Bullock Heather L, Lavis John N, Mulvale Gillian, Wilson Michael G, Mulhern Celine
Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
Waypoint Centre for Mental Health Care, 500 Church St, Penetanguishene, ON , L9M 1G3, Canada.
Implement Sci Commun. 2025 Aug 5;6(1):82. doi: 10.1186/s43058-025-00761-6.
Shifts toward "new public governance" (NPG), where policy decisions and their implementation are "co-produced" by a policy network, have captured the attention of policymakers as an approach that may produce better outcomes. It is particularly promising in mental health, where it is increasingly acknowledged that effective change requires actions by multiple actors across a range of policy and system settings. In Ontario, Canada, the government's recent mental health reform, Open Minds, Healthy Minds, Ontario's Comprehensive Mental Health and Addictions Strategy, is unique in terms of its scope and the NPG-inspired processes employed. This study addresses two questions: 1) Who was engaged in the implementation of the Strategy and how were they engaged? and 2) How and why did their involvement contribute to the implementation process and early outcomes?
We used a single case study design and partnered with the Ontario Ministry of Health. We used two complementary analytical methods: 1) stakeholder analysis, and 2) political landscape analysis. Seventeen interviews were conducted with citizens, government officials and people with lived experience, and 21 documents analyzed using directed content analysis and drawing from theoretical frameworks regarding political and actor-related determinants of implementation.
Stakeholder analysis highlighted the wide range of interdependent actors involved, the multiple ways they provided input, and the structures utilized. The political landscape analysis revealed the role of interests as having a large influence on the implementation process and early outcomes, particularly political actors' decision to tie the process to their election platform. Relational and contextual variables, such as the relative instability of the policy actors, had a negative impact on the process, but that was offset by the perceived level of dedication of the individuals involved.
Our findings point to five practical insights for policymakers and implementers: being attentive to the power distribution among actors, the importance of building and maintaining trust amongst actors, the opportunity-cost of taking a NPG approach, the timing/sequencing of the process, and the need for careful consider of the type of actors involved and the expertise they bring.
向“新公共治理”（NPG）的转变，即政策决策及其实施由政策网络“共同产生”，已引起政策制定者的关注，被视为一种可能产生更好结果的方法。在心理健康领域，这种方法尤其具有前景，因为人们越来越认识到，有效的变革需要一系列政策和系统环境中的多个行为体采取行动。在加拿大安大略省，政府最近的心理健康改革《开放思维，健康心灵，安大略省综合心理健康与成瘾战略》，在其范围和采用的受NPG启发的过程方面独具特色。本研究探讨两个问题：1）谁参与了该战略的实施，他们是如何参与的？2）他们的参与如何以及为何对实施过程和早期成果做出贡献？
我们采用单案例研究设计，并与安大略省卫生部合作。我们使用了两种互补的分析方法：1）利益相关者分析，2）政治格局分析。对公民、政府官员和有生活经验的人进行了17次访谈，并使用定向内容分析和关于实施的政治及行为体相关决定因素的理论框架对21份文件进行了分析。
利益相关者分析突出了参与其中的广泛相互依存的行为体、他们提供投入的多种方式以及所利用的结构。政治格局分析揭示了利益在实施过程和早期成果中具有很大影响，特别是政治行为体将该过程与其选举纲领挂钩的决定。关系和背景变量，如政策行为体的相对不稳定性，对该过程产生了负面影响，但这被相关个人的敬业程度所抵消。
我们的研究结果为政策制定者和实施者提供了五点实际见解：关注行为体之间的权力分配、行为体之间建立和维持信任的重要性、采用NPG方法的机会成本、过程的时机/顺序，以及仔细考虑所涉及行为体的类型及其所具备的专业知识的必要性。
