‘Real-world’ priority setting for service improvement in English primary care: a decentred approach

Kislov, Roman; Checkland, Kath; Wilson, Paul; Howard, Susan J.

doi:10.1080/14719037.2021.1942534

Cited by 7 publications

(8 citation statements)

References 67 publications

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“…There may be broader barriers to co‐commissioning, such as different priorities of different actors even within the same policy area (such as health) in the same geographical context (Kislov et al., 2023). Where this occurs, top‐down intervention or incentives may be required—as evidenced by both Commonwealth‐ and State‐based policy interventions in Australia.…”

Section: Discussionmentioning

confidence: 99%

Understanding the costs of co‐commissioning: Early experiences with co‐commissioning in Australia

Bates,

Harris‐Roxas,

Wright

2023

Aust J Public Adm

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Public services, such as health and other human services, are increasingly being delivered by third‐party providers (providers) under contract to public sector organisations (PSOs). While often advantageous to PSOs, this creates a fragmented service context which is difficult for consumers to navigate. Further, providers often deliver services under multiple contracts to multiple funders, with high reporting requirements, high administrative costs, and low operational sustainability. Policymakers have encouraged co‐commissioning—where PSOs come together to jointly commission services—to increase the efficiency and effectiveness of outsourcing. This article seeks to understand the costs of co‐commissioning in Australia, and consequently the enablers and barriers to co‐commissioning. This qualitative study is based on the early experiences of co‐commissioning by one of 31 Primary Health Networks (PHNs). Using transaction cost economics (TCE) theory, the study explains how the PHN started co‐commissioning services with other PHNs, before co‐commissioning with other types of organisations. The PHN also co‐commissioned relatively simple activities first, before moving on to more complex services. The insights provided using TCE theory help explain why co‐commissioning is initially complicated (and costly), requiring time to understand both the services to be commissioned and the governance requirements of each party involved. While initial transaction costs may be high when co‐commissioning, this may reflect organisational learning and capacity development costs ‐ therefore, costs are expected to reduce over time.Points for practitioners Fragmentation in policy and funding also leads to fragmentation of human services and high costs to service providers. Co‐commissioning is where multiple funders pool funds and strategically commission services together. Co‐commissioning offers a way to reduce fragmentation and reduce costs to service providers, potentially offering better public value. Co‐commissioning can initially take time and resources to establish. Over time, as organisations learn, the cost of co‐commissioning reduces potentially offering benefits to funders, providers, and service users.

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Section: Discussionmentioning

confidence: 99%

Understanding the costs of co‐commissioning: Early experiences with co‐commissioning in Australia

Bates,

Harris‐Roxas,

Wright

2023

Aust J Public Adm

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“…The differences in responses from the wider survey to the top ten identified by the prioritisation exercise point to a need to keep in mind the influence those in the 'room' have on what is determined a priority or not (26) which is a critique of priority setting studies more broadly.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

UK general practice service delivery research priorities: an adapted James Lind Alliance approach

Abrams

Blake

2023

Br J Gen Pract

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Background: General practice in the UK and countries including Australia, Canada and New Zealand is in a state of crisis. In the UK, a range of measures have been introduced to address the situation. Innovations include practice networks, multidisciplinary roles, and use of digital technologies. However, identifying what still needs fixing could benefit from more evidence, particularly in relation to day-to-day service delivery. Aim: To identify the general practice workforce’s top ten research priorities to improve service delivery. Design and setting: A priority setting study which used an adapted James Lind Alliance (JLA) methodology and involved staff working in general practice across the UK. Method: The study comprised four phases: (1) an online qualitative survey issued to the general practice workforce (clinical and non-clinical groups); (2) thematic analysis of free-text responses; (3) generation of indicative research questions and (4) ranking exercises with original survey respondents. Results: 93 staff completed the phase 1 survey from which 20 themes were categorised and developed into research questions. Twenty-two staff responded to the first ranking activity, 11 confirmed the final top ten. However, there was no clear ranking within these ten priorities, instead they carried equal weight and were closely interconnected. Conclusion: Appling a marginal gains approach by seeking to explore all ten priorities simultaneously may provide more noticeable improvements overall, as opposed to concentrating on one area at a time. Systems based approaches which take account of the significant role of context may be a particularly useful lens for future research.

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“…In pluralistic contexts, in which a multiplicity of actors and groups pursue varying goals, leadership configurations are often fragile because they have simultaneously to maintain internal harmony between their members, gain support from their organisations and achieve coherence between a leadership configuration's vision and environmental demands (Denis et al, 2001). The next section develops this line of thought by reflecting on collective leadership in the pluralistic context of university-healthcare partnerships, which are characterised -typically for public sector networks -by the co-existence of hierarchical control and horizontal forms of governance (Kislov et al, 2021).…”

Section: Blending Individualistic and Collective Leadershipmentioning

confidence: 99%

Supporting the transition from individualistic to collective leadership: a longitudinal study of a university–healthcare partnership

Kislov,

Harvey,

Bresnen

2023

Research Handbook on Leadership in Healthcare

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This chapter reports a qualitative longitudinal study conducted in a large-scale UK-based collaborative university-healthcare partnership to examine how collective leadership develops over time, what implications this evolution has for the tension between production and implementation of research, and how the transition from individualistic to collective leadership can be supported. It shows that this transition can be both enabled and constrained by the asymmetrical power relationships within a leadership team, whereby upward, downward and lateral directions of agency are exercised by multiple actors. It also demonstrates that the development of collective leadership can provide a clear direction for the partnership as a whole, whilst allowing for a plurality of approaches to enact this direction at the level of individual programmes of work. Finally, it argues that the development of collective leadership can be enabled by a combination of process-focused, reflection-focused and action-focused interventions.

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‘Real-world’ priority setting for service improvement in English primary care: a decentred approach

Cited by 7 publications

References 67 publications

Understanding the costs of co‐commissioning: Early experiences with co‐commissioning in Australia

Understanding the costs of co‐commissioning: Early experiences with co‐commissioning in Australia

UK general practice service delivery research priorities: an adapted James Lind Alliance approach

Supporting the transition from individualistic to collective leadership: a longitudinal study of a university–healthcare partnership

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