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    Attending to History' in Major System Change in Healthcare in England: Specialist Cancer Surgery Service Reconfiguration

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    Authors
    Perry, C.
    Boaden, R. J.
    Black, G. B.
    Clarke, C. S.
    Darley, S.
    Ramsay, A. I. G.
    Shackley, David C
    Vindrola-Padros, C.
    Fulop, N. J.
    Issue Date
    2022
    
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    Abstract
    Background The reconfiguration of specialist hospital services, with service provision concentrated in a reduced number of sites, is one example of major system change (MSC) for which there is evidence of improved patient outcomes. This paper explores the reconfiguration of specialist oesophago-gastric (OG) cancer surgery services in a large urban area of England (Greater Manchester, GM), with a focus on the role of history in this change process and how reconfiguration was achieved after previous failed attempts. Methods This study draws on qualitative research from a mixed-methods evaluation of the reconfiguration of specialist cancer surgery services in GM. Forty-six interviews with relevant stakeholders were carried out, along with ~160 hours of observations at meetings and the acquisition of ~300 pertinent documents. Thematic analysis using deductive and inductive approaches was undertaken, guided by a framework of ‘simple rules’ for MSC. Results Through an awareness of, and attention to, history, leaders developed a change process which took into account previous unsuccessful reconfiguration attempts, enabling them to reduce the impact of potentially challenging issues. Interviewees described attending to issues involving competition between provider sites, change leadership, engagement with stakeholders, and the need for a process of change resilient to challenge. Conclusion Recognition of, and response to, history, using a range of perspectives, enabled this reconfiguration. Particularly important was the way in which history influenced and informed other aspects of the change process and the influence of stakeholder power. This study provides further learning about MSC and the need for a range of perspectives to enable understanding. It shows how learning from history can be used to enable successful change.
    Citation
    Perry C, Boaden RJ, Black GB, Clarke CS, Darley S, Ramsay AIG, et al. "Attending to History" in Major System Change in Healthcare in England: Specialist Cancer Surgery Service Reconfiguration. Int J Health Policy Manag. 2022.
    Journal
    Int J Health Policy Manag
    URI
    http://hdl.handle.net/10541/625158
    DOI
    10.34172/ijhpm.2022.6389
    PubMed ID
    35297232
    Additional Links
    https://dx.doi.org/10.34172/ijhpm.2022.6389
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.34172/ijhpm.2022.6389
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