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J Health Serv Res Policy. 2016 Jul;21(3):156-65. doi: 10.1177/1355819615626189. Epub 2016 Jan 24.

Lessons for major system change: centralization of stroke services in two metropolitan areas of England.

Author information

1
Senior Research Associate, Department of Applied Health Research, University College London, London, UK Senior Research Associate, National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care North Thames, London, UK simon.j.turner@ucl.ac.uk.
2
Senior Research Associate, Department of Applied Health Research, University College London, London, UK.
3
Research Associate, Alliance Manchester Business School, University of Manchester, Manchester, UK.
4
Professor of Service Operations Management, Alliance Manchester Business School, University of Manchester, Manchester, UK.
5
Professor of Social Sciences & Health, Department of Primary Care and Public Health Sciences, King's College London and National Institute of Health Research Comprehensive Biomedical Research Centre, Guy's & St Thomas' NHS Foundation Trust and King's College London, London, UK.
6
Professor of Health Economics, Department of Applied Health Research, University College London, UK.
7
Patient Representative, King's College London Stroke Research Patients and Family Group, Division of Health & Social Care Research, Faculty of Life Sciences & Medicine, King's College London, London, UK.
8
Professor of Stroke Medicine, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK and National Clinical Director of Stroke, NHS England, and London Stroke Clinical Director, UK.
9
Professor of Stroke Medicine, Stroke & Vascular Centre, University of Manchester, Manchester Academic Health Science Centre, Salford Royal Hospitals NHS Foundation Trust, Salford, UK.
10
Professor of Public Health Medicine, Department of Primary Care and Public Health Sciences, King's College London, National Institute of Health Research Comprehensive Biomedical Research Centre, Guy's & St Thomas' NHS Foundation Trust and King's College London, and National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care South London, London, UK.
11
Professor of Health Care Organisation and Management, Department of Applied Health Research, University College London, London, UK.

Abstract

OBJECTIVES:

Our aim was to identify the factors influencing the selection of a model of acute stroke service centralization to create fewer high-volume specialist units in two metropolitan areas of England (London and Greater Manchester). It considers the reasons why services were more fully centralized in London than in Greater Manchester.

METHODS:

In both areas, we analysed 316 documents and conducted 45 interviews with people leading transformation, service user organizations, providers and commissioners. Inductive and deductive analyses were used to compare the processes underpinning change in each area, with reference to propositions for achieving major system change taken from a realist review of the existing literature (the Best framework), which we critique and develop further.

RESULTS:

In London, system leadership was used to overcome resistance to centralization and align stakeholders to implement a centralized service model. In Greater Manchester, programme leaders relied on achieving change by consensus and, lacking decision-making authority over providers, accommodated rather than challenged resistance by implementing a less radical transformation of services.

CONCLUSIONS:

A combination of system (top-down) and distributed (bottom-up) leadership is important in enabling change. System leadership provides the political authority required to coordinate stakeholders and to capitalize on clinical leadership by aligning it with transformation goals. Policy makers should examine how the structures of system authority, with performance management and financial levers, can be employed to coordinate transformation by aligning the disparate interests of providers and commissioners.

KEYWORDS:

centralization; major system change; service transformation; stroke care

PMID:
26811375
PMCID:
PMC4904350
DOI:
10.1177/1355819615626189
[Indexed for MEDLINE]
Free PMC Article

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