Transitions and Boundaries in the Coordination and Reform of Health Services

Building Knowledge, Strategy and Leadership

Peter Nugus, Charo Rodriguez, Jean-Louis Denis, Denis Chênevert, Peter Nugus, Charo Rodriguez, Jean-Louis Denis, Denis Chênevert

• Publisher: Palgrave Macmillan
• Year: 2020
• Print ISBN:
  9783030266837
• eBook ISBN:
  9783030266844
• Topic: Business
• Subtopic: Business Strategy
• Index: Business

Health systems worldwide are grappling with the challenge of coordinating difference in an increasingly complex care environment. In response this book features the latest research on organizational studies in healthcare and explores the relationship between strategic and organic change and what this means for the way we organize health work. Focusing on the complexity of healthcare environments, it discusses the need to cross professional and organizational boundaries.  Specifically, this book focuses on the implications for health systems in the way that they continue to balance planning and intervention with organic learning systems. 

Comprising the best contributions from the 2018 Conference on Organizational Behaviour in Health Care (OBHC), this book is an important resource for healthcare researchers, as well as policy-makers and managers within the industry. Contributors explore the extent to which healthcare is codified through empirical analysis of practical interventions and conceptual debate.

Part ICoordinating Care Across Organisational and Sectoral Boundaries

This first Part orients the book with a series of conceptually-informed innovations in policy and practice that aim to contribute to care coordination across organisational and sectoral boundaries. The first chapter, contributed by Maniatopoulos and colleagues, focuses on initiatives in the National Health Service of England, to support system-wide lessons of care organisation among a select group of “Vanguard” sites. In the second chapter, also from the UK, Bridges and colleagues trace the contextual factors that are central to embedding compassionate care interventions and micro and meso organisational levels. The following chapter, contributed by Dickinson and colleagues, stands outside conventional health services, showing how a single Australian organisation, One Disease, is able to optimise various and diverse networks that might be less easy for embedded health services to reach. Finally, Goldberg and Mohan’s study, from the US, shows the dexterity of local health services to be able to respond uniquely and appropriately, through multi-sector collaboration, relationship-building and embedding professional training opportunities, to the health and social needs of vulnerable communities.

© The Author(s) 2020

P. Nugus et al. (eds.)Transitions and Boundaries in the Coordination and Reform of Health ServicesOrganizational Behaviour in Healthcarehttps://doi.org/10.1007/978-3-030-26684-4_1

Begin Abstract

1. Implementing the New Care Models in the NHS: Reconfiguring the Multilevel Nature of Context to Make It Happen

Gregory Maniatopoulos¹ , David J. Hunter¹ , Jonathan Erskine² and Bob Hudson³

(1)

Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK

(2)

Durham University, Durham, UK

(3)

Center for Health Services, University of Kent, Canterbury, UK

Gregory Maniatopoulos (Corresponding author)

Email: [email protected]

David J. Hunter

Email: [email protected]

Jonathan Erskine

Email: [email protected]

Bob Hudson

Email: [email protected]

Keywords

New care modelsHealth systemsImplementationNational Health ServiceEngland

List of Abbreviations

ACC:

Acute Care Collaboration Vanguard

ACO:

Accountable Care Organisations

CCG:

Clinical Commissioning Group

EHCH:

Enhanced Health in Care Homes

GP:

General Practice

ICP:

Integrated Care Partnerships

MCPs:

Multispeciality Community Providers

MDT:

Multidisciplinary Team

NCMs:

New Care Models

NHS:

National Health System

PACS:

Primary and Acute Care Systems

PbR:

Payments by Results

STPs:

Sustainability and Transformation Partnerships

UEC:

Urgent and Emergency Care

UK:

United Kingdom

5YFV:

NHS Five Year Forward View

End Abstract

Introduction

With health systems globally facing new and complex challenges, policy-makers are increasingly preoccupied with and thus prioritize transforming the way services are organised and provided to meet rapidly changing conditions (Hunter 2016; Hunter et al. 2015; WHO 2016, 2018). In the UK, the health and social care system faces mounting pressures to improve outcomes and reduce inequalities despite increasing financial stringency and uncertainty.

Following publication of the NHS Five Year Forward View (5YFV) in 2014, a Vanguard programme was introduced by NHS England (the executive non-departmental public body of the Department of Health and Social Care oversees the NHS) to test different approaches to health and social care service delivery (NHS England 2017). The reform programme has constituted the most significant and ambitious set of changes experienced by the health and social care sectors in England in recent years. In particular, the changes are not concerned primarily with structures or top-down reform edicts; rather, they seek new ways of working and joining up care across a whole system, driven by those on the front line. These reform initiatives have typically taken place under the banner of “Triple Aim” thinking, focusing on population health, effective patient-centred care, and per capita cost (Berwick et al. 2008). The NHS invited individual organisations and partnerships, including those with voluntary and community sector involvement, to apply to become pilot sites for the Vanguard new care models (NCMs) programme. In this context, the term “Vanguard” signifies a new care model that is exemplary in its innovative capacity to optimise the health of individuals and the population, through and while providing efficient health care. Overall, 50 Vanguards were established across England, tasked with designing and delivering a range of NCMs to tackle deep-seated problems typical of all health systems to a greater or lesser degree.

The NCMs include managing rising demand on accident and emergency services, keeping people out of hospital, effecting rapid discharge for those no longer in need of acute care, integrating health and social care, reducing silo working, and giving higher priority to prevention. The reform is intended to foster greater engagement of frontline staff by providing innovative ways of working that connect care and lessons across other services and indeed the whole health system, rather than rely solely on top-down reform edicts.

Against this background, we explore factors shaping the implementation of five Vanguard pilot sites for the NCM programme in the North East region of England. We draw upon an evaluation study, conducted over 12 months, which explored the implementation arrangements of the following Vanguards: Multispecialty Community Providers (MCP); Integrated Primary and Acute Care Systems (PACS) Vanguard; Acute Care Collaboration (ACC) Vanguard; Enhanced Health in Care Homes (EHCH) Vanguard; and Urgent and Emergency Care (UEC) Vanguard (see Appendix A for a brief description of each Vanguard). The evaluation was conducted during a time of ongoing policy changes, notably developments surrounding Sustainability and Transformation Partnerships (STPs), Accountable Care Organisations (ACOs), and Integrated Care Partnerships (ICPs).

In seeking to understand the changes and the likelihood of success, we draw upon Pettigrew et al.’s (1992a) “receptive contexts for change” framework, which we combine with more recent theoretical developments aiming to address the multilevel nature of context (Maniatopoulos et al. 2015; Greenhalgh et al. 2017). Despite its emphasis on the complex, multifaceted nature of implementing changes, we consider that the framework of “receptive contexts” acquires even greater nuance when framed in terms of multiple levels of context (macro-, meso-, and micro-) which has gained increasing currency among organisational and healthcare researchers (ibid.). Our purpose here is to broaden the scope and scale of analysis across the multiple levels of context shaping both process and outcomes of health systems transformation.

Implementation, Context, and Change: Towards a Multilevel Contextual Analysis

Theory and research addressing the diffusion of changes in healthcare organisations have accelerated and developed across a large, diverse, and complex literature, related frameworks, and disciplines, seeking to explore the contextual factors shaping the implementation process (Greenhalgh et al. 2004, 2005; Dopson and Fitzgerald 2005; Kaplan et al. 2010; Aarons et al. 2011; Bate 2014; Greener et al. 2014; Fulop and Robert 2015; Squires et al. 2015; May et al. 2016; Kyratsis et al. 2012; Nilsen 2015). Various conceptualisations of context reflect the different perspectives exploring the recursive relationship between human action and the wider organisational and system context (Greenhalgh et al. 2016; Damschroder et al. 2009).

Pettigrew et al.’s (1992a) “receptive contexts for change” framework was one of the first attempts to explicitly recognise the complex, multifaceted nature of implementing changes in practice. Such a perspective challenges the conventional split between policy formulation and implementation by viewing these processes not as discrete but as interactive (Pettigrew 1990; Pettigrew et al. 1992b). Its basic proposition is that any analysis of change should focus not solely on the content of the change initiative, but also on the process (including actions and interactions of key players) and on the context (both local or “inner” context and the “outer” context of national and regional policies and events) (Pettigrew et al. 1992a). This requires viewing change as a multifaceted process, involving social, political, cultural, environmental, and structural dimensions. As such, “receptive contexts” are defined as situations where there are features of both context and individual action that seem to be favourably disposed to change. Conversely, non-receptive contexts are those situations where a combination of conditions effectively creates blockages or resistance to change. The key fact...

Table of contents

• Cover
• Front Matter
• Part I. Coordinating Care Across Organisational and Sectoral Boundaries
• Part II. Reaching Across Ideological, Learning and Practice Boundaries
• Part III. Leadership as Boundary-Spanning Between Strategy, Identity, Knowledge and Change
• Part IV. Enacting Boundary Capabilities
• Back Matter