Leadership and transformational change in healthcare organisations: A qualitative analysis of the North East Transformation System

Erskine, Jonathan; Hunter, David J.; Small, Adrian; Hicks, C; McGovern, Tom; Lugsden, Ed; Whitty, Paula; Steen, Nick; Eccles, Martin

doi:10.1177/0951484813481589

Cited by 55 publications

(29 citation statements)

References 17 publications

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“…Previous studies of health systems transformation have identified factors that are key to the successful implementation of policy, including supportive organisational culture, cooperative interorganisation networks, clear communication and a willingness to engage with systems leaders 17. Our key findings echo those reported in an earlier ambitious transformational change initiative undertaken in the North East of England 26. This occurred prior to the major structural changes imposed on the NHS as a consequence of the Health and Social Care Act 2012, and had it not been for that disruptive legislation the initiative would have continued as there was a high degree of commitment to it and a significant investment of resources and political and managerial capital.…”

Section: Discussionsupporting

confidence: 79%

Lessons learnt from the implementation of new care models in the NHS: a qualitative study of the North East Vanguards programme

et al. 2019

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ObjectiveTo examine lessons learnt from the implementation of five Vanguard initiatives in the North East of England.DesignData collection comprised semistructured interviews with key informants at each site.SettingThe study took place across six local authority areas in the North East of England and within six clinical commissioning groups responsible for the delivery of each Vanguard’s aims and objectives.ParticipantsSixty-six interviewees with participants from five Vanguard initiatives in the North East of England, including senior clinicians, project leads and directors, commissioners, and healthcare managers.ResultsWhile the context for each Vanguard is separate and distinct, there also exists a set of common issues which have a regional dimension. Participants felt that the national programme helped to raise the profile of local change initiatives and also contributed to the wider understanding of regional service integration issues. At the same time our findings demonstrate that all five sites experienced, and were subject to, unrealistic pressure placed on them to deliver outcomes. Of particular concern among all sites was the sheer scale and pace of change occurring at the same time as the National Health Service was being tasked with making significant, if unrealistic, efficiency savings.ConclusionsIt is too early to conclude with any confidence that a successful outcome for the new care models programme will be forthcoming. While early indications show some encouraging signs of promise, the overall context in which the complex and ambitious changes are being implemented remains both fragile and fluid.

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Section: Discussionsupporting

confidence: 79%

Lessons learnt from the implementation of new care models in the NHS: a qualitative study of the North East Vanguards programme

et al. 2019

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“…It was certainly a key factor throughout the NETS at all levels and across all organisations in our case study sites. 148 The Pettigrew et al 125 'receptive contexts for change' framework includes as one of the eight factors 'key people leading change'. The words were deliberately chosen to avoid connotations of heroic and individualistic 'macho managers'.…”

Section: The Importance Of Leadership and Its Effectivenessmentioning

confidence: 99%

A mixed-methods evaluation of transformational change in NHS North East

Hunter

Erskine

Hicks

et al. 2014

Health Services and Delivery Research

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BackgroundThe North East Transformation System (NETS) was conceived as an experiment in adopting large-scale transformational change across a NHS region in England. Although the NHS in the North East performs well, the health of the population ranks among the poorest in the country. The NETS was viewed as a means of addressing this conundrum. It comprised three components: Vision, Compact and Method.ObjectivesThe evaluation study comprised six elements: a literature review; an evaluation of the evolution and impact of the NETS; an identification of the factors facilitating, and/or acting as barriers to, successful change; an assessment of the role of the NETS project team; establishing how far the changes introduced through the NETS became embedded and sustained; and an evaluation of the impact of the NETS on end users.DesignThe research comprised a longitudinal mixed-methods study conducted over 3.5 years. Research methods included 68 semistructured interviews, observation, two focus groups, documentary analysis and interrupted time series (ITS) analysis. The ITS component comprised analysis of five rapid process improvement workshops in two of the sites.SettingThe research setting was the NHS North East region until its abolition in April 2013 following the UK government’s NHS changes. Fourteen sites were selected for the study, comprising primary care trusts as commissioners, and provider trusts including mental health, community, acute care and ambulance services.ParticipantsThe study respondents were members of staff in the 14 sites drawn from different levels of their organisations.InterventionsThe NETS comprised a complex set of interventions aimed at improving the efficiency and effectiveness of care pathways for staff and patients.Main outcome measuresThe ‘receptive contexts for change’ framework was used to evaluate the transformational change process and its outcomes.Data sourcesQualitative parts of the study drew on semistructured interviews, focus groups, observation and documents. Quantitative parts of the study used routinely collected NHS data.ResultsTransformational change in a complex system takes time and demands consistency, constancy of purpose and organisational stability. The NETS was seriously disrupted by the NHS changes announced in July 2010. Progress was sustained at four of the study sites, but slowed or ceased at the other sites. Leadership style was found to be critical to the success of transformational change.ConclusionsThe NETS was a bold and ambitious initiative which succeeded in bringing about real and lasting change in some parts of the North East. However, it was unable to fully realise its vision and purpose partly because of the widespread reorganisation of the NHS by the new coalition government.Future workThere is a need to develop new methods to understand how change occurs, or fails, in complex settings like the NHS. There is a need for more in-depth studies in those sites that were able to implement and sustain change. This would inform future policy and practice. The results of the quantitative analyses were less conclusive than those obtained by qualitative methods. Further development of mixed-methods approaches would provide additional support for evidence-based decision-making.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…The NETS would not have been conceived or happened if a handful of key people in NHS North East had not had the vision and commitment to see it happen (Erskine et al, 2013). These individuals largely remained together over a period of years to provide continuity and consistency of purpose.…”

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confidence: 99%

Doing transformational change in the English NHS in the context of “big bang” redisorganisation

Hunter

Erskine²,

Small³

et al. 2015

Journal of Health Organization and Management

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For AuthorsIf you would like to write for this, or any other Emerald publication, then please use our Emerald for Authors service information about how to choose which publication to write for and submission guidelines are available for all. Please visit www.emeraldinsight.com/authors for more information. About Emerald www.emeraldinsight.comEmerald is a global publisher linking research and practice to the benefit of society. The company manages a portfolio of more than 290 journals and over 2,350 books and book series volumes, as well as providing an extensive range of online products and additional customer resources and services.Emerald is both COUNTER 4 and TRANSFER compliant. The organization is a partner of the Committee on Publication Ethics (COPE) and also works with Portico and the LOCKSS initiative for digital archive preservation.*Related content and download information correct at time of download. Edward LugsdenNewcastle University Business School, Newcastle University, Newcastle upon Tyne, UK AbstractPurpose -The purpose of this paper is to examine a bold and ambitious scheme known as the North East transformation system (NETS). The principal aim of the NETS is the achievement of a step-change in the quality of health services delivered to people living in the North East region of England. The paper charts the origins of the NETS and its early journey before describing what happened to it when the UK coalition government published its proposals for unexpected major structural change in the NHS. This had a profound impact on the leadership and direction of the NETS and resulted in it taking a different direction from that intended. Design/methodology/approach -The research design took the form of a mixed methods, longitudinal 3.5-year study aimed at exploring transformational change in terms of content, context, process and outcomes. The sample of study sites comprised 14 NHS trusts in the North East region chosen to provide geographical coverage of the area and to reflect the scale, scope and variety of the bodies that formed part of the NETS programme. The qualitative component of the research, which the paper draws upon, included 68 semi-structured interviews, observational studies and focus groups. Data analysis made use of both deductive and inductive frameworks. The deductive framework adopted was Pettigrew et al.'s "receptive contexts for change" and four of the eight factors stood out as especially important and form the basis of the paper. being especially significant: environmental pressure, quality and coherence of policy, key people leading change, supportive organisational culture. Perhaps the most significant lesson from the NETS is that achieving whole systems change is particularly vulnerable to the vicissitudes of politics especially where that system, like the UK NHS, is itself subject to those very same pressures. Yet, despite having an enormous influence on health policy, the political context is frequently avoided in research or not regarded as instrumental in determining the ...

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Leadership and transformational change in healthcare organisations: A qualitative analysis of the North East Transformation System

Cited by 55 publications

References 17 publications

Lessons learnt from the implementation of new care models in the NHS: a qualitative study of the North East Vanguards programme

Lessons learnt from the implementation of new care models in the NHS: a qualitative study of the North East Vanguards programme

A mixed-methods evaluation of transformational change in NHS North East

Doing transformational change in the English NHS in the context of “big bang” redisorganisation

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