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

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