Comparative analysis of health policy implementation:

Abstract

Documentary analysis has been widely used in the comparative analysis of health care policy implementation in England. However, the value of the method is rarely debated, and the process whereby it is carried out rarely described in detail, or justified. Documentary analysis has obvious appeal. Documents may be the only source of data at an early stage of a policy innovation. They also present none of the problems (practical, ethical, interactive) of human subjects of research, and can provide a useful supplement to data collected from human subjects by other means. However, official documents are likely to be partial or superficial, representing aspirations rather than realities. The scope for analysis is therefore limited. Analysis may also tend to be positivist in philosophy, taking at face value the ‘apparent’ meanings of texts. It will be argued in this article, however, that a more interpretative analysis is also possible, when implied assumptions or underlying ideologies are identified and discussed. Thus, in the case of policy documents in the NHS, analysis may focus on one or more of three layers of meanings: those which are overt and explicit in the document; those which reflect the rhetoric of the policy environment and the government's intentions; and, those which reflect the ideology, usually implicit, underpinning policies at local and/or national level.