The goals of CPB are to provide a still and bloodless field for the surgeon to operate while not damaging the heart muscle.This chapter reviews the conduct of CPB starting with cannulation (arterial and venous), general management of both the mechanical and physiologic aspects of CPB and finishes with a section regarding important aspects of CPB related to minimally invasive cardiac surgery (MICS).It is important that each institution has detailed protocols and procedures for CPB, and many of the points discussed in this chapter will be performed within the construct of these protocols.

This essay argues that contemporary Caribbean women exploit the malleability of life writing as a genre in a variety of ways that recognize the precariousness of life-making and self-making in the post-plantation Caribbean. While each of the writers discussed here critically refashions life-narrative for their own distinct purposes, they frequently share an interest in filtering personal life experiences through familiar familial and regional histories to emphasize the imbrication of the personal and political. Narrating life-stories is presented in these texts as inextricably linked to the difficult cultural politics of self-making that is so powerfully evidenced from The History of Mary Prince through to the present. While life-writing remains haunted by the region’s violent history, Caribbean women writers continue to excavate that history in order to record, affirm, rescue, restore, and celebrate self and life-making possibilities, however fragmented, precarious, or itinerant.

This chapter examines how a variety of writers have strategically manipulated reductive ‘Orientalist’ strategies of representation across quite different texts and historical moments. It begins with a discussion of the life and works of Sake Dean Mahomed, Travels of Dean Mahomet (1794) and Shampooing or Benefits Resulting (1822), the first Indian to write in English and publish in Britain. It also draws briefly on the letters of Ignatius Sancho to show how both writers similarly exploit and play on the concept of ‘exoticisation’ to create different personas which aid their passage through British culture. The chapter highlights how the seductive trope of the ‘Oriental’ and the ‘exotic’ persisted in the reception of influential twentieth-century Indian poets who were both prominent in British literary culture, Rabindranath Tagore and Sarojini Naidu. The chapter concludes with an analysis of Hanif Kureishi’s much later invention of Karim Amir and his father in The Buddha of Suburbia (1990), Englishmen ‘almost’ (Kureishi), to show how all these writers deliberately straddle multiple positions and use dualities, the ability to look in two directions at once, to their own advantage.

This chapter engages with the thematic, formal, and linguistic breadth that characterises contemporary Black and Asian women’s poetry. It argues that the anthology continues to be an important platform for supporting, publishing, and disseminating Black and Asian women’s poetry, given the continuing dearth of publication opportunities for such poets. While there are continuities in style, form, and focus across the generations, there has been a significant shift away from a focus on identity towards more protean and fragmented forms. Language, migration, and diaspora remain central concerns, but are often more varied and diverse in their global reach, representing a wide range of experiences of crossings and arrivals, and of the melancholic un-belonging that often follows. The work of women poets across the generations is marked by a greater willingness to experiment with form, structure, and rhythm and to shift between experimental and expressive poetic registers with ease and confidence. In engaging a wide range of poets, this chapter prepares the ground for comparisons of similar preoccupations and concerns, charting continuities and discontinuities across the generations

We noted in Chapter 2 that the linear model of the policy process creates a false dichotomy between the stages of policy formulation and implementation. Policy-making and implementation are seen as distinct activities, separate from each other. An interactive model of the policy process suggests, on the contrary, that policies can be reformulated in the implementation process and, therefore, the distinction between the processes of policy formulation and implementation is not water tight. In this chapter, we look more closely at the factors that influence the policy implementation process, as well as theoretical frameworks that help analyse the same.

The key question that we answer in this chapter is: How can we explain the difference between the intended and actual outcomes of public policy?What factors shape the implementation process? What analytic frameworks or conceptual approaches can be employed for the analysis of the implementation of public policy? In Chapter 2, we examined the importance of understanding the management of change; in this chapter, we look at different conceptual approaches and analytical frameworks that help analyse the management of change. In attempting to answer these questions, we draw upon concepts and frameworks developed in legal anthropology, development sociology and management literature.

Importance of the study of the implementation process

The interest in the study of implementation of public policy can be traced back to the publication of the book ‘Implementation’ by Pressman and Wildavsky in 1973. Prior to this, interest in public policy was confined more to the prescriptive dimensions of policy; earlier studies tended to be of decisions rather than of policies (Hogwood and Gunn 1984). The focus was on the moment at which the decision was taken or the policy was made. What happened after that was seen to be the concern of other disciplines such as public administration or management in the public sector. Since the 1970s, however, there has been a greater interest in studying what has been described by Dunsire as the ‘implementation gap’.

Mathur (1998) notes that most public administration could be seen as the implementation strategy of public policy. This means that the effort at dichotomising policy and administration needs to be given up.

Wildavsky, the eminent political scientist, noted, ‘…policy analysis is one activity for which there can be no fixed program, for policy analysis is synonymous with creativity, which may be stimulated by theory and sharpened by practice, which can be learned but not taught. In large part, it must be admitted, knowledge is negative – it tells us what we cannot do, where we cannot go, wherein we have been wrong, but not necessarily how to correct these errors. After all, if current efforts were judged wholly satisfactory, there would be little need for analysis and less for analysts (Wildavsky 1979: 3, 9).’

In Chapter 1, we examined the rationale for the study of public policy and in particular, the need for the study of policy processes. We introduced the policy sciences as a field of study comprising both the process and the prescriptive dimensions of public policy. In this chapter, we further explore the characteristics of policy analysis and describe its evolution as a field of enquiry. We then review different models of policy choice and theories of the policy process. These models are conceptual lenses for studying policy and explaining how policy processes take shape. They provide an analytic framework for the analysis of public policy. These models help us structure our thinking on policy; however, none of them is necessarily superior to the others. It is for us, as students of public policy, to critically evaluate each of them and examine their relevance for the study of public policy processes. Policy processes can be explained using one or a combination of these.

The organisation of this chapter is thus: we start with a review of some characteristics of policy analysis: it is applied, client-oriented and politically sensitive. We then look at how policy analysis has emerged as an interdisciplinary field, drawing from but at the same time deviating from conventional disciplines. The evolution of policy analysis as an applied interdisciplinary field is traced to the disenchantment with conventional disciplines on the supply side and the quest for the explanation of unsatisfactory development performance on the demand side.

We then move on to examine what is meant by a model, and why we should be interested in modelling social phenomena. The objectives of developing models of policy processes are described.

In recent years, three distinct fields of enquiry have developed that contribute to our understanding of public policy. The first of these is the field of policy sciences that grew in response to a call by Harold Lasswell in the 1950s, to overcome the weaknesses of conventional disciplines in understanding the poor record of development policy. This evolved as an inter-disciplinary field, drawing on several disciplines. Contributions to this field came to be organised around the journal Policy Sciences. The second was the field of policy studies, that emerged as a sub-field of political science; contributions to this field of enquiry were organised around the journals Policy Studies Review and Policy Studies Journal. The third was the field of policy analysis, further developed by a Ford Foundation grant in the 1990s, which began as a group of institutions doing applied micro-economics, later broadening under the Journal of Policy Analysis and Management. Policy analysis was an applied extension of microeconomics to the study of public policy.

Each of these fields retains a distinct approach to the study of public policy. However, they suffer from several weaknesses in terms of their applicability to a context beyond the one in which they developed. Policy sciences, in particular, emerged as a very inter-disciplinary field, drawing on several concepts across disciplines. However, the large bulk of this literature is rooted in western contexts and has been developed by western scholars. There remains a question of whether these terms and concepts can be used to understand public policy processes in the global South. Within the international public policy scholarship, there is a burning question of whether tools, theories and concepts that explain policy change developed in the north can be used to understand policy processes in the South.

In general, efforts to understand the relevance and application of these concepts and theories to a Third World context are lacking. There remains a critical challenge of integrating public policy literature developed in the global North with the policy experience of the global South. The large number of books on public policy available to Indian students are written by western authors and cater to a western context; they use examples and cases from Britain and the USA. This is of little relevance to Indian students, who need something tailored to or drawing upon an Indian context.

In this chapter, we turn our attention to crucial issues surrounding the evaluation and monitoring of public policy. The chapter is intended not so much to provide prescriptions on how to monitor and evaluate policies; instead to trigger reflection among readers on their experiences with policy monitoring and evaluation, approaches adopted, political motivations and problems encountered.

We start with examining the conceptual connotations of public policy evaluation and distinguish between different types of policy evaluation; particularly, in this context, we emphasise the need to distinguish policy outcomes from policy outputs. We then look at the imperatives and need for policy evaluation. This is followed by a review of different types of evaluation that may be typically carried out as well as the different approaches that may be adopted.

The latter part of this chapter is devoted to an analysis of the politics of public policy evaluation. Policy evaluation is not simply a positivist exercise using scientific tools and techniques, as seen in a linear rational model of the policy process; rather, it is an inherently political activity, shaped by and enmeshed in social relations of power. The linear rational model of policy analysis sees policy monitoring and evaluation as culminating in policy termination and/or continuation. We look at why this may not always be the case and how protecting certain political and legal interests could keep policies in continuation even when analysis has proven that they have not been effective. We conclude the chapter with some discussion on the issues in the monitoring of public policy.

Public policy evaluation

Policy evaluation could be defined as the process of learning about the consequences of public policy (Dye 2002). Wholey et al. (2004) define policy evaluation to be the assessment of the overall effectiveness of a national programme in meeting its objectives or assessment of the relative effectiveness of two or more programmes in meeting a common objective.

Policy evaluation needs to be distinguished from monitoring. While monitoring provides routine feedback, evaluation offers a more in-depth study of particular issues or concerns at any specific point in time. Public policies, nevertheless, could be evaluated at all phases of policy-making: in the identification and articulation of policy problems, in the formulation of alternative policy options, during the implementation of a particular policy, or at the termination of policy to determine its final impact.