Exploring the neglected and hidden dimensions of large‐scale healthcare change

Objectives This study sought to understand the different approaches taken to involving the public in service reconfiguration in the four United Kingdom health systems. Methods This was a multi-method study involving policy document analysis and qualitative semi-structured interviews in England, Northern Ireland, Scotland and Wales. Results Despite the diversity of local situations, interview participants tended to use three frames within which they understood the politics of service reconfigurations: an adversarial approach which assumed conflict over scarce resources (change against the public); a communications approach which defined the problem as educating the public on the desirability of change (change for the public); and a collaborative approach which attempted to integrate the public early into discussions about the shape and nature of desirable services (change with the public). These three framings involved different levels of managerial time, energy, and resources and called on different skill sets, most notably marketing and communications for the communications approach and community engagement for the collaborative approach. Conclusions We argue that these framings of public involvement co-exist within organisations. Health system leaders, in framing service reconfiguration as adversarial, communicative or collaborative, are deciding between conceptions of the relationship between health care organisations and their publics in ways that shape the nature of the debates that follow. Understanding the reasons why organisations adopt these frames would be a fruitful way to advance both theory and practice.

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“…This definition allowed us to acknowledge the subjectivity of what constitutes ‘major’ in different contexts. 7…”

Section: Methodsmentioning

confidence: 99%

Changing health care with, for, or against the public: an empirical investigation into the place of the public in health service reconfiguration

Greer

Stewart

Ercia

et al. 2020

J Health Serv Res Policy

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“…While recent interest in the theory and practice of MSC has grown [7,8,9,21,22,23], there is a lack of research on the navigation of MSC within health systems in low and middle-income countries (LMIC).…”

Section: Study Context and Case Selectionmentioning

confidence: 99%

Qualitative Analysis of the Coordination of Major System Change Within the Colombian Health System in Response to COVID-19: Study Protocol

Turner¹,

Niño

2020

Preprint

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Background Coronavirus (COVID-19) is posing a major and unprecedented challenge to health service planning and delivery across health systems internationally. This nationally-funded study is analysing the response of the Colombian health system to the COVID-19 pandemic, drawing on qualitative case studies of three local health systems within the country. The approach will be informed by the concept of 'major system change' - or coordinated change among a variety of healthcare organisations and other relevant stakeholders - in order to identify processes that both enable and inhibit adaptation of health services to the challenges presented by COVID-19. The study will collect information on capacity “bottlenecks” as well as successful practices and forms of innovation that have emerged locally, which have the potential for being 'scaled up' across Colombia's health services. Methods/design This qualitative study will be undertaken in two phases. In the first, up to 30 stakeholder interviews will be conducted to ascertain and share immediate challenges and opportunities for improvement in response to COVID-19 that can be shared in a timely way with health service leaders to inform immediate health service planning. The stakeholders will be selected in order to sample a range of planning, provider and intermediary organizations within the health system at the national level. In the second, up to 60 further interviews will be conducted to develop in-depth case studies of three local health systems at the metropolitan area level within Colombia. The interview data will be supplemented with documentary analysis and, where feasible, non-participant observation of meetings directly related to the planning and implementation of actions responding to COVID-19. The study will also establish mechanisms for providing timely, formative feedback to inform health system planning relating to COVID-19 and future pandemics by ascertaining stakeholders' preferences during the interviews and wider scoping discussions. Discussion The study's findings will aid evaluation of the relevance of the concept of major system change in a context of 'crisis' decision-making and contribute to international lessons on improving health systems' capacity to respond to COVID-19 and future pandemics. Study findings will be shared among various stakeholders in the Colombian healthcare system in a formative and timely way in order to inform healthcare planning in response to COVID-19 and future pandemics. Conducting the study at a time of COVID-19 raises a number of practical issues (including physical distancing and pressure on health services) which have been anticipated in the study design and research team's ways of working.

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“…There may also be negative consequences of MSC as clinical teams, therapeutic relationships and collective identities may be disrupted, possibly without generating promised health care benefits for the population. 6…”

Section: Introductionmentioning

confidence: 99%

Implementing major system change in specialist cancer surgery: The role of provider networks

Vindrola‐Padros

Ramsay

Perry

et al. 2020

J Health Serv Res Policy

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Objective Major system change (MSC) has multiple, sometimes conflicting, goals and involves implementing change across a number of organizations. This study sought to develop new understanding of how the role that networks can play in implementing MSC, using the case of centralization of specialist cancer surgery in London, UK. Methods The study was based on a framework drawn from literature on networks and MSC. We analysed 100 documents, conducted 134 h of observations during relevant meetings and 81 interviews with stakeholders involved in the centralization. We analysed the data using thematic analysis. Results MSC in specialist cancer services was a contested process, which required constancy in network leadership over several years, and its horizontal and vertical distribution across the network. A core central team composed of network leaders, managers and clinical/manager hybrid roles was tasked with implementing the changes. This team developed different forms of engagement with provider organizations and other stakeholders. Some actors across the network, including clinicians and patients, questioned the rationale for the changes, the clinical evidence used to support the case for change, and the ways in which the changes were implemented. Conclusions Our study provides new understanding of MSC by discussing the strategies used by a provider network to facilitate complex changes in a health care context in the absence of a system-wide authority.

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Exploring the neglected and hidden dimensions of large‐scale healthcare change

Cited by 30 publications

References 76 publications

Changing health care with, for, or against the public: an empirical investigation into the place of the public in health service reconfiguration

Changing health care with, for, or against the public: an empirical investigation into the place of the public in health service reconfiguration

Qualitative Analysis of the Coordination of Major System Change Within the Colombian Health System in Response to COVID-19: Study Protocol

Implementing major system change in specialist cancer surgery: The role of provider networks

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