Doing transformational change in the English NHS in the context of “big bang” redisorganisation

Abstract

For AuthorsIf you would like to write for this, or any other Emerald publication, then please use our Emerald for Authors service information about how to choose which publication to write for and submission guidelines are available for all. Please visit www.emeraldinsight.com/authors for more information. About Emerald www.emeraldinsight.comEmerald is a global publisher linking research and practice to the benefit of society. The company manages a portfolio of more than 290 journals and over 2,350 books and book series volumes, as well as providing an extensive range of online products and additional customer resources and services.Emerald is both COUNTER 4 and TRANSFER compliant. The organization is a partner of the Committee on Publication Ethics (COPE) and also works with Portico and the LOCKSS initiative for digital archive preservation.*Related content and download information correct at time of download. Edward LugsdenNewcastle University Business School, Newcastle University, Newcastle upon Tyne, UK AbstractPurpose -The purpose of this paper is to examine a bold and ambitious scheme known as the North East transformation system (NETS). The principal aim of the NETS is the achievement of a step-change in the quality of health services delivered to people living in the North East region of England. The paper charts the origins of the NETS and its early journey before describing what happened to it when the UK coalition government published its proposals for unexpected major structural change in the NHS. This had a profound impact on the leadership and direction of the NETS and resulted in it taking a different direction from that intended. Design/methodology/approach -The research design took the form of a mixed methods, longitudinal 3.5-year study aimed at exploring transformational change in terms of content, context, process and outcomes. The sample of study sites comprised 14 NHS trusts in the North East region chosen to provide geographical coverage of the area and to reflect the scale, scope and variety of the bodies that formed part of the NETS programme. The qualitative component of the research, which the paper draws upon, included 68 semi-structured interviews, observational studies and focus groups. Data analysis made use of both deductive and inductive frameworks. The deductive framework adopted was Pettigrew et al.'s "receptive contexts for change" and four of the eight factors stood out as especially important and form the basis of the paper. being especially significant: environmental pressure, quality and coherence of policy, key people leading change, supportive organisational culture. Perhaps the most significant lesson from the NETS is that achieving whole systems change is particularly vulnerable to the vicissitudes of politics especially where that system, like the UK NHS, is itself subject to those very same pressures. Yet, despite having an enormous influence on health policy, the political context is frequently avoided in research or not regarded as instrumental in determining the ...

Lessons learnt from the implementation of new care models in the NHS: a qualitative study of the North East Vanguards programme

“…Moreover, it was felt that the programme enhanced or sped up certain actions (in particular regional MDT involvement). However, the need for a system-wide approach was recognised and an emphasis was placed on collective rather than individual action 17. At an organisational level, the need for, and importance of, relationship-building was also common to all five sites, but in each there appeared to be different obstacles to progress 18.…”

Primary care workforce development in Europe: An overview of health system responses and stakeholder views

“…In our sample, England and Germany represent two extremes of primary care provision and policy as well as of health systems and governance. England is a National Health Service (NHS) system funded (mainly) from central taxation and based on more centralised governance with a tradition of universal healthcare coverage and equal access [40,70]. Germany is a social health insurance (SHI) system funded (mainly) by contributions from employers and employees.…”

“…Health system reform alone will not be the magic pill to effect the desired changes. For successful change to occur, there needs to be comprehensive institutional change as well as sufficient capacity and political commitment [25,54,70,89]. It is important to be clear what such leadership entails when applied to the development of a people-centred primary care work and the skill mix, financial resources and education systems required for it to work, just to mention some of the main conditions.…”

Transformational Change in Health Care Through Operational Excellence

“…From a systems perspective, transformational change is emergent in that the end-state is often not exactly known [11,13]. By its nature, transformational change involves re-engineering of the entire organization [14][15][16]. To paraphrase the National Hockey League Hall of Famer Wayne Gretsky, while transitional change involves Bskating to where the puck is,^transformational change involves Bskating to where the puck is going.T here have been a number of different approaches to transformational change that have been used successfully in health care [12,13].…”

“…For this reason, successful organizations pay particular attention to measurement systems and data management and analysis. Finally, and perhaps most importantly, any transformational change initiative should be consistent with, and adapted directly from, the organization's strategic plan, which in turn is consistent with and adapted directly from the organization's mission, vision, and core values [12,[14][15][16]. In this way, everyone from the board of trustees, chief executive officer, and senior leadership team to middle management and front-line clinical leaders and providers fully know why the organization exists and for what purpose, who they are as an organization and what they stand for, and where the organization is collectively going [27][28][29].…”