case challenges conventional wisdom regarding regulatory capture, demonstrating that individual agency can reshape regulatory outcomes despite opposition. By elucidating how policy entrepreneurs can drive transformative change in resistant regulatory environments under authoritarian regimes, the study contributes to the literature on policy entrepreneurship and regulation.

Process tracing represents the empirical core of many, if not most, case studies because inferences on causal mechanism and processes often are at the heart of small-n research (Mahoney 2007a, 2007b). The literature on process tracing and mechanisms burgeoned over the last years and contributed to the improvement of causal inference in within-case analyses. As I explain in Chapter 8, however, many of the inferential issues dealt with in the context of process tracing fully extend to cross-case analysis. A discussion of tools, such as Bayesian inference, with an exclusive focus on process tracing therefore misrepresents the potential of these instruments. For this reason, I reserve a consideration of many aspects that one knows from the process tracing literature for Chapter 8 as this chapter takes a view on causal inference that covers cross-case and within-case analysis alike.KeywordsForeign Direct InvestmentCausal InferenceForeign RelationCritical JunctureDomestic GovernmentThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

A key mission of many applied linguists is to understand how language-related processes work. The inner workings of a process can be explained by theorizing about the underlying causal mechanism that enables the process to unfold and evidencing the mechanism with empirical material. However, the methodological repertoire of applied linguistics is limited in this regard. Thus, we step outside of our field-specific literature and showcase Process Tracing, a family of qualitative, within-case research methods often used in political science to trace causal mechanisms. We describe Process Tracing's key tenets that are applicable to most variations. We then refer specifically to the systems understanding of Process Tracing. This variation views mechanisms as systems with interlocking parts. Each part is theorized to transmit causal force from a hypothesized cause to an outcome. Our concentrated focus enables us to provide specific recommendations for researchers looking to maximize the method's practical explanatory power without over-formalizing its procedures. As such, our coverage bridges the gap between broad introductions to Process Tracing currently available in applied linguistics and an increasingly technical literature found elsewhere. We also provide a preliminary state-of-the-art review of studies that have claimed to use Process Tracing in applied linguistics, often to very different ends. Finally, we demonstrate how we have applied the systems understanding of Process Tracing in one of our own studies as a methodological exemplar. We conclude with a call for researchers to explore the affordances of Process Tracing alongside us as we adapt it for future use in applied linguistics.

Complex health system questions often have a case study (such as a country) as the unit of analysis. Process tracing, a method from policy studies, is a flexible approach for causal analysis within case studies, increasingly used in applied health research. The aim of this study was to identify the ways in which process tracing methods have been applied in health research, and provide insights for best practice. We conducted a systematic scoping review of applied studies purporting to use process tracing methods in health research contexts. We examined the range of studies and how they conducted and reported process tracing. We found 84 studies published from 2011 to 2023. Studies were categorised into two groups: those with greater methodological description (n=19 studies) and those with less methodological description (n=65 studies). A majority of studies were focused on public health and health policy with around half of studies focused on low and middle income countries. Of those 19 studies that provided greater methodological description eight studies featured four areas of good practice: (1) reporting the development of a mechanistic theory and making it explicit; (2) linking empirical material collected to the mechanistic theory; (3) clearly presenting the causal mechanism tracing; and (4) reporting how consideration of counterfactuals or evidence of alternatives within the study were analysed in practice. The review demonstrates the rapid take-up of process tracing to generate theory and evidence to support a better understanding of causal mechanisms in complex health research. To support future studies in conducting and reporting process tracing, we provide emergent recommendations.

As economic activity in marine environments accelerates and expands, conflicts may increase following increased demand over marine resources, unequal distribution of benefits, as well as fluctuating resource availability and quality due to climate change. Anticipation and resolution of these conflicts require understanding of the causal mechanisms through which they originate and persist. Process tracing is a promising social science method that allows producing this knowledge by sequentially ordering events that produce conflict. The aim of this paper is to introduce process tracing as a method for the study of conflicts over marine environments and to assess how the method so far is used in previous studies of conflicts over marine environments. Our review of these studies reveals that scholars of conflicts over marine environments tend to apply process tracing using a deductive approach and a probabilistic understanding of causal mechanisms. The causal mechanisms that are identified to understand the dynamics that drive conflicts over marine environments often include power dynamics between states, institutions, movements or communities. Less articulated is how local social dynamics drives conflicts and how scholars select their cases to represent a wider population of conflicts. We conclude that applying a micro-sociological approach, more attention to case selection, and the interaction between contexts and mechanisms are promising ways forward for further use of process tracing in maritime studies.

Process tracing is an in-depth within-case study method used in the social sciences for tracing causal mechanisms and how they play out within an actual case. Process tracing can be used to build and test theories of processes that link causes and outcomes in a bounded population of causally similar cases, in combination with comparative methods, or, when used in a more pragmatic fashion, to gain a greater understanding of the causal dynamics that produced the outcome of a particular historical case. The strength of process tracing is that detailed knowledge is gained through the collection of within-case, mechanistic evidence about how causal processes work in real-world cases. Process tracing enables only within-case inferences to be made, making comparative methods necessary to enable inferences to causally similar cases. Comparisons make generalization possible because we can then claim that as a set of other cases are causally similar to the studied one, we should expect similar mechanisms to also be operative in these cases. Process tracing as a method can be broken down into three core components: theorization about causal mechanisms linking causes and outcomes, the development and analysis of the observable empirical manifestations of the operation of parts of theorized mechanisms, and the complementary use of comparative methods to enable generalizations of findings from single case studies to other causally similar cases.

The purpose of the research is to study the survival strategies of small and medium-sized businesses within the framework of the state policy in conditions of uncertainty, including in crisis situations. Methodology. Qualitative and quantitative research methods were used to conduct this study. To analyze the state policy regarding small and medium-sized businesses and their adaptation to new conditions in Kazakhstan, this study uses the method of primary and secondary data research. The primary data were obtained during an online sociological survey among representatives of small and medium-sized businesses of the Karaganda region. The survey was conducted using the Google Forms tool, which was attended by 287 entrepreneurs of micro, small and medium-sized businesses. The purpose of the survey was to study measures of state support, the consequences of the pandemic and strategies for the survival of SMEs, as well as to assess the understanding of SMEs of state policy in relation to them. Secondary data are obtained from open sources:statistical data of state bodies, international organizations. The advantages of the chosen research strategy are the possibility of conducting a comprehensive analysis of both the state strategy in relation to entrepreneurship and the adaptation of business in conditions of uncertainty. Originality / value of the research. Small and medium-sized businesses implement socially signifi cant functions for the economy. The results of this study can fi nd their application in the improvement and transformation of state policy in the fi eld of entrepreneurship support. Findings. Within the framework of this study, an analysis of the current situation of state policy in the field of entrepreneurship is presented. In the course of conducting a sociological survey among SMEs, the main di ffi culties of doing business during the pandemic were identifi ed, as well as the main survival strategies within the framework of state policy were presented. Recommendations are given regarding the emphasis of the policy on encouraging and stimulating the introduction of digitalization of SMEs.