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dc.contributor.authorVindrola-Padros, C
dc.contributor.authorRamsay, AI
dc.contributor.authorPerry, C
dc.contributor.authorDarley, S
dc.contributor.authorWood, VJ
dc.contributor.authorClarke, CS
dc.contributor.authorHines, J
dc.contributor.authorLevermore, C
dc.contributor.authorMelnychuk, M
dc.contributor.authorMoore, CM
dc.contributor.authorMorris, S
dc.contributor.authorMughal, MM
dc.contributor.authorPritchard-Jones, Kathy
dc.contributor.authorShackley, D
dc.contributor.authorFulop, NJ
dc.date.accessioned2020-08-10T08:09:17Z
dc.date.available2020-08-10T08:09:17Z
dc.date.issued2020en
dc.identifier.citationVindrola-Padros C, Ramsay AI, Perry C, Darley S, Wood VJ, Clarke CS, et al. Implementing major system change in specialist cancer surgery: The role of provider networks. J Health Serv Res Policy. 2020:1355819620926553.en
dc.identifier.pmid32508182en
dc.identifier.doi10.1177/1355819620926553en
dc.identifier.urihttp://hdl.handle.net/10541/623070
dc.description.abstractObjective: Major system change (MSC) has multiple, sometimes conflicting, goals and involves implementing change across a number of organizations. This study sought to develop new understanding of how the role that networks can play in implementing MSC, using the case of centralization of specialist cancer surgery in London, UK. Methods: The study was based on a framework drawn from literature on networks and MSC. We analysed 100 documents, conducted 134 h of observations during relevant meetings and 81 interviews with stakeholders involved in the centralization. We analysed the data using thematic analysis. Results: MSC in specialist cancer services was a contested process, which required constancy in network leadership over several years, and its horizontal and vertical distribution across the network. A core central team composed of network leaders, managers and clinical/manager hybrid roles was tasked with implementing the changes. This team developed different forms of engagement with provider organizations and other stakeholders. Some actors across the network, including clinicians and patients, questioned the rationale for the changes, the clinical evidence used to support the case for change, and the ways in which the changes were implemented. Conclusions: Our study provides new understanding of MSC by discussing the strategies used by a provider network to facilitate complex changes in a health care context in the absence of a system-wide authority. Keywords: Major system change; cancer surgery; networks.en
dc.language.isoenen
dc.relation.urlhttps://dx.doi.org/10.1177/1355819620926553en
dc.titleImplementing major system change in specialist cancer surgery: The role of provider networksen
dc.typeArticleen
dc.contributor.departmentSenior Research Fellow, Department of Applied Health Research, University College London, London, UK.en
dc.identifier.journalJournal of Health Services Research and Policyen
dc.description.noteen]
refterms.dateFOA2020-08-12T09:46:02Z


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