Implementation Of Local Strategies Research Articles

Health care providers' communication with pediatric patients and carers: a best practice implementation project.

Health care providers need a high level of communication skills in dealing with pediatric patients and their carers. The objective of this project was to evaluate current practice and implement best practices promoting health care provider communication with pediatric patients and carers in a children's hospital in Tabriz, Iran. This project used the JBI Model of Evidence-Based Healthcare, which guided the conceptualization of evidence implementation, context analysis, project implementation, and evaluation of outcomes using evidence-based quality indicators. An audit and feedback strategy was adopted to measure baseline compliance with best practices, develop strategies to address areas of non-compliance, and conduct a final audit to measure any changes in compliance. Four criteria were developed for the baseline and follow-up audits. Criteria 1 and 2 were evaluated using a sample of 30 health care providers, while Criteria 3 and 4 were evaluated using a sample of 80 pediatric patients and carers. All four criteria improved at the end of the project. Criterion 1 (health care staff receive communication skills training) had the highest mean score at baseline and follow-up (63% and 83%, respectively). Criterion 2 (implementation of local strategies by health care organizations) increased from 45% to 55%. However, this rate of improvement was the lowest of all the criteria. Criterion 3 (pediatric patients receive relevant education) improved from low to moderate, rising from 18% to 49%. A more significant improvement was noted for Criterion 4 (parents receive relevant education), which rose from 19% to 56%. The strategies implemented in this project successfully improved health care provider communication with pediatric patients and their carers. To ensure project sustainability, repeat audits will be conducted after 3, 6, and 12 months. http://links.lww.com/IJEBH/A199.

A Community Needs Assessment and Implementation Planning for a Community Exercise Program for Survivors of Stroke: Protocol for a Pilot Hybrid Type I Clinical Effectiveness and Implementation Study.

Physical activity and exercise are important aspects of maintaining health. People with mobility impairments, including survivors of stroke, are less likely to exercise and at greater risk of developing or worsening chronic health conditions. Increasing accessible, desired options for exercise may address the gap in available physical activity programs, provide an opportunity for continued services after rehabilitation, and cultivate social connections for people after stroke and others with mobility impairments. Existing evidence-based community programs for people after stroke target cardiovascular endurance, mobility, walking ability, balance, and education. While much is known about the effectiveness of these programs, it is important to understand the local environment as implementation and sustainment strategies are context-specific. This study protocol aims to evaluate community needs and resources for exercise for adults living with mobility impairments with initial emphasis on survivors of stroke in Richland County, South Carolina. Results will inform a hybrid type I effectiveness and implementation pilot of an evidence-based group exercise program for survivors of stroke. The exploration and preparation phases of the EPIS (Exploration, Preparation, Implementation, and Sustainment) implementation model guide the study. A community needs assessment will evaluate the needs and desires of survivors of stroke through qualitative semistructured interviews with survivors of stroke, rehabilitation professionals, and fitness trainers serving people with mobility impairments. Additional data will be collected from survivors of stroke through a survey. Fitness center sites will be assessed through interviews and the Accessibility Instrument Measuring Fitness and Recreation Environments inventory. Qualitative data will be evaluated using content analysis and supported by mean survey results. Data will be categorized by the community (outer context), potential participants (outer context), and fitness center (inner context) and evaluate needs, resources, barriers, and facilitators. Results will inform evidence-based exercise program selection, adaptations, and specific local implementation strategies to influence success. Pilot outcome measures for participants (clinical effectiveness), process, and program delivery levels will be identified. An implementation logic model for interventions will be created to reflect the design elements for the pilot and their complex interactions. The study was reviewed by the institutional review board and exempt approved on December 19, 2023. The study data collection began in January 2024 and is projected to be completed in June 2024. A total of 17 participants have been interviewed as of manuscript submission. Results are expected to be published in early 2025. Performing a needs assessment before implementing it in the community allows for early identification of complex relationships and preplanning to address problems that cannot be anticipated in controlled effectiveness research. Evaluation and preparation prior to implementation of a community exercise program enhance the potential to be successful, valued, and sustained in the community. DERR1-10.2196/55432.

A Baker's Dozen of Top Antimicrobial Stewardship Intervention Publications in 2022.

Keeping abreast of the antimicrobial stewardship-related articles published each year is challenging. The Southeastern Research Group Endeavor identified antimicrobial stewardship-related, peer-reviewed literature that detailed an actionable intervention during 2022. The top 13 publications were selected using a modified Delphi technique. These manuscripts were reviewed to highlight actionable interventions used by antimicrobial stewardship programs to capture potentially effective strategies for local implementation.

Application of Participatory Ergonomics to the Dissemination of a Quality Improvement Program for Optimizing Blood Culture Use.

Blood cultures are overused in pediatric ICUs (PICUs), which may lead to unnecessary antibiotic use and antibiotic resistance. Using a participatory ergonomics (PE) approach, the authors disseminated a quality improvement (QI) program for optimizing blood culture use in PICUs to a national 14-hospital collaborative. The objective of this study was to evaluate the dissemination process and its impact on blood culture reduction. The PE approach emphasized three key principles (stakeholder participation, application of human factors and ergonomics knowledge and tools, and cross-site collaboration) with a six-step dissemination process. Data on interactions between sites and the coordinating team and site experiences with the dissemination process were collected using site diaries and semiannual surveys with local QI teams, respectively, and correlated with the site-specific change in blood culture rates. Overall, participating sites were able to successfully implement the program and reduced their blood culture rates from 149.4 blood cultures per 1,000 patient-days/month before implementation to 100.5 blood cultures per 1,000 patient-days/month after implementation, corresponding to a 32.7% relative reduction (p < 0.001). Variations in the dissemination process, as well as in local interventions and implementation strategies, were observed across sites. Site-specific changes in blood culture rates were weakly negatively correlated with the number of preintervention interactions with the coordinating team (p = 0.057) but not correlated with their experiences with the six domains of the dissemination process or their interventions. The authors applied a PE approach to disseminate a QI program for optimizing PICU blood culture use to a multisite collaborative. Working with local stakeholders, participating sites tailored their interventions and implementation processes and achieved the goal of reducing blood culture use.

Burden of neglected tropical diseases and access to medicine and diagnostics in Ethiopia: a scoping review

BackgroundMore than 1.7 billion people are affected by neglected tropical diseases (NTDs) worldwide. Forty percent of the NTD-affected people live in Africa with the poorest, most vulnerable, and hard to reach geographical areas. The NTDs cause significant social and economic burden and deepen marginalization and stigmatization. The World Health Organization’s current roadmap for NTD aims to prevent, control, eliminate, or eradicate 20 tropical diseases. Ethiopia experiences a high burden of these diseases, but current access to diagnostics, medicine, and/or care has been little explored to inform the country’s NTD strategic plan. The overall purpose of the scoping review was to map and characterize the burden of NTDs and challenges in access to diagnostics, medicine, and/or care in Ethiopia.MethodsA systematic search of evidence was conducted in PubMed, Cochrane Library, and Google Scholar from January 2000 until May 2022, without restrictions of language or study design. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review was followed for screening of studies. Key findings were extracted and narrated qualitatively.ResultsThe search resulted in 4532 articles, of which 105 met the inclusion criteria and were included in the scoping review under three themes: burden of NTDs, access to diagnostics, medicine and/or care, and key barriers. Although gains have been made in the prevention and control of NTDs in Ethiopia, the burden remains high, and progress in access to diagnostics, medicine/drugs, and/or care is very slow. Poverty, poor quality of life, and underfunding of NTD programs decelerate the process of NTD elimination program in the country.ConclusionsThe scoping review identified a considerable number of studies on the burden of NTDs in Ethiopia and strategies for diagnosis, treatment, and/or care; however, there is a paucity of evidence on the suitability and potential benefits of novel diagnostic technologies and medicines in the country. A regular review and analysis of such country-level evidence is important to inform the country NTDs roadmap and local implementation strategies.

Future Directions for HIV/HCV Care: Lessons Learned From Local Evaluation Projects in Texas and Connecticut and Implications for Practice and Health Promotion.

The Health Resources Service Administration (HRSA) Special Projects of National Significance (SPNS) project titled "Curing Hepatitis C among People of Color Living with HIV," funded two sites, University of Texas (TX) San Antonio and Yale University School of Medicine in Connecticut (CT) to explore barriers and facilitators towards achieving HCV cure in the era of curative DAAs for HCV in different local contexts. Through individualized approaches that study patient, provider and system level barriers, the nine articles in this Focus Issue highlight key themes that are important in designing local implementation strategies that will enable achievement of HCV elimination goals in priority populations.

Balancing global corporate sustainability engagement in asymmetric markets: The Coca-Cola Co. case

Motivated by the changes in the understanding and the growing importance of sustainability engagement among companies, investors, and societies, this paper has for objective to understand how a multinational corporation adjusts its sustainability engagement to different cultures, institutions, and market realities as this topic becomes imperative through the triad Environment, Social, and Governance (ESG) responsibilities. To that end, a qualitative case study of The Coca-Cola Company was used as the basis for this research. The methodology chosen supported the analysis of a situation where an international company operating in different markets must implement a balanced approach in order to fulfill its asymmetries. One important finding was that ESG implementation depends on local resources, which may lead to further asymmetries instead of increased global balance. Another result presented is a model that helps identify essential corporate sustainability issues for defining the strategies, targets, and plans for global, local, and individual levels that may be used by researchers and practitioners alike. This model shall be refined and improved by future research with other organizations that operate globally and must adjust their corporate sustainability strategy according to the United Nations' Sustainable Development Goals while using local implementation strategies aligned with the national institutional realities of the different countries.

A Baker's Dozen of Top Antimicrobial Stewardship Intervention Publications for Hospitalized Patients in 2021.

Keeping abreast of the antimicrobial stewardship-related articles published each year is challenging. The Southeastern Research Group Endeavor (SERGE-45) identified antimicrobial stewardship-related, peer-reviewed literature that detailed an "actionable" intervention among hospitalized populations during 2021. The top 13 publications were selected using a modified Delphi technique. These manuscripts were reviewed to highlight "actionable" interventions used by antimicrobial stewardship programs in hospitalized populations to capture potentially effective strategies for local implementation.

Because how we talk matters: using action inquiry to nurture a coaching culture

ABSTRACT This account explores the experience of an action inquiry approach to develop a coaching culture within a public service organisation. We position action inquiry as a fresh interpretation of action learning that draws on a variety of roots and traditions and focuses on the nurturing of the collective capacity to lead through everyday interactions. Working with an initial core group of staff, we expanded our reach through an iterative process to intentionally bring more people into the work. We show how we adapted our original plans to respond to the COVID pandemic, the use of stories to propel inquiry and playback insights into the inquiry process, how we deepened inquiry in some settings and how ultimately being online was an opportunity to connect people across a system that we had not anticipated. We share insights into the commissioning process and of the importance of internal sponsorship. It concludes with a striking, participant-led call to approach scaling differently by supporting the co-creation of local implementation strategies and sponsor confidence in the case to use this approach in more circumstances, where participants in action inquiry explore, rather than assume, what the organisation and its staff need.

German translation and pre-testing of Consolidated Framework for Implementation Research (CFIR) and Expert Recommendations for Implementing Change (ERIC)

BackgroundImplementation frameworks may support local implementation strategies with a sound theoretical foundation. The Consolidated Framework for Implementation Research (CFIR) facilitates identification of contextual barriers and facilitators, and the Expert Recommendations for Implementing Change (ERIC) allows identifying adequate implementation strategies. Both instruments are already used in German-speaking countries; however, no standardised and validated translation is available thus far. The aim of this study was to translate the CFIR and ERIC framework into German, in order to increase the use of these frameworks and the adherence to evidence-based implementation efforts in German-speaking countries.MethodsThe translation of the original versions of the CFIR and ERIC framework was guided by the World Health Organisation’s recommendations for the process of translating and adapting both conceptual frameworks. Accordingly, a four-step process was employed: first, forward translation from English into German was conducted by a research team of German native speakers with fluent knowledge of the English language. Second, a bilingual expert panel comprising one researcher with German as his mother tongue and expert command of the English language and one English language expert and university teacher reviewed the translation and discussed inconsistencies with the initial translators. Third, back-translation into English was conducted by an English native speaking researcher. The final version was pre-tested with 12 German researchers and clinicians who were involved in implementation projects using cognitive interviews.ResultsThe translation and review process revealed some inconsistencies between the original version and the German translations. All issues could be solved by discussion. Central aspects of the items were confirmed in 60 to 70% of the items, and modifications were proposed in 30% of the items. Finally, we revised one CFIR-item heading after pre-testing. The final version was given consent by all involved parties.ConclusionsNow, two validated and tested implementation frameworks to guide implementation efforts are available in the German language and can be used to increase the application of agreed-on implementation strategies into practice.

Community implementation of the 3 Wishes Project: an observational study of a compassionate end-of-life care initiative for critically ill patients.

Background:The 3 Wishes Project (3WP) promotes a personalized dying experience by eliciting and facilitating individualized terminal wishes for patients, families and the clinicians caring for them. We aimed to evaluate the adaptability of the 3WP to a community intensive care unit (ICU), and to describe the patients cared for with this palliative approach, as well as local implementation strategies.Methods:The 3WP was implemented in a 15-bed community hospital ICU in southern Ontario from 2017 to 2019. In this observational, descriptive study, we invited adult patients (≥ 18 yr) whose risk of death was deemed to be 95% or greater by the attending physician, or patients undergoing withdrawal of life-support to participate. We abstracted patient data from medical records, as well as the type, timing and cost of each wish, which person or service made and facilitated each wish, and if and why wishes were completed or not. We summarized data both narratively and quantitatively.Results:The 3WP helped to realize 479 (99.2%) of 483 terminal wishes for 101 dying patients. This initiative was introduced as an interprofessional intervention and championed by nursing staff who were responsible for most patient enrolment and wish facilitation. Wishes included humanizing the ICU environment for the patient with belongings and blankets, musical performances, smudging and bathing ceremonies, and keepsakes. The cost was $5.39 per patient (standard deviation $22.40), with 430 (89.8%) wishes incurring no cost. Wishes made directly by patients accounted for 30 (6.2%) of wishes; those from family members and ICU staff accounted for 236 (48.9%) and 238 (49.3%) of wishes, respectively. The program comforted patients and their loved ones, motivating clinicians to sustain this end-of-life intervention.Interpretation:We documented successful implementation of the 3WP in a community hospital, showing program adaptability and uptake outside of academic centres at relatively low cost. The lack of strict protocolization and personalized design of this intervention underscores its inherent flexibility, with potential to promote individualized end-of-life care in nonacademic hospital wards, homes or hospice.

MANAJEMEN PENGEMBANGAN KURIKULUM MUATAN LOKAL DI RA NU BANAT KUDUS

AbstractThis research aimed to describe the planning, organization, implementation, and evaluation of local content curriculum development at RA NU Banat Kudus. This research used qualitative approach and belongs to descriptive design. Data collection was done through observation, in depth interview, and documentation. The data was then analyzed by using triangulation technique. The research results showed that: 1) planning of local content curriculum development at RA NU Banat Kudus is done in the beginning of academic year and the material of local content is adjusted to the curriculum of Religion Ministry of Kudus. 2) Organizing of local content curriculum development classified by students’ age and taught classically in the classroom. 3) The implementation of development including the characteristic of local content curriculum (scope of teaching material, purpose, function, etc.) and implementation strategy. 4) Evaluation of local content curriculum development in learning process is done every day (daily achievement scale).Keywords: Curriculum Management, Curriculum Development, Local Content

First Aid Guidelines for Bites and Stings: Educational Approach &amp; Adaptation

Topic Bites and stings can transmit diseases, cause wounds that can become infected, and in some cases, can cause an allergic reaction. Their prevalence across all parts of the world means that they are an important topic to cover in first aid education for most populations and contexts. Context The updated First Aid, Resuscitation and Education Guidelines of the International Federation of the Red Cross and Red Crescent (IFRC, 2020) reflect the evidence regarding specific first aid clinical actions and pair the evidence regarding first aid education. This approach was designed so that users of the Guidelines are easily able to apply them through adaptation to relevant learner contexts, contextualization to different levels of resources and medical care, and local implementation strategies. Educational approach and adaptation The role of the educator in adapting content to the learner context is crucial for this topic since the variety and level of risk in different countries, and in different localities within countries is so great. In general, and across all levels of risk and exposure, education needs to focus initially on prevention measures such as covering the body exposed to possible bites and stings; and then on recognition and fast action to manage pain and to reduce the possibility of infection and/or allergic reaction. Visual aids can support learning on this topic to identify reactions which need urgent treatment. Discussion and conclusions The immense variety of stinging and biting agents, coupled with the equally great variety of symptoms (in terms of manifestations and severity), makes “Bites and Stings” perhaps one of the most difficult subjects to teach in first aid. Inevitably, there are significant gaps in the evidence base and therefore educators need to retain a principled approach, being clear that they cannot cover all eventualities, but that prevention, fast recognition and treatment can be critical, particularly where there is limited or no access to EMS.

Toward a Common Goal: Improving Safety of Oral Chemotherapy Prescribing Practices at a Jurisdictional Level.

Extending the safety agenda from parenteral to oral chemotherapy was identified as a provincial improvement priority in the 2014-2019 Cancer Care Ontario (CCO) Systemic Treatment Provincial Plan. Elimination of handwritten prescriptions for oral chemotherapy was one of the specific goals and led to a provincial quality improvement (QI) initiative involving systemic treatment facilities across 14 regional cancer programs. The initiative was centrally organized by CCO but locally implemented by the regional partners. CCO provided templates and tools, such as preprinted orders (PPOs), project charters, and an evaluation plan, and facilitated cross-jurisdictional knowledge sharing and exchange. Regions had flexibility in determining their local implementation strategies and were responsible for conducting chart audits to evaluate implementation success. Each participating hospital completed 3 audits-at baseline, immediately after implementation (audit 1), and 1 year later (audit 2)-using either a clinic-based or an outpatient pharmacy-based assessment. Thirty-five facilities providing systemic treatment participated. At baseline, the provincial average for the use of computerized physician order entry (CPOE) or PPOs for prescribing oral chemotherapy was 71%. After implementation of the QI initiative, the provincial average for the use of CPOE or PPO increased to 91% at audit 1 and 95% at audit 2. Although not all facilities met the goal of 100% CPOE or PPO compliance, the QI initiative led to improvement in safe prescribing practices for oral chemotherapy. A coordinated QI approach between a central decision maker and local partners can be an effective strategy to encourage high-quality cancer care and promote a culture of safety across a jurisdiction.

A local strain-based implementation strategy for the extended peridynamic model with bond rotation

The conventional grid displacements-based implementation of the extended peridynamic model with bond rotation may give rise to some difficulty in predicting non-uniform deformation field, essentially due to the existence of local rigid rotation in solid. This paper presents a novel alternative local strain-based implementation technique for handling the numerical issue. The key is to formulate the relative displacement between particles in terms of the strain tensor approximated locally rather than the direct use of displacements at peridynamic particles. It is critically proved that bond stretch is independent of the rigid rotation tensor. Local strain is thus required only for approximating local shear deformation. The model is currently implemented for static problems in a hybrid manner and in a finite element/peridynamics coupling framework, the latter allowing direct and correct imposition of boundary conditions. To illustrate the performance of the proposed method in numerical accuracy and computational efficiency, various examples are performed with varying Poisson’s ratio and comparisons with the results from finite element analysis are presented.

The 10-year impact of a ward-level quality improvement intervention in acute hospitals: a multiple methods study

Background The ‘Productive Ward: Releasing Time to Care’™ programme (Productive Ward; PW) was introduced in English NHS acute hospitals in 2007 to give ward staff the tools, skills and time needed to implement local improvements to (1) increase the time nurses spend on direct patient care, (2) improve the safety and reliability of care, (3) improve staff and patient experience and (4) make structural changes on wards to improve efficiency. Evidence of whether or not these goals were met and sustained is very limited. Objective To explore if PW had a sustained impact over the past decade. Design Multiple methods, comprising two online national surveys, six acute trust case studies (including a secondary analysis of local audit data) and telephone interviews. Data sources Surveys of 56 directors of nursing and 35 current PW leads; 88 staff and patient and public involvement representative interviews; 10 ward manager questionnaires; structured observations of 12 randomly selected wards and documentary analysis in case studies; and 14 telephone interviews with former PW leads. Results Trusts typically adopted PW in 2008–9 on their wards using a phased implementation approach. The average length of PW use was 3 years (range &lt; 1 to 7 years). Financial and management support for PW has disappeared in the majority of trusts. The most commonly cited reason for PW’s cessation was a change in quality improvement (QI) approach. Nonetheless, PW has influenced wider QI strategies in around half of the trusts. Around one-third of trusts had impact data relating specifically to PW; the same proportion did not. Early adopters of PW had access to more resources for supporting implementation. Some elements of local implementation strategies were common. However, there were variations that had consequences for the assimilation of PW into routine practice and, subsequently, for the legacies and sustainability of the programme. In all case study sites, material legacies (e.g. display of metrics data; storage systems) remained, as did some processes (e.g. protected mealtimes). Only one case study site had sufficiently robust data collection systems to allow an objective assessment of PW’s impact; in that site, care processes had improved initially (in terms of patient observations and direct care time). Experience of leading PW had benefited the careers of the majority of interviewees. Starting with little or no QI experience, many went on to work on other initiatives within their trusts, or to work in QI at regional or national level within the NHS or in the private sector. Limitations The research draws on participant recall over a lengthy period characterised by evolving QI approaches and system-level change. Conclusions Little robust evidence remains of PW leading to a sustained increase in the time nurses spend on direct patient care or improvements in the experiences of staff and/or patients. PW has had a lasting impact on some ward practices. As an ongoing QI approach continually used to make ongoing improvements, PW has not been sustained, but it has informed current organisational QI practices and strategies in many trusts. The design and delivery of future large-scale QI programmes could usefully draw on the lessons learnt from this study of the PW in England over the period 2008–18. Funding This National Institute for Health Research Health Services and Delivery Research programme.

Exploring the sustainability of quality improvement interventions in healthcare organisations: a multiple methods study of the 10-year impact of the ‘Productive Ward: Releasing Time to Care’ programme in English acute hospitals

BackgroundThe ‘Productive Ward: Releasing Time to Care’ programme is a quality improvement (QI) intervention introduced in English acute hospitals a decade ago to: (1) Increase time nurses spend in direct...

A South African experience in applying the Adopt\u2013Contextualise\u2013Adapt framework to stroke rehabilitation clinical practice guidelines

BackgroundClinical practice guideline (CPG) activity has escalated internationally in the last 20 years, leading to increasingly sophisticated methods for CPG developers and implementers. Despite this, there remains a lack of practical support for end-users in terms of effectively and efficiently implementing CPG recommendations into local practice. This paper describes South African experiences in implementing international CPG recommendations for best practice stroke rehabilitation into local contexts, using a purpose-build approach.MethodsComposite recommendations were synthesised from 16 international CPGs to address end-user questions about best practice rehabilitation for South African stroke survivors. End-user representatives on the project team included methodologists, policy-makers, clinicians, managers, educators, researchers and stroke survivors. The Adopt–Contextualise–Adapt model was applied as a decision-guide to streamline discussions on endorsement and development of implementation strategies. Where recommendations required contextualisation to address local barriers before they could be effectively implemented, prompts were provided to identify barriers and possible solutions. Where recommendations could not be implemented without additional local evidence (adaptation), options were identified to establish new evidence.FindingsThe structured implementation process was efficient in terms of time, effort, resources and problem solving. The process empowered the project team to make practical decisions about local uptake of international recommendations, develop local implementation strategies, and determine who was responsible, for what and when. Different implementation strategies for the same recommendation were identified for different settings, to address different barriers.ConclusionThe South African evidence translation experience could be useful for evidence implementers in other countries, when translating CPG recommendations developed elsewhere, into local practice.

Policy Making “by the way” in a Crowded Education Policy Space: The Case of the Swedish Teacher Certificate Reform

&#x0D; &#x0D; &#x0D; Education has always been a reform-intensive policy sector, perhaps more so now than ever before. In studying education reforms, analysis has typically emphasised elements and/or the entire policy process of individual reforms. The same is essentially true for the management of education reforms, which tends to treat an individual reform as a cycle in which every element is subject to organisational management practices. In contrast to approaching education policies as stand-alone phenomena, we argue that policies exist in context: they are occupants of a “policy space”. In this paper, we draw on a contemporary Swedish teacher certification (STC) reform to explore what happens when a reform is implemented in a policy space that can potentially be portrayed as crowded, or even overcrowded. The main results indicate that while diverse local implementation strategies have been employed, STC has ended up in an overcrowded educational policy space. In this space, new and former reforms jostle against each other, giving rise to various un- foreseen problems that are difficult or even impossible to solve locally. Based on these observations, we identify several different interactions and unintended consequences or "policies by the way", thereby adding components useful in refining the theory of policy space.&#x0D; &#x0D; &#x0D;

Breathe Easy? Local Nuances of Authoritarian Environmentalism in China's Battle against Air Pollution

AbstractThe heavy smog suffocating China's cities is increasingly being perceived as a threat by both the population and the authorities. Consequently, political action aiming at regulating ambient air pollution has become increasingly comprehensive and rigid in recent years. Even measures limiting consumption and production seem to become acceptable as China is facing an airpocalypse. Does this suggest a genesis of real “authoritarian environmentalism” (AE) in China? Taking this as a heuristic point of departure, we present findings from research on the implementation of air pollution control measures in Hangzhou city. We offer a critical examination of the concept of AE and, in particular, of local policy implementation strategies vis-à-vis the general public. Two measures in Hangzhou's air policy portfolio are analysed that reveal considerable variation: restrictions on the use of private cars and the (re)location of industrial facilities. Describing the conditions that have helped to produce different implementation strategies, we argue for different emphases in a potential Chinese model of AE. In a context where outcomes are sought at any cost, we observe more complexity and nuances than are usually captured by the AE concept.