“Attending to History” in Major System Change in Healthcare in England: Specialist Cancer Surgery Service Reconfiguration

Document Type : Original Article

Authors

1 Applied Research Collaboration Greater Manchester, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK

2 Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK

3 Alliance Manchester Business School, University of Manchester, Manchester, UK

4 Department of Applied Health Research, University College London (UCL), London, UK

5 UCL Research Department of Primary Care and Population Health, University College London (UCL), London, UK

6 Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK

7 Christie NHS Foundation Trust, Manchester, UK

8 Institute of Cancer Sciences, Manchester Academic Health Science Centre (MAHSC), Manchester, UK

9 Department of Targeted Intervention, University College London (UCL), London, UK

Abstract

Background 
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.

Methods 
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.

Results 
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.

Conclusion 
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.

Highlights

 

Commentary Published on this Paper

  •  The Role of the Policy Process on Health Service Reconfigurations: Evidence, Path Dependency and Framing; Comment on “‘Attending to History’ in Major System Change in Healthcare in England: Specialist Cancer Surgery Service Reconfiguration”

        Abstract | PDF

 

Keywords


  • epublished Author Accepted Version: February 21, 2022
  • epublished Final Version: March 14, 2022
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Articles in Press, Corrected Proof
Available Online from 21 February 2022
  • Receive Date: 21 May 2021
  • Revise Date: 16 February 2022
  • Accept Date: 19 February 2022
  • First Publish Date: 21 February 2022