Clinical leadership through commissioning: Does it work in practice?

Storey, John; Holti, Richard; Hartley, Jean; Marshall, Martin; Matharu, Tatum

doi:10.1177/0951484815607540

Cited by 5 publications

(7 citation statements)

References 4 publications

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“…They point to relatively limited ambitions in some CCGs, and report the role of senior managers in encouraging or constraining such ambition, and conclude that there is a lack of good evidence for widespread larger scale change initiated by CCGs. 28 Our evidence provides important context for these findings, and suggests some important underlying mechanisms which may underpin these findings, in particular the variation in operational and strategic decision-making arrangements in CCGs, and the variation in the scope of roles played by GPs.…”

Section: Discussionmentioning

confidence: 62%

Complexity in the new NHS: longitudinal case studies of CCGs in England

et al. 2016

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ObjectiveThe reform in the English National Health Services (NHS) under the Health and Social Care Act 2012 is unlike previous NHS reorganisations. The establishment of clinical commissioning groups (CCGs) was intended to be ‘bottom up’ with no central blueprint. This paper sets out to offer evidence about how this process has played out in practice and examines the implications of the complexity and variation which emerged.DesignDetailed case studies in CCGs across England, using interviews, observation and documentary analysis. Using realist framework, we unpacked the complexity of CCG structures.Setting/participantsIn phase 1 of the study (January 2011 to September 2012), we conducted 96 interviews, 439 h of observation in a wide variety of meetings, 2 online surveys and 38 follow-up telephone interviews. In phase 2 (April 2013 to March 2015), we conducted 42 interviews with general practitioners (GPs) and managers and observation of 48 different types of meetings.ResultsOur study has highlighted the complexity inherent in CCGs, arising out of the relatively permissive environment in which they developed. Not only are they very different from one another in size, but also in structure, functions between different bodies and the roles played by GPs.ConclusionsThe complexity and lack of uniformity of CCGs is important as it makes it difficult for those who must engage with CCGs to know who to approach at what level. This is of increasing importance as CCGs are moving towards greater integration across health and social care. Our study also suggests that there is little consensus as to what being a ‘membership’ organisation means and how it should operate. The lack of uniformity in CCG structure and lack of clarity over the meaning of ‘membership’ raises questions over accountability, which becomes of greater importance as CCG is taking over responsibility for primary care co-commissioning.

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Section: Discussionmentioning

confidence: 62%

Complexity in the new NHS: longitudinal case studies of CCGs in England

et al. 2016

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“…This NPM emphasis was supported by a study of a range of NHS boards (Storey et al, 2010), which found NEDs brought legal or business skills to the role, with a positive association between PCT NEDs' influence and "effective use of resources" reflected by an independent measure of organisational performance. However, within CCGs the NED role appears less influential in a more recent study by this team, focused primarily on GP leadership in CCGs, which also included NEDs as respondents (Storey et al, 2015;Marshall et al, 2018). The GPs and Executives were felt to be far more influential on service redesign and communicating with patients and the public than other board members including NEDs.…”

Section: Influence Of New Public Managementmentioning

confidence: 98%

Guardians of public interest: the expectation and experience of non-executive directors in National Health Service commissioning boards in England

Tweed

Wallace

2020

JHOM

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PurposeThe purpose of the study is to examine how Non-Executive Directors (NEDs) in the English National Health Service (NHS) commissioning bodies experienced their role and contribution to governance.Design/methodology/approachSemi-structured interviews were conducted with a purposive sample of 31 NEDs of Primary Care Trusts (PCTs) and 8 Clinical Commissioning Group (CCG) NEDs. Framework analysis was applied using a conceptualisation of governance developed by Newman, which has four models of governance: the hierarchy, self-governance, open systems and rational goal model.FindingsNEDs saw themselves as guardians of the public interest. NEDs’ power is a product of the explicit levers set out in the constitution of the board, but also how they choose to use their knowledge and expertise to influence decisions for, as they see it, the public good. They contribute to governance by holding to account executive and professional colleagues, acting largely within the rational goal model. CCG NEDs felt less powerful than in those in PCTs, operating largely in conformance and representational roles, even though government policy appears to be moving towards a more networked, open systems model.Originality/valueThis is the first in-depth study of NEDs in English NHS local commissioning bodies. It is of value in helping to inform how the NED role could be enhanced to make a wider contribution to healthcare leadership as new systems are established in the UK and beyond.

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“…Academic teaching centers play a key role in health innovation because of their expertise, skills and active involvement in clinical research (Lega et al, 2017;Storey et al, 2015). Yet, as our interviewees underscored, a hierarchical governance and physician-centered culture limit their capacity to engage a diversified set of innovation stakeholders (Busch-Casler et al, 2020).…”

Section: Implications For Healthcare Managersmentioning

confidence: 99%

Responsible innovation in health and health system sustainability: Insights from health innovators’ views and practices

Lehoux

Silva

Oliveira

et al. 2021

Health Serv Manage Res

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Although healthcare managers make increasingly difficult decisions about health innovations, the way they may interact with innovators to foster health system sustainability remains underexplored. Drawing on the Responsible Innovation in Health (RIH) framework, this paper analyses interviews ( n=37) with Canadian and Brazilian innovators to identify: how they operationalize inclusive design processes; what influences the responsiveness of their innovation to system-level challenges; and how they consider the level and intensity of care required by their innovation. Our qualitative findings indicate that innovators seek to: 1) engage stakeholders at an early ideation stage through context-specific methods combining both formal and informal strategies; 2) address specific system-level benefits but often struggle with the positioning of their solution within the health system; and 3) mitigate staff shortages in specialized care, increase general practitioners’ capacity or patients and informal caregivers’ autonomy. These findings provide empirical insights on how healthcare managers can promote and organize collaborative processes that harness innovation towards more sustainable health systems. By adopting a RIH-oriented managerial role, they can set in place more inclusive design processes, articulate key system-level challenges, and help innovators adjust the level and intensity of care required by their innovation.

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Clinical leadership through commissioning: Does it work in practice?

Cited by 5 publications

References 4 publications

Complexity in the new NHS: longitudinal case studies of CCGs in England

Complexity in the new NHS: longitudinal case studies of CCGs in England

Guardians of public interest: the expectation and experience of non-executive directors in National Health Service commissioning boards in England

Responsible innovation in health and health system sustainability: Insights from health innovators’ views and practices

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