Evaluating the design and implementation of the whole systems integrated care programme in North West London: why commissioning proved (again) to be the weakest link
| Autor: | Holly Holder, Judith Smith, Matthew Gaskins, Gerald Wistow |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Process management National Health Programs National Health Service Project commissioning HD28 Management. Industrial Management Health informatics Health administration 03 medical and health sciences 0302 clinical medicine Large-scale change Transactional leadership London medicine Humans Commissioning 030212 general & internal medicine Delivery of Health Care Integrated business.industry lcsh:Public aspects of medicine Coordinated care 030503 health policy & services Health Policy Nursing research Public health Commissioning cycle Integrated care lcsh:RA1-1270 Health and social care integration Purchasing Health Planning Planning RA Public aspects of medicine Family Practice 0305 other medical science business Social Welfare Program Evaluation Research Article |
| Zdroj: | BMC Health Services Research BMC Health Services Research, Vol 19, Iss 1, Pp 1-14 (2019) |
| ISSN: | 1472-6963 |
| DOI: | 10.1186/s12913-019-4013-5 |
| Popis: | Background Commissioning is a term used in the English National Health Service (NHS) to refer to what most health systems call health planning or strategic purchasing. Drawing on research from a recent in-depth mixed methods study of a major integrated care initiative in North West London, we examine the role of commissioning in attempts to secure large-scale change within and between health and social care services to support the delivery of integrated care for people living with complex long-term conditions. Methods We analysed data collected in semi-structured interviews, surveys, workshops and non-participant observations using a thematic framework derived both deductively from the literature on commissioning and integrated care, as well as inductively from our coding and analysis of interview data. Results Our findings indicate that commissioning has significant limitations in enabling large-scale change in health services, particularly in engaging providers, supporting implementation, and attending to both its transactional and relational dimensions. Conclusions Our study highlights the consequences of giving insufficient attention to implementation, and especially the need for commissioners to enable, support and performance manage the delivery of procured services, while working closely with providers at all times. We propose a revised version of Øvretveit’s cycle of commissioning that gives greater emphasis to embedding effective implementation processes within models of commissioning large-scale change. Electronic supplementary material The online version of this article (10.1186/s12913-019-4013-5) contains supplementary material, which is available to authorized users. |
| Databáze: | OpenAIRE |
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