Devolving healthcare services redesign to local clinical leaders: does it work in practice?
Journal of Health Organization and Management
ISSN: 1477-7266
Article publication date: 25 January 2019
Issue publication date: 5 April 2019
Abstract
Purpose
The purpose of this paper is to present the findings arising from a three year research project which investigated a major system-wide change in the design of the NHS in England. The radical policy change was enshrined in statute in 2012 and it dismantled existing health authorities in favour of new local commissioning groups built around GP Practices. The idea was that local clinical leaders would “step-up” to the challenge and opportunity to transform health services through exercising local leadership. This was the most radical change in the NHS since its inception in 1948.
Design/methodology/approach
The research methods included two national postal surveys to all members of the boards of the local groups supplemented with 15 scoping case studies followed by six in-depth case studies. These case studies focused on close examination of instances where significant changes to service design had been attempted.
Findings
The authors found that many local groups struggled to bring about any significant changes in the design of care systems. But the authors also found interesting examples of situations where pioneering clinical leaders were able to collaborate in order to design and deliver new models of care bridging both primary and secondary settings. The potential to use competition and market forces by fully utilising the new commissioning powers was more rarely pursued.
Practical implications
The findings carry practical implications stemming from positive lessons about securing change even under difficult circumstances.
Originality/value
The paper offers novel insights into the processes required to introduce new systems of care in contexts where existing institutions tend to revert to the status quo. The national survey allows accurate assessment of the generalisability of the findings about the nature and scale of change.
Keywords
Acknowledgements
The research underpinning this paper was funded by the NIHR (Grant Number 12/136/104). The views expressed are those of the authors and not necessarily those of the National Institute for Health Research or the Department of Health. Further details of this project can be found in the Final Report published by the NIHR: Storey J., Holti R., Hartley J, Marshall M., Matharu T. (2018) “Clinical leadership in service redesign using clinical commissioning groups: a mixed-methods study”, Health Service Delivery Research 6(2).
Citation
Storey, J., Holti, R., Hartley, J. and Marshall, M. (2019), "Devolving healthcare services redesign to local clinical leaders: does it work in practice?", Journal of Health Organization and Management, Vol. 33 No. 2, pp. 188-203. https://doi.org/10.1108/JHOM-05-2018-0144
Publisher
:Emerald Publishing Limited
Copyright © 2019, Emerald Publishing Limited