How does policy alienation develop? Exploring street-level bureaucrats’ agency in policy context shift in UK telehealthcare

Abstract

Policies can fail when frontline staff feel they have limited influence on policy implementation (powerlessness) or that policy has little or no personal meaning (meaninglessness) – they become alienated from the policy – but how does this alienation develop? In this article we ask whether policy alienation might be viewed as a process that develops over time: a process that ebbs and flows, interacting with the policy landscape as it shifts, rather than a psychological state. Feelings of alienation can be shared across groups of actors, as they collectively shift and initiate change. This study uses participant observation and interviews with front-line employees as they navigate a UK government policy introducing telehealthcare to improve health management of patients with chronic conditions. We find that: (i) cumulative misalignment between different policy implementation contexts allows policy alienation to develop over time; (ii) the shared experience of alienation in co-worker groups contributes to further misalignment; and (iii) front-line staff use their discretion to respond to policy alienation, which has the power to enhance or destroy policy implementation. We offer an alternative perspective for understanding how policy alienation can be prevented and policy implementation can be enhanced.