Towards a new paradigm of healthcare: Addressing challenges to professional identities through Community Operational Research

Abstract

Healthcare worldwide faces severe quality and cost issues, and the search for sustainability in healthcare establishes a grand challenge. Public interest is growing in a systemic re-conceptualizing of healthcare, from primarily a consumerist problem of individual need for treatment to a need for communities themselves to become more effective in systemic prevention, coping and caring. In community led approaches, scarce resources are moved away from ever-increasing consumerist services to empower, develop and enable communities to plan their own health and community improvements in mutually interdependent patterns of care often seen as 'co-production'. This approach is exemplified by the innovative NUKA system of community led healthcare which originated in Alaska and which was trialled in Scotland in 2012, where it did not achieve similar acclaim as in the United States. The Scottish NUKA trial was due to run for six months and initially appeared to be working well, but opposition from professionals meant the trial was ended early. Our research found that omitting to account for the strong professional identity of GPs and other practice staff was instrumental in the failure of the trial. Beyond deficiencies inadequately considering professional identities, the trial also failed to engage the community and its patients as owners and architects of the system. We argue that the root cause of these problems, was a more general critical systemic failure to manage participatory boundaries and associated identities. Community Operational Research practitioners have developed relevant theories, methodologies and methods to address issues of participation and identity, so could make a significant contribution to opening up new solutions for community led healthcare.

Designing a recovery-orientated system of care: A community operational research perspective

“…For instance, we note the identity barriers to community led healthcare observed by Walsh, Kittler & Mahal (2018). This suggests that more attention needs to be given, as Johnson et al (2018) suggest, to the emerging trend of behavioural operational research as well as cross pollination of COR with other domains within operational research, management science and systems thinking.…”

“…Realising these mutual benefits requires a significant degree of shared understandings between current or potential partners which may be quite limited (Howieson et al, 2013, Walsh et al, 2018.…”

“…This may be achieved, Walsh, Kittler & Mahal (2018) suggest from a COR viewpoint, by empowering, developing and enabling communities to plan their own health and community improvements. Our research suggests this can be achieved with some aid being used to catalyse the development of assets, the building of relationships and the generation of social capital.…”

Let’s Require Patients to Review a High-quality Decision Aid Before Receiving Important Tests and Treatments

“…This proposal is highly consistent with other thinking about how to increase the voice and power of patients in their medical care, such as the highly praised NUKA project: an innovative reorganization of health care delivery in Anchorage, Alaska, through which Alaska Native people are in control as the “customer-owners” of their health care system. 45 , 46 …”

Community Operational Research: Innovations, internationalization and agenda-setting applications

“…Switching attention to the strategic planning of public health services, Walsh, Kittler and Mahal (2018) discuss the attempt of a Scottish regional health authority to import a Native American model of health care provision from Alaska, which emphasised strong community engagement and a preventative approach to common health problems. The latter model had been very successful in Alaska in both improving population health and reducing the cost burden of disease at a time when the latter was massively rising in other geographical areas.…”