Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
Durham University, Durham, UK.
J Health Organ Manag. 2020 Mar 18;ahead-of-print(ahead-of-print):325-44. doi: 10.1108/JHOM-05-2019-0144.
Following publication of a new vision for the English National Health Service (NHS) in 2014, known as the NHS Five-Year Forward View, a Vanguard programme was introduced by NHS England charged with the task of designing and delivering a range of new care models (NCMs) aimed at tackling deep-seated problems of a type facing all health systems to a greater or lesser degree. Drawing upon recent theoretical developments on the multilevel nature of context, we explore factors shaping the implementation of five NCM initiatives in the North East of England.
DESIGN/METHODOLOGY/APPROACH: Data collection was based on semi-structured interviews (66 in total) between December 2016 and May 2017 with key informants at each site and a detailed review of Trusts' internal documents and policies related to the implementation of each NCM. Our analysis explores factors shaping the implementation of five NCM pilot sites as they touched on the multiple levels of context ranging from the macro policy level to the micro-level setting of workforce redesign.
It is far too early to conclude with any confidence that a successful outcome for the NCM programme will be forthcoming although the NHS Long-Term Plan seeks to build on the earlier vision set out in the Five-Year Forward View. Early indications show some signs of promise, especially where there is evidence of the ground having been prepared and changes already being put in place prior to the official launch of NCM initiatives. At the same time our findings demonstrate that all five pilot sites experienced, and were subject to, unrealistic pressure placed upon them to deliver outcomes.
ORIGINALITY/VALUE: Our findings demonstrate the need for a deeper understanding of the multilevel nature of context by exploring factors shaping the implementation of five NCMs in the North East of England. Exploring the wider national policy context is desirable as well as understanding the perceptions of front-line staff and service users in order to establish the degree of alignment or, conversely, to identify where policy and practice are at risk of pushing and pulling against each other.
2014 年发布了英国国家医疗服务体系（NHS）的新愿景，即 NHS 五年展望，NHS 英格兰推出了先锋计划，负责设计和提供一系列旨在解决所有医疗体系或多或少面临的深层次问题的新型护理模式（NCM）。本研究借鉴了关于背景多层次性质的最新理论发展，探讨了影响英格兰东北部五个 NCM 试点实施的因素。
设计/方法/方法：数据收集基于 2016 年 12 月至 2017 年 5 月与每个地点的主要信息提供者进行的半结构化访谈（共 66 次），并详细审查了信托基金与实施每个 NCM 相关的内部文件和政策。我们的分析探讨了影响五个 NCM 试点实施的因素，因为它们涉及从宏观政策层面到劳动力重新设计的微观环境层面的多层次背景。
尽管 NHS 长期计划试图在五年展望中提出的早期愿景的基础上继续前进，但要自信地得出 NCM 计划将取得成功的结论还为时过早。早期迹象显示出一些有希望的迹象，特别是在有证据表明已经为 NCM 计划的正式启动做好了准备并且已经开始进行变革的地方。与此同时，我们的研究结果表明，所有五个试点项目都经历了，并受到了不切实际的压力，要求他们取得成果。
原创性/价值：我们的研究结果表明，需要通过探索影响英格兰东北部五个 NCM 实施的因素，更深入地了解背景的多层次性质。探索更广泛的国家政策背景以及了解一线工作人员和服务用户的看法是可取的，以便确定政策和实践的一致性程度，或者相反，确定政策和实践是否存在相互推搡的风险。
