| Understanding the complexity of government policy decision-making is crucial to influencing policies that create equity in access to health and social resources and that serve to reduce health disparities within populations. The literature and practice knowledge provides some understanding of decision-making styles of senior executives, and of a multitude of variables affecting policy decisions. However, there is little systematic documentation about the actual policy decision-making process and about the thinking and ethical processes senior decision-makers engage in when recommending policy options to elected officials. This descriptive multiple-case study is the first attempt at gaining a more systematic understanding of the phenomenon of policy decision-making at senior levels of a Canadian provincial government and an important step in filling the existing conceptual and empirical gap. The study was conducted post- the global economic downturn of Fall 2008 when government leaders within public service were challenged to mitigate the effects of the economic downturn while still meeting government goals and objectives. The study provides an understanding of the decision-making contexts influencing senior decision-makers and of the thinking and ethical processes they engaged in when deciding on policy options. Holistic and cross-case analysis was conducted. Major influences senior decision-makers paid attention to were: the democratic structure; will and preferences of elected officials (political decision-makers); economic context; and governance. Minor influences included stakeholders and scientific evidence. The decision-makers' experience in senior decision-making roles in public service, and the use of flexible and integrative decision-making styles were important. Thinking and ethical processes were intricately connected in guiding the decision-making process, with twelve themes emerging. The decision-makers' thinking processes included: vision, political astuteness, being tactical, being strategic, due diligence, risk-management, and the ethical processes included: respect for diverse opinions, integrity and trust, democracy, impact of policies, passion for public service, intuition about doing the right thing. Strong face validity and trustworthiness of the data was achieved to inform future research and the development of a comprehensive framework of government policy decision-making. A preliminary model is constructed from the knowledge uncovered. Implications for nursing practice, policy-makers, education and research are provided. |
