NURS 8100 Week 1 Discussion Selecting a Policy Analysis Framework
The selected policy is the implementation of state agency worksite wellness programs, as directed by Texas Government Code, Section 664.053. The health of state employees affects the state’s healthcare expenditures and the productivity of state agencies. For example, obese individuals cost employers an average of $5,555 per year in covered medical, sick days, short-term disability, and workers’ compensation claims combined, whereas the average cost for an employee of recommended weight is $3,839 per year (Texas Department of State Health Services, 2020). Texas Government Code, Section 664.053 requires the Texas Department of State Health Services (DSHS) to designate a statewide wellness coordinator to create and promote a model wellness program for state agencies. The statute also directs DSHS to study the implementation and participation rates of state agency worksite wellness programs and report the findings to the Legislature biennially. In 2020, DSHS conducted two surveys, one asking agency wellness liaisons from across Texas state agencies about wellness programs at their respective worksites, and a second asking state employees about their use of wellness-related resources. Of the wellness liaisons surveyed, 65 out of 188 responded to the survey (a 35 percent response rate). Of the responding wellness liaisons, 99 percent reported that their agency has a wellness policy and 55 percent reported a wellness plan that involved implementing activities. However, 46 percent of liaisons reported their agency did not have a wellness budget. Most wellness activities implemented among state agencies required minimal resources so as to work within limited funds, time, agency size, and space. A total of 5,840 state employees out of 145,645 responded to the survey (a 4 percent response rate). A majority of respondents found wellness services and benefits useful but are not aware of the breadth of opportunities available. This indicates more work is needed to raise awareness of these benefits. DSHS leadership and the Statewide Wellness Coordinator will continue to provide technical assistance to wellness liaisons as they implement wellness programs at their agencies. They will also carry out statewide initiatives that align with the objectives of the model wellness program, Work Well Texas (Texas Department of State Health Services, 2020).
The framework is John Kingdon’s multiple streams theory. John Kingdon’s Agendas, Alternatives, and Public Policies advance theoretically by proposing a differentiation between the concepts of governmental agendas and decision agendas. The agenda is the list of subjects or problems to which governmental officials, and people outside of government closely associated with those officials, are paying some serious attention at any given time. For the author, an issue is placed on the governmental agenda when it catches the attention and the interest of policymakers. Kingdon expands the set of actors related to agenda-setting, considering not only decision-makers within the state but also individuals and groups related to them. In addition, given the complexity and the volume of questions facing policymakers, Kingdon reminds us that only a few issues are seriously considered within the governmental agenda at any given time. These issues correspond to the decision agenda: a subset of the governmental agenda where issues are ready for an active decision (Capella, 2020). In the highly competitive agenda-setting process, few issues move from the government agenda to the decision agenda. In his words, we should also distinguish the governmental agenda, the list of subjects that are getting attention, and the decision agenda, or the list of subjects within the governmental agenda that are up for an active decision. Kingdon explains how agendas change from time to time, proposing an explanatory model organized around three streams, the problems stream, the policy stream, and the political stream. The multiple streams model proposed by the author seeks to analyze the pre-decisional stages of the policy process by explaining policy formulation through three streams connected by a public policy entrepreneur who plays an important role when windows of opportunity make changes possible (Capella, 2020).
The policy is in the implementation stage. DSHS will focus on implementing statewide initiatives that align with the objectives of the model wellness program and will continue to support wellness liaisons as they implement related activities in their agencies. Additionally, DSHS plans to initiate demonstration projects at state agencies that currently do not participate in wellness programming. Such projects may include promoting lactation support policies, partnering with cafeteria/vending operators to increase healthy food options in state buildings, and maintaining annual initiatives such as the fitness challenge and wellness conference. Evidence-based, ready-to-implement activities will decrease the time and effort other agencies need to spend developing their own activities. State agencies would only need to make minor logistical changes to integrate activities into their system. Finally, through ongoing collaboration with the Employees Retirement System of Texas (ERS), DSHS will continue to address state-level issues related to improving employee health, raising awareness of available benefits, building wellness infrastructure across all agencies, and providing resources and technical assistance.
References
Capella, A. C. N. (2020). Policy agenda-setting studies: an overview of Brazilian research. Revista de Administração Pública, 54, 1498-1512.
Texas Department of State Health Services (2020). Implementation and Participation in State Agency Worksite Wellness
