Examining Policy Implementation in Health Care: Rule Abidance and Deviation in Emergency Medical Services

Abstract

Island University, Post Campus. His current research examines frontline behavior in emergency medical services organizations, as well as broader inquiry into the structuring of EMS systems. He previously served as chief administrative offi cer, operational offi cer, director, and volunteer with several emergency services organizations in suburban Philadelphia.

Formalization and consistency heighten organizational rule following: Experimental and survey evidence

“…Scholars offer a range of theoretical explanations, some pertaining to organizational factors, such as performance pressures (Sandfort 2000;Sekerka and Zolin 2007;Tummers et al 2015) or organizational culture (Pandey and Moynihan 2006;Borry 2017), while others focus on individual influences such as personality (Bozeman and Rainey 1998;DeHart-Davis 2007) or professional or gender socialization (Kaufman 1960;Hutchinson 1990;Portillo and DeHart-Davis 2009). Still others draw on interactions of the individual with the organization: perceived risks and benefits (Battmann and Klumb 1993), extrinsic vs. intrinsic mechanisms (Tyler and Blader 2005), or the relationships between public employees and citizens (Maynard-Moody and Musheno 2003;Riccucci 2005;Henderson 2013).…”

Ethical Climate and Rule Bending: How Organizational Norms Contribute to Unintended Rule Consequences

“…Instead, managers could choose to focus on the organization's climate. This research also adds more to the literature by showing that rule bending is influenced by more than organizational structure and personality characteristics (DeHart‐Davis ) and specifically testing the impact of organizational context on rule bending, a relationship to which previous studies have alluded (Henderson ; Brockman ). Finally, this research gives rise to various avenues for future investigation, including the role of ethical climate in public organizations in general as well as understanding the many nuances of rule bending.…”

“…Two recent studies on rule bending in public organizations suggest that an organization's climate may influence rule bending behaviour. Alexander Henderson () categorized two views of rule bending: one understood only taking into account the information surrounding specific incidents, which is consistent with Maynard‐Moody and Musheno's citizen‐ or state‐agents (); and another understood as a ‘set of beliefs’ that people have based on their experiences and organizational contexts (Portillo and DeHart‐Davis ). In the context of emergency medical services (EMS), he found that employees make choices about their rules based on the specific details about the situation at hand, supporting the first view of rule bending.…”

“…Two recent studies on rule bending suggest that professional norms and context may influence judgement and discretion that may lead to rule bending. In emergency medicine, employees are likely to consider the circumstances as they make their choices about rules (Henderson ) and police officers in Germany who are encouraged to voice their thoughts and opinions may bend rules with the benefit of improving organizational processes (Brockmann ). In both of these cases, the informal aspects of one's work context influences one's rule bending behaviour, and this study proposes that ethical climate may be one element of that.…”

Unbureaucratic Behavior among Street-Level Bureaucrats: The Case of the German State Police

“…For example, the literature focuses on street-level bureaucrats' (SLBs; for example, police officers, teachers) behavior such as bureaucratic posture (Wise, 2004), entrepreneurial behavior (Denhardt & Denhardt, 2000;Grady & Tax, 1996), exercise of discretion (e.g., Meyers & Lehmann-Nielsen, 2012;Oberfield, 2009;Taylor, 2007), and deviation and rule abidance (e.g., DeHart-Davis, 2009;Henderson, 2013). For example, the literature focuses on street-level bureaucrats' (SLBs; for example, police officers, teachers) behavior such as bureaucratic posture (Wise, 2004), entrepreneurial behavior (Denhardt & Denhardt, 2000;Grady & Tax, 1996), exercise of discretion (e.g., Meyers & Lehmann-Nielsen, 2012;Oberfield, 2009;Taylor, 2007), and deviation and rule abidance (e.g., DeHart-Davis, 2009;Henderson, 2013).…”