Senior Research Fellow, Department of Applied Health Research, University College London, London, UK.
Applied Research Collaboration Greater Manchester, Division of Population Health, Health Services Research and Primary Care, University of Manchester, UK.
J Health Serv Res Policy. 2021 Jan;26(1):4-11. doi: 10.1177/1355819620926553. Epub 2020 Jun 7.
Major system change (MSC) has multiple, sometimes conflicting, goals and involves implementing change across a number of organizations. This study sought to develop new understanding of how the role that networks can play in implementing MSC, using the case of centralization of specialist cancer surgery in London, UK.
The study was based on a framework drawn from literature on networks and MSC. We analysed 100 documents, conducted 134 h of observations during relevant meetings and 81 interviews with stakeholders involved in the centralization. We analysed the data using thematic analysis.
MSC in specialist cancer services was a contested process, which required constancy in network leadership over several years, and its horizontal and vertical distribution across the network. A core central team composed of network leaders, managers and clinical/manager hybrid roles was tasked with implementing the changes. This team developed different forms of engagement with provider organizations and other stakeholders. Some actors across the network, including clinicians and patients, questioned the rationale for the changes, the clinical evidence used to support the case for change, and the ways in which the changes were implemented.
Our study provides new understanding of MSC by discussing the strategies used by a provider network to facilitate complex changes in a health care context in the absence of a system-wide authority.
重大系统变革（MSC）具有多个，有时甚至相互冲突的目标，并涉及在多个组织中实施变革。本研究旨在通过英国伦敦癌症外科手术集中化的案例，探讨网络在实施 MSC 中所起的作用。
本研究基于网络和 MSC 文献中的一个框架。我们分析了 100 份文件，观察了相关会议期间的 134 小时，并对参与集中化的利益相关者进行了 81 次访谈。我们使用主题分析方法对数据进行分析。
专家癌症服务的 MSC 是一个有争议的过程，需要在几年内保持网络领导的一致性，以及在网络中水平和垂直分布。由网络领导者、管理人员和临床/管理混合角色组成的核心中央团队负责实施变革。该团队与服务提供商组织和其他利益相关者建立了不同形式的合作关系。网络中的一些参与者，包括临床医生和患者，对变革的基本原理、支持变革的临床证据以及实施变革的方式提出了质疑。
我们的研究通过讨论一个服务提供商网络在没有系统范围权威的情况下，在医疗保健背景下促进复杂变革所使用的策略，为 MSC 提供了新的理解。
