There is increasing pressure for the implementation of marriage equality: an increasing number of states are granting same-sex marriages, there is a large and growing segment of the population that supports marriage equality, and courts have become more willing to strike down discrimination against lesbian, gay, bisexual, and transgender people.
Individual surgeons are usually not in a position to make judgments about collective resource allocation, and may exert pressure for the implementation of innovations outside the usual institutional decision-making process.
Four categorizations of policy implementation: passive implementation, normal implementation (low speed), campaign-style implementation, and normal implementation (high speed) Applicability of policy Low High Pressure for implementation Low Passive implementation Normal implementation (low speed) High Campaign-style implementation Normal implementation (high speed).
Another factor affecting policy implementation is the pressure for implementation, namely the corresponding rewards and punishment assigned by superiors.
If the pressure for implementation is low, passive implementation will occur, which means that the grassroots governments do not openly resist policies but implement policies perfunctorily without achieving the core objectives of the policies.
As long as policies are poorly applicable and the pressure for implementation is low, passive implementation will proliferate in grassroots governance.
If the applicability of policies is low along with changes in pressure for implementation from above, "passive implementation" and "campaign-style implementation," which seem to oppose but are actually related to each other, will alternate and fluctuate.
Second, at the analytical framework level this article briefly identifies the two dimensions of the applicability of policies and the pressure for implementation with reference to the context of policy implementation.
If the applicability of policy is low and the pressure for policy implementation varies, policy implementation at the grassroots level often fluctuates between passive implementation and campaign-style implementation.
The analytical framework developed here is based on the two dimensions of the applicability of policy and the pressure for policy implementation, as illustrated in Table 1.
Increased consideration is currently being given to pressure ulcers in the Netherlands, as a result of the development of updated pressure ulcer guidelines, publications in professional journals, increased involvement of nurse specialists for pressure ulcers and the implementation of the Annual National Prevalence Pressure Ulcer Surveys [ 3, 4].
