Australian Institute for Primary Care and Ageing, La Trobe University, Bundoora, Vic. 3086, Australia.
Australian Institute for Primary Care and Ageing, La Trobe University, Bundoora, Vic. 3086, Australia; and Corresponding author. Email:
Aust J Prim Health. 2020 Aug;26(4):332-337. doi: 10.1071/PY20011.
Commissioning health and community services is a complex task involving planning, purchasing and monitoring services for a population. It is particularly difficult when attempting system-level reform, and many barriers to effective commissioning have been documented. In Victoria, the state government has operated as a commissioner of many services, including mental health community support and alcohol and other drug treatment services. This study investigated the perceived consequences of a reform process in these two sectors after recommissioning was used as a mechanism to achieve sector-wide redesign. Semi-structured interviews were conducted with 23 senior staff from community health, mental health and drug and alcohol services 6 months after implementation. The process was affected by restructuring in the commissioning department resulting in truncation of preparatory planning and technical work required for system design. Consequently, reform implementation was reportedly chaotic, costly to agencies and staff, and resulted in disillusionment of enthusiastic reform supporters. Negative service system impacts were produced, such as disruption of collaborative and/or comprehensive models of care and strategies for reaching marginalised groups. Without careful planning and development commissioning processes can become over-reliant on competitive tendering to produce results, create significant costs to service providers and engender system-level issues with the potential to disrupt innovative models focused on meeting client needs.
委托健康和社区服务是一项复杂的任务，涉及为特定人群规划、采购和监测服务。当试图进行系统层面的改革时，这尤其困难，并且已经记录了许多有效委托的障碍。在维多利亚州，州政府曾作为许多服务的管理者，包括精神健康社区支持和酒精和其他药物治疗服务。本研究调查了在重新委托作为实现全部门重新设计的机制之后，这两个部门的改革过程中被认为产生的后果。在实施 6 个月后，对来自社区卫生、心理健康以及药物和酒精服务部门的 23 名高级工作人员进行了半结构化访谈。委托部门的重组影响了这一过程，导致系统设计所需的预备规划和技术工作缩短。因此，据报道，改革的实施是混乱的，对机构和工作人员来说代价高昂，并导致热心的改革支持者感到失望。产生了负面的服务系统影响，例如破坏协作和/或全面的护理模式以及针对边缘化群体的战略。如果没有仔细的规划和发展，委托过程可能会过度依赖竞争性招标来产生结果，给服务提供商带来巨大成本，并引发可能破坏以满足客户需求为重点的创新模式的系统层面问题。
