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

6. Conclusion

Scotland’s approach to designing and implementing policy is subject to continual debate. It has been reported that Scotland delivers its policies in distinctive ways which has now become known as the ‘Scottish Approach’. Literature published in the last 20 years suggests that there are several identifiable features of this approach (Figure 2).

This Research Internship Project set out to serve as a case study of Scotland’s first national OHCA Strategy – to qualitatively explore whether the strategy represents the Scottish Approach in practice. By interviewing 13 partners involved its design and delivery, as well as reviewing other data sources, this project concludes that the OHCA Strategy displays the hallmarks of the Scottish Approach. There is strong evidence that the document focusses on outcomes, partners are working across sectors, the Strategy is co-produced from different bodies – including those that represent the patient voice – and that a variety of assets are being utilised. Other features of this Scottish Approach, whilst applied to a greater or lesser extent, have cumulatively contributed to this Strategy being perceived by interviewees as inclusive, productive and beneficial to Scottish society. Although challenges have been identified, the majority of interviewees cited elements of this OHCA policy-making process as best practice. These insights can help inform future policy development.

The extent to which the Strategy was purposively designed and delivered with the Scottish Approach in mind is unclear. Reflecting on the narratives that have emerged from the interviews, it appears that partners involved in the early stages of policy development did not cite their practice as the ‘Scottish Approach’ or being driven by this model; rather, their practices can now be qualitatively determined as this approach. Whilst the majority of the interviewees were aware of the Scottish model to some degree, the effect that this had on decisions and practices at the time of policy implementation is challenging to interpret through retrospective interviews.

Accordingly, a useful ‘next step’ in understanding the Scottish Approach, and complementing this OHCA Strategy case study, could be a policy ethnography. A policy ethnography would involve a researcher ‘living’ the lifecycle of a strategy – they would observe, document and analyse all the practices that contribute to policy.

This would give insight into how and why decisions are made, the effect of cultures and organisational norms on working practices, and give analysis of policy in real-time. This would offer a far richer understanding of the Scottish Approach and could be applied in specific policy areas such as OHCA.