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

Passage of the Patient Protection and Affordable Care Act (ACA) has served to refocus attention on the complexity of health care delivery in the United States, with particular attention to concepts of quality, access, and outcomes. This article argues that our understanding of the ACA must be informed by an examination of policy implementation in health care, including the core public function of emergency medical services (EMS). Key concepts of implementation in frontline service—notably, rule abidance and deviation—are examined from the perspective of street‐level EMS workers. Results indicate that the intersection of rules, patient needs, and professional culture creates instances of both rule abidance and deviation, both of which contribute substantively to concepts of quality in a health care setting.     

Childhood animal cruelty methods and their link to adult interpersonal violence

Recent research has begun to establish a relationship between childhood acts of animal cruelty and later violence against humans. However, few studies have focused on the influence of animal cruelty methods on later interpersonal violence. In a replication of a study by Hensley and Tallichet (2009) and based on a sample of 180 inmates at medium- and maximum-security prisons in a Southern state, the present study examines the relationship between several retrospectively identified animal cruelty methods (drowned, hit, shot, kicked, choked, burned, and sex) and interpersonal violence committed against humans. Four out of 5 inmates reported hitting animals. Over one third of the sample chose to shoot or kick animals, while 1 in 5 had sex with them. Less then one fifth of the sample drowned or choked animals, while less than one sixth of the inmates burned animals. Regression analyses revealed that the age at which offenders began committing animal cruelty and having sex with animals were predictive of adult interpersonal violence.     

Report: increases in police use of force in the presence of body-worn cameras are driven by officer discretion: a protocol-based subgroup analysis of ten randomized experiments

Objectives

Our multisite randomized controlled trial reported that police body-worn cameras (BWCs) had, on average, no effect on recorded incidents of police use of force. In some sites, rates of use of force decreased and in others increased. We wanted to understand these counter-intuitive findings and report pre-specified subgroup analyses related to officers’ discretion on activating the BWCs.

Methods

Using pre-established criteria for experimental protocol breakdown in terms of treatment integrity, ten experimental sites were subgrouped into “high-compliance” (no officer discretion applied to when and where BWCs should be used; n?=?3), “no-compliance” (treatment integrity failure in both treatment and control conditions; n?=?4), and tests where officers applied discretion during treatment group but followed protocol in control conditions only (n?=?4).

Results

When officers complied with the experimental protocol and did not use discretion, use of force rates were 37 % lower [SMD?=?(?.346); SE?= .137; 95?% CI (?.614) – (?.077)]; when officers did not comply with treatment protocol (i.e., officers chose when to turn cameras on/off), use of force rates were 71 % higher [SMD?= .392; SE?= .130; 95?% CI (.136) – (.647)], compared to control conditions. When full discretion (i.e., overall breakdown of protocol) was applied to both treatment and control conditions, null effects were registered [SMD?= .009; SE=.070; 95?% CI (?.127) – (.146)], compared to control conditions.

Conclusions

BWCs can reduce police use of force when then officers’ discretion to turn cameras on or off is minimized—in terms of both case types as well as individual incidents. BWCs ought to be switched on and the recording announced to suspects at early stages of police–public interactions. Future BWCs tests should pay close attention to adherence to experimental protocols.