Out-of-Hospital Cardiac Arrest (OHCA) strategy: case study

5. Realising the potential of the Scottish Approach

Conducting interviews about the Scottish Approach and reviewing its associated literature has revealed 2 important issues for the future of the approach: (1) the need for definitions and avoidance of conceptual stretching (2) the need for critically informed discussion.

(1) Despite over 10 years of observations about the potentially distinctive way Scotland implements policy, “what is meant by the ‘emerging Scottish model’ of policy-making is not clear” (Mitchell 2015, p 3). This is influenced by a phenomenon called conceptual stretching.

Coined by Giovanni Sartori, conceptual stretching occurs as individuals “seek to apply their models and hypotheses to more cases in the effort to achieve broader knowledge, they must often adapt their categories to fit new contexts” (Collier and Mahon 1993, p 845). The ‘Scottish Approach’ has become a phrase that connotes more diverse principles in light of changing practice, meaning that the list of identifiable features continues to grow. An insightful article by Mitchell highlights that “if the Scottish model means everything then it comes to mean nothing” (p 3), and advocates of the Scottish Approach should be mindful that the term is becoming conceptually stretched to the extent that it is now reported to represent most aspects of ‘good’ policy-making.

This case study has been challenged by the flexibility of this term and echoes Mitchell’s suggestion that developing models of the Scottish Approach – not one unifying model – is necessary to take into account diverse policy areas and sectors. Whilst a ‘one size fits all’ model is not optimum, developing standardised taxonomies would offer clarity around the language and practices of the Scottish Approach.

(2) Although the features of the Scottish Approach are inherently progressive, some opposition to how these are put into practice does exist (Mooney and Poole 2004, Mooney and Scott 2005). Central to this challenge is that if the approach corresponds with certain values and behaviours, this would lead to improved outcomes for those in Scottish society.

However, it was recognised in the Christie Commission that “Despite a series of Scottish Government initiatives…on most key measures social and economic inequalities have remain unchanged or become more pronounced” (p viii). More recently reports from the National Audit Office (2012), Nuffield Trust (2014) and the Scottish Government (2010) have highlighted the continual challenges of tackling national health issues, and the most recent Scottish Health Survey statistics (2015b) shows that many of Scotland’s health issues persist. This suggests that critique may be warranted and a thorough appraisal of the Scottish approach in practice may be necessary. Scrutiny from external and academic bodies should be welcomed if the potential benefits of this approach – the benefits reported by stakeholders in this OHCA case study – are to be realised.