Understanding the impetus for major systems change: A multiple case study of decisions and non-decisions to reconfigure emergency and urgent care services

McHugh, Sheena; Droog, Elsa; Foley, Conor; Boyce, M; Healy, Orla; Browne, John

doi:10.1016/j.healthpol.2019.05.018

Cited by 8 publications

(14 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 59 Having physicians act as champions of a policy change, can help to get buy-in from other clinicians and thereby facilitate the implementation of a policy reform. 65 …”

Section: Resultsmentioning

confidence: 99%

“…59 Having physicians act as champions of a policy change, can help to get buy-in from other clinicians and thereby facilitate the implementation of a policy reform. 65 Participatory leadership practices motivate, provide autonomy, make performance measurement more accurate and meaningful, enable local improvement and can reinforce professionalism in ways that improve the manager-clinician relationship. 20 41 47 48 57 66-68 Anchoring quality improvement in professional practice develops a sense of common responsibility in the organisation, and combining it with education and research nurtures positive views on further improvement initiatives.…”

Section: Organisational Attributesmentioning

confidence: 99%

See 1 more Smart Citation

Medical leadership: boon or barrier to organisational performance? A thematic synthesis of the literature

Savage

Brommels

et al. 2020

BMJ Open

View full text Add to dashboard Cite

ObjectiveThe influx of management ideas into healthcare has triggered considerable debate about if and how managerial and medical logics can coexist. Recent reviews suggest that clinician involvement in hospital management can lead to superior performance. We, therefore, sought to systematically explore conditions that can either facilitate or impede the influence of medical leadership on organisational performance.DesignSystematic review using thematic synthesis guided by the Enhancing Transparency in Reporting the synthesis of Qualitative research statement.Data sourcesWe searched PubMed, Web of Science and PsycINFO from 1 January 2006 to 21 January 2020.Eligibility criteriaWe included peer-reviewed, empirical, English language articles and literature reviews that focused on physicians in the leadership and management of healthcare.Data extraction and synthesisData extraction and thematic synthesis followed an inductive approach. The results sections of the included studies were subjected to line-by-line coding to identify relevant meaning units. These were organised into descriptive themes and further synthesised into analytic themes presented as a model.ResultsThe search yielded 2176 publications, of which 73 were included. The descriptive themes illustrated a movement from 1. medical protectionism to management through medicine; 2. command and control to participatory leadership practices; and 3. organisational practices that form either incidental or willing leaders. Based on the synthesis, the authors propose a model that describes a virtuous cycle of management through medicine or a vicious cycle of medical protectionism.ConclusionsThis review helps individuals, organisations, educators and trainers better understand how medical leadership can be both a boon and a barrier to organisational performance. In contrast to the conventional view of conflicting logics, medical leadership would benefit from a more integrative model of management and medicine. Nurturing medical engagement requires participatory leadership enabled through long-term investments at the individual, organisational and system levels.

show abstract

“… 59 Having physicians act as champions of a policy change, can help to get buy-in from other clinicians and thereby facilitate the implementation of a policy reform. 65 …”

Section: Resultsmentioning

confidence: 99%

Section: Organisational Attributesmentioning

confidence: 99%

Medical leadership: boon or barrier to organisational performance? A thematic synthesis of the literature

Savage

Brommels

et al. 2020

BMJ Open

View full text Add to dashboard Cite

show abstract

“…Ten EDs were closed or re-designated, seven of which were in towns outside the main urban centres. 10 The reconfiguration programme received impetus from various patient safety investigations, and these informed a 2013 policy document on the role of smaller hospitals which reinforced the rationale for ongoing reconfiguration. 11 Details of the ED reconfiguration programme are shown in Fig 1 .…”

Section: Policy Historymentioning

confidence: 99%

“…The evidence, therefore, maps poorly to the policy arena because it does not speak to the majority of patients that are impacted when EDs are closed or downgraded. 10 There was also a sense that smaller EDs were not 'proper' by international standards as they had insufficient on-site support from surgery, anaesthesia and intensive care, and variable out-of-hours consultant cover. Some internal clinical stakeholders were less inclined to agree with broad generalisations about the safety of smaller EDs.…”

Section: Safetymentioning

confidence: 99%

See 1 more Smart Citation

The drivers and impact of emergency care reconfiguration in Ireland: Results from a large mixed-methods research programme

Browne

2020

Future Healthcare Journal

View full text Add to dashboard Cite

SMALL AND RURAL HOSPITALS POLICY The drivers and impact of emergency care reconfiguration in Ireland: Results from a large mixed-methods research programme Ireland, like many countries, has reconfi gured emergency care in recent years towards a more centralised model. Although centralisation is presented as 'evidence-based', the relevance of this evidence is challenged by groups which hold values beyond those implicit in the literature. The Study of the Impact of Reconfi guration on Emergency and Urgent Care Networks (SIREN) programme was funded to evaluate the development and performance of emergency and urgent care systems in Ireland. SIREN found that the drivers of reconfi guration in Ireland are based on safety and effi ciency claims which are highly contestable. Reconfi guration was not associated with improvements in safety or effi ciency and may have exacerbated the growing capacity challenges for acute hospitals. These fi ndings are consistent with UK research. Our study adds to an emerging literature on the interaction between a narrow technocratic approach to health system planning and the perspectives of the public and patients. ContextIreland is a country of 70,200 km² on the west of Europe with a population of 4.8 million in 2016. 1 This is projected to rise to as much as 6 million people by 2030. 2 While there is uncertainty over the exact geographical distribution of this growth, all regions, including those outside the main urban centres, will see an absolute rise. 3 It is also projected that older age groups will see a disproportionate rise. 2 This will substantially increase demand for public hospital services, for example, emergency department (ED) attendances are projected to increase by as much as 26% by 2030. 2 These demographic changes are occurring at a time of stress on the public hospital service. ED overcrowding, as measured by patients waiting for hospital admission on trolleys, is now a yearround phenomenon, particularly at the major regional hospitals. 4 Some of this stress is due to demographic pressure and some is related to resource constraints. ED attendances and emergency ABSTRACT admissions have increased in the last decade, while staff and acute bed numbers have fallen. 5-7 Ireland now has a very low stock of hospital beds by international standards and a bed occupancy rate of 95%, well above the Organisation for Economic Co-operation and Development average of 76%. 8

show abstract

A two-tiered public-private health system: Who stays in (private) hospitals in Ireland?

2020

View full text Add to dashboard Cite

Understanding the impetus for major systems change: A multiple case study of decisions and non-decisions to reconfigure emergency and urgent care services

Cited by 8 publications

References 28 publications

Medical leadership: boon or barrier to organisational performance? A thematic synthesis of the literature

Medical leadership: boon or barrier to organisational performance? A thematic synthesis of the literature

The drivers and impact of emergency care reconfiguration in Ireland: Results from a large mixed-methods research programme

A two-tiered public-private health system: Who stays in (private) hospitals in Ireland?

Contact Info

Product

Resources

About