Tackling disinvestment in health care services

Abstract

Purpose -The aims of this paper are to explore the experiences of budget holders within the English National Health Service (NHS), in their attempts to implement programmes of disinvestment, and to consider factors which influence the success (or otherwise) of this activity. Design/methodology/approach -Between 24 January and 15 March 2011 semi-structured, telephone interviews were conducted with representatives of 12 Primary Care Trusts in England. Interviews focussed on: understanding of the term "disinvestment"; current activities, and perceived determinants of successful disinvestment decision making and implementation. Data were organised into themes according to standard qualitative data coding practices. Findings -Findings indicate that experiences of disinvestment are varied and that organisations are currently adopting a range of approaches. There are a number of apparently influential determinants of disinvestment which relate to both health system features and organisational characteristics. According to the experiences of the interviewees, many of the easier disinvestment options have now been taken and more ambitious plans, which require wider engagement and more thorough project management, will be required in the future. Research limitations/implications -Findings from the research suggest that issues around understanding and usage of disinvestment terminology should be addressed and that a more in-depth and ethnographic research agenda will be of most value in moving forward both the theory and practice of disinvestment. Originality/value -This research suggests that, in the English NHS at least, there is a disjuncture between common usage of the term "disinvestment" and the way that it has previously been understood by the wider research community. In addition to this, the research also highlights a broader range of potential determinants of disinvestment than are considered in the extant literature.

Knowledge translation and health technology reassessment: identifying synergy

“…Disinvestment, is defined as the process of completely or partially withdrawing healthcare resources from currently funded areas that provide little benefit for their cost [7]. Disinvestment can lead to full or partial withdrawal of a technology, contractual variation, restriction, or substitution and employs financial disincentives [5, 8]. De-implementation is defined as the process where the use of low-value care is reduced or stopped on a structural basis in a planned process that uses a set of activities, which can include financial disincentives, but also uses other activities such as data feedback, education, and system interventions [8].…”

“…Additionally, providers could succumb to pressure from the patient in providing unnecessary tests or treatments. Facilitators to overcome these barriers include the use of KT strategies such as clinical champions to increase buy-in, and providing knowledge of the net benefit to patients if the technology is removed or decreased [2, 5, 8]. Knowledge translation and implementation of HTR recommendations could also be motivated by explicitly stating that the intention is to improve efficiency, patient safety and patient outcomes, rather than cost savings [21].…”

“…There could be public pressure or the need for government to follow another jurisdiction’s decision on a particular technology. Political support, collaboration with government, and building relationships are important mitigating factors [2, 5, 20, 21]. In addition, policy regulations and restrictions in funding could be the policy change levers used to implement HTR recommendations [3, 8].…”

“…Broad and early stakeholder engagement, trusting and respectful relationships, and face-to-face interactions are facilitators to ensure ongoing linkage and exchange. From a provider perspective, strong leadership, the use of clinical champions, and understanding their perceptions is key [2, 5, 20]. From the public/patient perspective, the concept of HTR or ‘low-value care’ may not be well understood [24].…”

Models and applications for measuring the impact of health research: update of a systematic review for the Health Technology Assessment programme

“…Between them they identified 78 articles, of which 38 were deemed relevant. Of these: l 16 were descriptive or discursive 83,[301][302][303][304][305][306][307][308][309][310][311][312][313][314][315] l six were on programme budgeting and marginal analysis [316][317][318][319][320][321] l six were surveys of attitudes to disinvestment 302, [322][323][324][325][326] l five related to NICE [327][328][329][330][331] l one analysed a RCT in terms of discontinuation of a particular drug. 332 Four systematic reviews were identified, three of which were concerned with disinvestment.…”