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Disentangling rhetoric and reality : an international Delphi study of factors and processes that facilitate the successful implementation of decisions to decommission healthcare services
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Robert, Glenn, Harlock, Jenny and Williams, Iestyn (2014) Disentangling rhetoric and reality : an international Delphi study of factors and processes that facilitate the successful implementation of decisions to decommission healthcare services. Implementation Science, 9 (1). 123. doi:10.1186/s13012-014-0123-y ISSN 1748-5908.
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Official URL: http://dx.doi.org/10.1186/s13012-014-0123-y
Abstract
Background
The need to better understand processes of removing, reducing, or replacing healthcare services that are no longer deemed essential or effective is common across publicly funded healthcare systems. This paper explores expert international opinion regarding, first, the factors and processes that shape the successful implementation of decommissioning decisions and, second, consensus as to current best practice.
Methods
A three round Delphi study of 30 international experts was undertaken. In round one, participants identified factors that shape the outcome of decommissioning processes; responses were analysed using conventional content analysis. In round two, responses to 88 Likert scale statements derived from round one were analysed using measures of the degree of consensus. In round three the statements that achieved low consensus were then repeated but presented alongside the overall results from round two. The responses were re-analysed to observe whether the degree of consensus had changed. Any open comments provided during the Delphi study were analysed thematically.
Results
Participants strongly agreed that three considerations should ideally inform decommissioning decisions: quality and patient safety, clinical effectiveness and cost-effectiveness. Although there was less consensus as to which considerations informed such decisions in practice, those that drew the most agreement were: cost/budgetary pressures, government intervention and capital costs/condition. Important factors in shaping decommissioning were: strength of executive leadership, strength of clinical leadership, quality of communications, demonstrable benefits and clarity of rationale/case for change. Amongst the 19 best practice recommendations high consensus was achieved for: establishing a strong leadership team, engaging clinical leaders from an early stage, and establishing a clear rationale for change.
Conclusions
There was a stark contrast between what experts thought should determine decommissioning decisions and what does so in practice; a contrast mirrored in the distinction the participants drew between the technical and political aspects of decommissioning processes. The best practice recommendations which we grouped into three categories—change management and implementation; evidence and information; and relationships and political dimensions—can be seen as contemporary responses or strategies to manage the tensions that emerged between the rhetoric and reality of implementing decommissioning decisions.
Item Type: | Journal Article | |||||||||
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Subjects: | R Medicine > RA Public aspects of medicine | |||||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Social Science & Systems in Health (SSSH) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Medical care—Research , Health services administration, Health planning, Health services accessibility, Delphi method, Health -- Research -- Methodology, Medical care -- Quality control | |||||||||
Journal or Publication Title: | Implementation Science | |||||||||
Publisher: | BioMed Central Ltd. | |||||||||
ISSN: | 1748-5908 | |||||||||
Official Date: | 10 August 2014 | |||||||||
Dates: |
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Volume: | 9 | |||||||||
Number: | 1 | |||||||||
Article Number: | 123 | |||||||||
DOI: | 10.1186/s13012-014-0123-y | |||||||||
Status: | Peer Reviewed | |||||||||
Publication Status: | Published | |||||||||
Access rights to Published version: | Open Access (Creative Commons) | |||||||||
Date of first compliant deposit: | 1 April 2019 | |||||||||
Date of first compliant Open Access: | 1 April 2019 | |||||||||
RIOXX Funder/Project Grant: |
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