How does policy alienation develop? Exploring street-level bureaucrats’ agency in policy context shift in UK telehealthcare

Policies can fail when frontline staff feel they have limited influence on policy implementation (powerlessness) or that has little no personal meaning (meaninglessness) – become alienated from the but how does this alienation develop? In article we ask whether might be viewed as a process develops over time: ebbs and flows, interacting with landscape it shifts, rather than psychological state. Feelings of shared across groups actors, collectively shift initiate change. This study uses participant observation interviews front-line employees navigate UK government introducing telehealthcare to improve health management patients chronic conditions. We find that: (i) cumulative misalignment between different contexts allows develop time; (ii) experience in co-worker contributes further misalignment; (iii) use their discretion respond alienation, which power enhance destroy implementation. offer an alternative perspective for understanding prevented enhanced.