Applied Research Collaboration Greater Manchester, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK.
Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK.
Int J Health Policy Manag. 2022 Dec 19;11(12):2829-2841. doi: 10.34172/ijhpm.2022.6389. Epub 2022 Mar 14.
The reconfiguration of specialist hospital services, with service provision concentrated in a reduced number of sites, is one example of major system change (MSC) for which there is evidence of improved patient outcomes. This paper explores the reconfiguration of specialist oesophago-gastric (OG) cancer surgery services in a large urban area of England (Greater Manchester, GM), with a focus on the role of history in this change process and how reconfiguration was achieved after previous failed attempts.
This study draws on qualitative research from a mixed-methods evaluation of the reconfiguration of specialist cancer surgery services in GM. Forty-six interviews with relevant stakeholders were carried out, along with ~160 hours of observations at meetings and the acquisition of ~300 pertinent documents. Thematic analysis using deductive and inductive approaches was undertaken, guided by a framework of 'simple rules' for MSC.
Through an awareness of, and attention to, history, leaders developed a change process which took into account previous unsuccessful reconfiguration attempts, enabling them to reduce the impact of potentially challenging issues. Interviewees described attending to issues involving competition between provider sites, change leadership, engagement with stakeholders, and the need for a process of change resilient to challenge.
Recognition of, and response to, history, using a range of perspectives, enabled this reconfiguration. Particularly important was the way in which history influenced and informed other aspects of the change process and the influence of stakeholder power. This study provides further learning about MSC and the need for a range of perspectives to enable understanding. It shows how learning from history can be used to enable successful change.
专科医院服务的重新配置，即将服务集中在少数几个地点提供，是一种主要系统变革（MSC）的例子，这种变革有改善患者结局的证据。本文探讨了在英格兰一个大城市（大曼彻斯特，GM）中对专科食管-胃（OG）癌症手术服务的重新配置，重点关注历史在这一变革过程中的作用，以及在之前失败的尝试之后如何实现重新配置。
本研究借鉴了 GM 专科癌症手术服务重新配置的混合方法评估中的定性研究。对相关利益攸关方进行了 46 次访谈，并在会议上进行了约 160 小时的观察，同时还获得了约 300 份相关文件。使用演绎和归纳方法进行主题分析，以 MSC 的“简单规则”框架为指导。
通过对历史的认识和关注，领导者制定了一个变革过程，考虑到之前不成功的重新配置尝试，使他们能够减少潜在挑战性问题的影响。受访者描述了关注涉及提供者站点之间竞争、变革领导力、与利益攸关方的参与以及需要对挑战具有弹性的变革过程的问题。
对历史的认识和响应，使用多种视角，促成了这一重新配置。特别重要的是历史如何影响和告知变革过程的其他方面以及利益攸关方权力的影响。本研究为 MSC 提供了进一步的学习，需要多种视角来理解。它展示了如何从历史中学习以实现成功变革。
