Why policies fail: a diagnostic framework for public policy analysis

Purpose This paper introduces a diagnostic framework for understanding policy failures – unintended negative outcomes or unmet objectives. By analogically mapping medical errors to policy contexts, it equips scholars and policymakers to anticipate risks, evaluate outcomes and design adaptable, evidence-based solutions for effective and equitable governance. Design/methodology/approach A three-phase qualitative approach was used. Phase 1 involved semi-structured interviews with 40 Tehran-based physicians to identify 18 medical errors. Phase 2 translated these into policy equivalents through interviews with 50 policy experts. Phase 3 validated the framework with a focus group of 12 international experts and incorporated global case studies. Qualitative content analysis ensured rigor through reflexivity, triangulation and audit trails. Findings The framework categorizes 18 causes of policy failure into four groups: implementation and monitoring errors, unintended consequences and public response errors, cognitive/theoretical errors and design/instrument errors. Key origins include flawed assumptions and institutional neglect, illustrated by cases such as the U.S. War on Drugs and India's demonetization. Research limitations/implications Some of the drawbacks include small sample sizes, a Phase 1 that is Tehran-centric and may limit generalizability and the conceptual nature that requires additional empirical validation across other domains. The consequences also apply to policy formulation and evaluation, allowing practitioners to enhance stakeholder trust, encourage adaptive governance and reduce financial losses brought on by errors like austerity measures. Practical implications By offering useful tools for ex-ante risk prediction and ex-post adjustments, the framework promotes evidence-based changes in domains such as economics and health. Social implications The framework supports risk prediction, corrective adjustments, stakeholder trust, adaptive governance and socially just policymaking, integrating indigenous knowledge to reduce societal harms. Originality/value By bridging medical diagnostics and policy analysis, this framework offers a globally relevant, systematic lens that extends beyond traditional typologies.