Caring after COVID: swiss health policy, windows of opportunity, and programmatic groups

Abstract The COVID-19 pandemic presented a window of opportunity for policy change, but was not exploited as such everywhere. Surprisingly, in Switzerland, usually characterized by a stable political landscape and incremental policy changes, an unexpected reform, the Nursing Initiative, was adopted. This paper examines the underlying mechanisms driving this adoption, employing a cross-fertilization of the multiple streams framework with the programmatic action framework and relying on expert interviews. The analysis shows that partial streams coupling began years before the pandemic, facilitated by the strengthening of nursing care professions’ identity into a programmatic group. Switzerland’s direct democracy enabled the opening of an agenda window, allowing the programmatic group to effectively couple their policy with political dynamics in the policy process. Finally, the COVID-19 crisis acted as a decision window, opening from the problem stream and providing momentum for policy action and decision-making.