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Williams I, Kapiriri L, Vélez CM, Aguilera B, Danis M, Essue B, Goold S, Noorulhuda M, Nouvet E, Razavi D, Sandman L. How did European countries set health priorities in response to the COVID-19 threat? A comparative document analysis of 24 pandemic preparedness plans across the EURO region. Health Policy 2024; 141:104998. [PMID: 38295675 DOI: 10.1016/j.healthpol.2024.104998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 12/21/2023] [Accepted: 01/15/2024] [Indexed: 02/26/2024]
Abstract
The COVID-19 pandemic has forced governments across the world to consider how to prioritise the allocation of scarce resources. There are many tools and frameworks that have been designed to assist with the challenges of priority setting in health care. The purpose of this study was to examine the extent to which formal priority setting was evident in the pandemic plans produced by countries in the World Health Organisation's EURO region, during the first wave of the COVID-19 pandemic. This compliments analysis of similar plans produced in other regions of the world. Twenty four pandemic preparedness plans were obtained that had been published between March and September 2020. For data extraction, we applied a framework for identifying and assessing the elements of good priority setting to each plan, before conducting comparative analysis across the sample. Our findings suggest that while some pre-requisites for effective priority setting were present in many cases - including political commitment and a recognition of the need for allocation decisions - many other hallmarks were less evident, such as explicit ethical criteria, decision making frameworks, and engagement processes. This study provides a unique insight into the role of priority setting in the European response to the onset of the COVID-19 pandemic.
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Affiliation(s)
- Iestyn Williams
- Health Services Management Centre, University of Birmingham Park house, 40 Edgbaston Park Rd Birmingham, B15 2RT, UK.
| | - Lydia Kapiriri
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, Hamilton, ON, L8S 4M4, Canada
| | - Claudia-Marcela Vélez
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, Hamilton, ON, L8S 4M4, Canada
| | - Bernardo Aguilera
- Faculty of Medicine and Science at the Universidad San Sebastian, Providencia, Santiago de Chile, Región Metropolitana, Chile
| | - Marion Danis
- Department of Bioethics, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20812, USA
| | - Beverley Essue
- Centre for Global Health Research, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada
| | - Susan Goold
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, 2800 Plymouth Road Building 14, G016, Ann Arbor, MI 48109, USA
| | - Mariam Noorulhuda
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, Hamilton, ON, L8S 4M4, Canada
| | - Elysee Nouvet
- School of Health Studies, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Donya Razavi
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, Hamilton, ON, L8S 4M4, Canada
| | - Lars Sandman
- National Centre for Priorities in Health, Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden
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Smith CQ, Williams I, Leggett W. A matter of (good) faith? Understanding the interplay of power and the moral agency of managers in healthcare service reconfiguration. Soc Sci Med 2024; 342:116553. [PMID: 38199008 DOI: 10.1016/j.socscimed.2023.116553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 12/12/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024]
Abstract
Previous studies of service reconfiguration in healthcare have explored the influence of power on processes and outcomes. However, in these accounts the moral agency of managers is often underemphasised. This paper draws on the theoretical tools provided by the sociology of morality to help deepen understanding of the interaction between power and moral agency in service reconfiguration in healthcare. It presents results from a qualitative study of a pan-organisational service reconfiguration in the NHS in England, involving nineteen in-depth interviews with those leading the change and the analysis of twelve programme documents. We combine concepts of the moral background and epistemic governance to interpret participants' conviction that the service change was 'the right thing to do'. The paper shows how epistemic work carried out by service change regulations shaped the moral background within which participants worked. This, in turn, channelled their moral agency - specifically their commitment to patient care - in a way that also reflected central priorities. The paper adds to sociological understandings of service reconfiguration through considering the interaction of structure, agency and power, while also developing the concept of the moral background to show how power relations can influence moral beliefs.
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Affiliation(s)
- Chris Q Smith
- Department of Social Policy, Sociology and Criminology, School of Social Policy, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.
| | - Iestyn Williams
- Health Services Management Centre (HSMC), School of Social Policy, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.
| | - Will Leggett
- Department of Social Policy, Sociology and Criminology, School of Social Policy, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.
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Smith CQ, Williams I. The Pervasiveness of Power: Dilemmas for Researchers of Major System Change in Healthcare Comment on "'Attending to History' in Major System Change in Healthcare in England: Specialist Cancer Surgery Service Reconfiguration". Int J Health Policy Manag 2023; 12:7639. [PMID: 38618819 PMCID: PMC10590230 DOI: 10.34172/ijhpm.2023.7639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 08/05/2023] [Indexed: 04/16/2024] Open
Abstract
To study major system change (MSC) in healthcare, it is crucial to consider the influence of power. Despite this, dominant perspectives on MSC in healthcare present these as relatively neutral processes, where reconfigurations are logical solutions to clearly defined problems. Perry and colleagues' paper adds to a growing body of research which challenges the presentation of MSC as neutral, managerial processes, instead identifying how power dynamics lie at the heart of why service change happens, how it unfolds, and its outcomes. However, the introduction of power considerations raises several overlapping methodological and ethical dilemmas for researchers, and questions regarding research design and dissemination. In this commentary, we use the insights generated by Perry et al to further explore these issues.
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Affiliation(s)
| | - Iestyn Williams
- School of Social Policy, University of Birmingham, Birmingham, UK
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Fredriksson M, Gustafsson IB, Winblad U. A New Way of Thinking and Talking About Economy: Clinic Managers' Perspectives on the Sustainable Implementation of a Decommissioning Programme in Sweden. Health Serv Insights 2023; 16:11786329231189402. [PMID: 37533504 PMCID: PMC10392155 DOI: 10.1177/11786329231189402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/05/2023] [Indexed: 08/04/2023] Open
Abstract
Healthcare systems may run into economic problems that may require 'active' decommissioning by policy-makers and managers. The aim of this study was to investigate, from a sustainability perspective, the implementation of an extensive decommissioning programme in one of the Swedish regions. Interviews were performed with 26 clinic managers 3 years after initial implementation. Those were analysed inductively, and then discussed based on a model of potential influences on sustainability. Although the programme was only 'partly sustained', the result point to a sustained attention to the health system's poor economy, visible in a great effort by the clinics to maintain their budgets. The most important influences were intervention fit and modifications made at the clinic level (i. innovation characteristics), clinic and health system leadership (ii. context), champions (iii. capacity) and shared decision-making and relationship building (iv. processes and interactions). When implementing decommissioning, it is particularly important to engage managers responsible for the care of patients and clinic budgets from an early stage and to allow them to design approaches based on the staff's and managers' detailed knowledge of the situation at their clinics and of the disease area, that is, to achieve fit at the clinics. In this way, the decommissioning approaches can more likely get the character of quality improvement efforts, which increases sustainability and may lead to positive quality outcomes. Despite being unpopular, the study suggests that decommissioning can have positive effects as well, such as creating opportunities to make difficult but necessary changes and fostering increased collegial support during the centralisation of services.
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Affiliation(s)
- Mio Fredriksson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Inga-Britt Gustafsson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Ulrika Winblad
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Davidson D, Williams I, Glasby J, Paine AE. 'Localism and intimacy, and… other rather imponderable reasons of that sort': A qualitative study of patient experience of community hospitals in England. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6404-e6413. [PMID: 36326043 PMCID: PMC10092860 DOI: 10.1111/hsc.14083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 08/03/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
Debates over the value and contribution of community hospitals are hampered by a lack of empirical assessment of the experience of patients using these services. This paper presents findings from a study which included a focus on patient and family-carer experiences of community hospitals in England. We adopted a qualitative design involving nine case study hospitals. Data collection included interviews with patients (n = 60), carers (n = 28) and staff (n = 89). Through patients and carers highlighting the value of community hospitals feeling 'close to home', providing holistic and personalised care and supporting them through difficult transitions, the study confirms the importance of functional and interpersonal aspects of care, while also highlighting the importance of social and psychological aspects. These included having family, friends and the community close, maintaining social connections during periods of hospital treatment, and feeling less anonymous and anxious when attending the hospital due to the high levels of familiarity and connectedness. Although the experiences uncovered in this study were not uniformly positive, patients and carers placed a high overall value on the care provided by community hospitals, often arguing that these were distinctive when compared to their experiences of using other health and care services. The study suggests the need to weigh the full range of these dimensions of patient experience-functional, interpersonal, social and psychological-when assessing the role and contribution of community hospitals.
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Affiliation(s)
- Deborah Davidson
- Health Services Management CentreSchool of Social PolicyUniversity of BirminghamBirminghamUnited Kingdom
| | - Iestyn Williams
- Health Services Management CentreSchool of Social PolicyUniversity of BirminghamBirminghamUnited Kingdom
| | - Jon Glasby
- School of Social PolicyUniversity of BirminghamBirminghamUnited Kingdom
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Black GB, Wood VJ, Ramsay AIG, Vindrola-Padros C, Perry C, Clarke CS, Levermore C, Pritchard-Jones K, Bex A, Tran MGB, Shackley DC, Hines J, Mughal MM, Fulop NJ. Loss associated with subtractive health service change: The case of specialist cancer centralization in England. J Health Serv Res Policy 2022; 27:301-312. [PMID: 35471103 PMCID: PMC9548928 DOI: 10.1177/13558196221082585] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Major system change can be stressful for staff involved and can result in 'subtractive change' - that is, when a part of the work environment is removed or ceases to exist. Little is known about the response to loss of activity resulting from such changes. Our aim was to understand perceptions of loss in response to centralization of cancer services in England, where 12 sites offering specialist surgery were reduced to four, and to understand the impact of leadership and management on enabling or hampering coping strategies associated with that loss. METHODS We analysed 115 interviews with clinical, nursing and managerial staff from oesophago-gastric, prostate/bladder and renal cancer services in London and West Essex. In addition, we used 134 hours of observational data and analysis from over 100 documents to contextualize and to interpret the interview data. We performed a thematic analysis drawing on stress-coping theory and organizational change. RESULTS Staff perceived that, during centralization, sites were devalued as the sites lost surgical activity, skills and experienced teams. Staff members believed that there were long-term implications for this loss, such as in retaining high-calibre staff, attracting trainees and maintaining autonomy. Emotional repercussions for staff included perceived loss of status and motivation. To mitigate these losses, leaders in the centralization process put in place some instrumental measures, such as joint contracting, surgical skill development opportunities and trainee rotation. However, these measures were undermined by patchy implementation and negative impacts on some individuals (e.g. increased workload or travel time). Relatively little emotional support was perceived to be offered. Leaders sometimes characterized adverse emotional reactions to the centralization as resistance, to be overcome through persuasion and appeals to the success of the new system. CONCLUSIONS Large-scale reorganizations are likely to provoke a high degree of emotion and perceptions of loss. Resources to foster coping and resilience should be made available to all organizations within the system as they go through major change.
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Affiliation(s)
- Georgia B Black
- Principal Research Fellow, Department of Applied Health Research, 4919University College London, London, UK
| | - Victoria J Wood
- Research Associate, Department of Applied Health Research, 4919University College London, London, UK
| | - Angus I G Ramsay
- Senior Research Fellow, Department of Applied Health Research, 4919University College London, London, UK
| | - Cecilia Vindrola-Padros
- Senior Research Fellow, Department of Targeted Intervention, University College London, London, UK
| | - Catherine Perry
- Research Fellow, Applied Research Collaboration Greater Manchester/Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Caroline S Clarke
- Senior Research Fellow, Research Department of Primary Care & Population Health, University College London, London, UK
| | - Claire Levermore
- Executive Director of Operations, North Central London Cancer Alliance, 8964University College London Hospitals NHS Foundation Trust, London, UK
| | - Kathy Pritchard-Jones
- Professor of Paediatric Oncology, North Central London Cancer Alliance, University College London Hospitals NHS Foundation Trust, & University College London Partners, London, UK
| | - Axel Bex
- Department of Urology, 4965Royal Free London NHS Foundation Trust London, London, UK.,Consultant Clinical Lead Specialist Centre for Kidney Cancer, Division of Surgery and Interventional Science, University College London, London, UK
| | - Maxine G B Tran
- Senior Lecturer in Renal Cancer Surgery, Division of Surgery and Interventional Science, University College London, London, UK.,Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - David C Shackley
- Director & Medical Lead, Greater Manchester Cancer; Clinical Lead Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - John Hines
- Department of Urology, 4965Royal Free London NHS Foundation Trust London, London, UK.,Consultant Urological Surgeon and Urology Pathway Director, Division of Surgery and Interventional Science, University College London, London, UK
| | - Muntzer M Mughal
- Honorary Clinical Professor, Division of Surgery and Interventional Science, University College London, London, UK
| | - Naomi J Fulop
- Professor of Health Care Organisation and Management, Department of Applied Health Research, 4919University College London, London, UK
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Gustafsson IB, Winblad U, Wallin L, Fredriksson M. Factors that shape the successful implementation of decommissioning programmes: an interview study with clinic managers. BMC Health Serv Res 2021; 21:805. [PMID: 34384416 PMCID: PMC8361631 DOI: 10.1186/s12913-021-06815-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 07/23/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND As a response to many years of repetitive budget deficits, Region Dalarna in Sweden started a restructuring process in 2015, and implemented a decommissioning programme to achieve a balanced budget until 2019. Leading politicians and public servants took the overall decisions about the decommissioning programme, but the clinical decision-making and implementation was largely run by the clinic managers and their staff. As the decommissioning programme improved the finances, met relatively little resistance from the clinical departments, and neither patient safety nor quality of care were perceived to be negatively affected, the initial implementation could be considered successful. The aim of this study was to investigate clinic managers' experience of important factors enabling the successful implementation of a decommissioning programme in a local healthcare organization. METHODS Drawing on a framework of factors and processes that shape successful implementation of decommissioning decisions, this study highlights the most important factors that enabled the clinic managers to successfully implement the decommissioning programme. During 2018, an interview study was conducted with 26 clinic managers, strategically selected to represent psychiatry, primary care, surgery and medicine. A deductive content analysis was used to analyze the interviews. By applying a framework to the data, the most important factors were illuminated. RESULTS The findings highlighted factors and processes crucial to implementing the decommissioning programme: 1) create a story to get a shared image of the rationale for change, 2) secure an executive leadership team represented by clinical champions, 3) involve clinic managers at an early stage to ensure a fair decision-making process, 4) base the decommissioning decisions on evidence, without compromising quality and patient safety, 5) prepare the organisation to handle a process characterised by tensions and strong emotions, 6) communicate demonstrable benefits, 7) pay attention to the need of cultural and behavioral change and 8) transparently evaluate the outcome of the process. CONCLUSIONS From these findings, we conclude that in order to successfully implement a decommissioning programme, clinic managers and healthcare professions must be given and take responsibility, for both the process and outcome.
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Affiliation(s)
- Inga-Britt Gustafsson
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden.
- Dalarna County Council, Falun, Sweden.
- Centre for Clinical Research, Falun, Dalarna, Sweden.
| | - Ulrika Winblad
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden
| | - Lars Wallin
- Dalarna County Council, Falun, Sweden
- Centre for Clinical Research, Falun, Dalarna, Sweden
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Mio Fredriksson
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden
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