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

Abstract

PurposeDecentralisation in health care has been proposed as a way to make services more responsive to local needs and by that improve patient care. This study analyses how the senior management team conceptualised and implemented a decentralised management model within a large public health care delivery organisation.Design/methodology/approachData from in-depth interviews with a senior management team were used in a directed content analysis. Underlying assumptions and activities in the decentralisation process are presented in the logic model and scrutinised in an a priori logic analysis using relevant scientific literature.FindingsThe study found support in the scientific literature for the underlying assumptions that increased responsibility will empower managers as clinical directors know their local prerequisites best and are able to adapt to patient needs. Top management should function like an air traffic control tower, trust and loyalty improve managerial capacity, increased managerial skills release creativity and engagement and a system perspective will support collaboration and learning.Originality/valueTo the authors’ knowledge this is the first a priori logic analysis of a decentralised management model in a healthcare delivery organisation in primary and community care. It shows that the activities consist with underlying assumptions, supported by evidence, and timely planned give managers decision space and ability to use their delegated authority, not disregarding accountability and fostering necessary organisational and individual capacities to avoid suboptimisation.

No man is an island: management of the emergency response to the SARS-CoV-2 (COVID-19) outbreak in a large public decentralised service delivery organisation

“…The aim of management decentralisation within a healthcare organisation is to improve resource utilisation to better match to patients’ needs and adapt to local conditions. The focus is on organisational performance and efficiency as shown in empirical studies of service delivery organisations outside the hospital environment [ 4 , 5 ]. In this study we have had the opportunity to explore if a decentralised service provider showed organisational agility when struck by unexpected turbulence caused by the outbreak of the Covid-19 pandemic,…”

“…There is a general consensus that these principles are shown to be valid on a systems level in public healthcare [ 1 – 3 ]. Our studies of one large healthcare service delivery organisation in Sweden indicate that the same mechanisms work intra-organisationally [ 4 , 5 ]. When applying management decentralisation at the organisational level the main objective and focus are, consequently, on promoting organisational performance.…”

“…We were able to do so as a result of access to such a provider that applies management decentralisation [ 13 ]. We see as an advantage that we have performed earlier in-depth studies of the management model [ 4 , 5 ]. To our mind, two alternative assumptions are both plausible: rapid adjustment to a radically changed environment can either be promoted by centralised, command-and-control management, or by a decentralised organisation with decision-making authority delegated to front-line managers, who flexibly and more rapidly will carry out the changes in operations needed.…”

Managers do it their way: How managers act in a decentralised healthcare services provider organisation – a mixed methods study

“…Findings were previously reported in detail in the a priori programme theory evaluation of the management model. 10…”

“…A semi-structured interview guide with open-ended questions was used, addressing the three components in the revised Bossert 12 model of management decentralisation. 10…”