Sustainability in Health care by Allocating Resources Effectively (SHARE) 6: investigating methods to identify, prioritise, implement and evaluate disinvestment projects in a local healthcare setting

Abstract

BackgroundThis is the sixth in a series of papers reporting Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. The SHARE program was established to investigate a systematic, integrated, evidence-based approach to disinvestment within a large Australian health service. This paper describes the methods employed in undertaking pilot disinvestment projects. It draws a number of lessons regarding the strengths and weaknesses of these methods; particularly regarding the crucial first step of identifying targets for disinvestment.MethodsLiterature reviews, survey, interviews, consultation and workshops were used to capture and process the relevant information. A theoretical framework was adapted for evaluation and explication of disinvestment projects, including a taxonomy for the determinants of effectiveness, process of change and outcome measures. Implementation, evaluation and costing plans were developed.ResultsFour literature reviews were completed, surveys were received from 15 external experts, 65 interviews were conducted, 18 senior decision-makers attended a data gathering workshop, 22 experts and local informants were consulted, and four decision-making workshops were undertaken. Mechanisms to identify disinvestment targets and criteria for prioritisation and decision-making were investigated. A catalogue containing 184 evidence-based opportunities for disinvestment and an algorithm to identify disinvestment projects were developed. An Expression of Interest process identified two potential disinvestment projects. Seventeen additional projects were proposed through a non-systematic nomination process. Four of the 19 proposals were selected as pilot projects but only one reached the implementation stage. Factors with potential influence on the outcomes of disinvestment projects are discussed and barriers and enablers in the pilot projects are summarised.ConclusionThis study provides an in-depth insight into the experience of disinvestment in one local healthcare service. To our knowledge, this is the first paper to report the process of disinvestment from identification, through prioritisation and decision-making, to implementation and evaluation, and finally explication of the processes and outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2269-1) contains supplementary material, which is available to authorized users.

Bibliometric Review of the Knowledge Base on Healthcare Management for Sustainability, 1994–2018

“…More specifically, author co-citation analysis revealed three schools of thought in the SHM literature: (1) sustainable change in health care services, (2) innovations in managing health care operations, and (3) prioritizing and allocating resources for sustainability. The science map of the SHM literature highlighted both the micro-level focus on healthcare management in organizations [11,13,49,63,66], as well as macro-level issues in healthcare systems [70][71][72][73][74][75][76][77].…”

“…The first school of thought, sustainable change in health care services, surfaced factors such as clear vision, program leadership, corporate culture, and ongoing capacity development that enable staff to adapt to changing requirements and conditions [3,72,85,86]. The second school of thought, innovations in managing health care operations, highlighted the role that innovation and technology have come to play in increasing access to quality care, and improving operational quality in healthcare organizations [49].…”

“…Key authors include five Australian scholars: Harris with 77 co-citations [70][71][72][73][74][75][76][77], Allen with 53 co-citations [70][71][72][75][76][77], King with 44 co-citations [70][71][72][75][76][77], Elshaung with 42 co-citations [74,[78][79][80], and Mitton with 42 co-citations [78,81]. Key literature within this School centers on a series of 11 research papers published under the acronym, 'SHARE' or 'Sustainability in health care by allocating resources effectively' [70,[72][73][74][75][76][77][82][83][84]. These papers investigated the process of disinvestment in the Australian health services network using an evidence-based approach.…”

Contributing to Sustainable Healthcare Systems with Case Theory

“…Other dimensions of the sustainability of healthcare systems have been identified in the effectiveness of resource allocation. To this extent, a practical tool was developed to evaluate disinvestment feasibility in Australian health services (Harris et al, 2017).…”

“…In an attempt to explore methods to identify technologies and practices suitable for disinvestments and drive the implementation and evaluation of relative projects, both case study research (with mixed methods and tools such as interviews, workshops, consultations, etc.) and action research methodologies were adopted (Harris et al, 2017).…”