Can management decentralisation resolve challenges faced by healthcare service delivery organisations? Findings for managers and researchers from a scoping review

Abstract

PurposeDecentralisation of decision‐making from central to lower level organisation has been proposed as a way to increase innovation and make services more responsive to local needs. The purpose of this study was to discover research that can contribute to understanding decentralisation as one strategy for resolving challenges in healthcare service delivery organisations. This scoping review provides examples and research‐informed guidance for decentralisation research, planning and implementation.FindingsThere is limited empirical research into management decentralisation within primary and community care, but some useful frameworks for assessing and planning decentralisation. Rapid changes are being made to workforce redesign, substitution and patient co‐production. Research into such ‘micro‐decentralisation’ is not considered in the decentralisation literature. Neither is how the context of culture, systems and regulations affects implementation of this type of decentralisation. Our recent experience suggests that management decentralisation can enable fast and effective local changes to respond to the evolving Severe acute respiratory syndrome coronavirus 2 (SARS COV‐2) pandemic.ConclusionsDecentralisation can create conditions that support innovation and improvement locally to develop primary and community care. Managers and policy makers can use an appropriate decentralisation strategy to address challenges in workforce retention and recruitment, rising care demands and expectations of patients. There are opportunities for researchers to provide actionable knowledge about changes in organisations and management which could address current challenges in healthcare.

That's how it should work: the perceptions of a senior management on the value of decentralisation in a service delivery organisation

“…The ten main activities (A 1–10) identified by the senior management team in the interviews are listed in Table 1 and described below. The activities can be categorised in three different dimensions from the perspective of the overarching aim; to increase the delegated authority, to assure accountability and improve capability both on organisational and individual level (Bossert, 1998; Ohrling et al , 2021).…”

“…The most important findings in a previous scoping review of the scientific literature and other research articles explaining effective decentralisation are used to test the logic of the underlying assumptions of the programme theory (Table 2) (Ohrling et al , 2021).…”

“…Bossert's decision space model, its development in subsequent empirical studies and stratified systems theory was synthesised in a revised model in our scoping review and proposed as an explanatory model to guide management decentralisation in service delivery organisations (Rowbottom and Billis, 1977; Bossert, 1998; Jaques, 1989; Bossert and Mitchell, 2011; Liwanag and Wyss, 2018; Abimbola et al , 2019; Ohrling et al , 2021).…”

“…Decentralisation has been offered as one way of increasing management efficiency. The literature on decentralisation in healthcare deals predominantly with systems and states, not service delivery organisations and providers of healthcare (Ohrling et al , 2021). Both positive and negative results of decentralisation are reported by single decentralisation studies as well as by reviews of empirical studies and perspective articles (Bossert, 1998; Peckham et al , 2005; Bossert and Mitchell, 2011).…”

“…We define decentralisation as a management practice where service delivery managers receive and exercise delegated authority to achieve high service performance within specified limits to their authority and are held accountable for doing so. This is based on the theory that the four most important factors explaining effective decentralisation are (1) delegated authority, clearly specified in relation to different sources, with limits to this authority specified, (2) the capacity of the manager to appropriately exercise this authority which is a function of their individual competence and the system´s capacity to provide the support they need, (3) effective accountability for performance, which means (a) operating within limits such as standards, including those requiring coordination, and (b) exercising authority appropriately to achieve high service performance and (4) a culture of norms that support using initiative to meet local needs and achieve high service performance (Bossert, 1998; Bossert and Mitchell, 2011; Ohrling et al , 2021).…”