the politics of health ehma june 2008 development and organizational change in primary care:...

The Politics of Health EHMA June 2008

Development and Organizational Change in Primary Care: Implications for

Tomorrow’s Clinical Leaders

Steffi Williams

PGMDE School

Cardiff University

The Politics of Health EHMA June 2008

Context of Study

• Policy aim– Devolution of decision-

making to health professionals at local level

• Rationale: Quality Improvement– Efficiency– Effectiveness– Responsiveness

The Politics of Health EHMA June 2008

Study Design

• Policy Ethnography• Case Study

– 22 Primary Care Organizations (Local Health Groups)

– Panel Design: 3 waves of 1:1 Interviews with Chairmen over 3 years

The Politics of Health EHMA June 2008

Local Health Boards in Wales

The Politics of Health EHMA June 2008

NHS Wales

Welsh Assembly Government

Health Authorities (5) Trusts (17)

The Politics of Health EHMA June 2008

Findings

• Structures set up to deliver policy intentions inhibited implementation– Powers stayed centrally via

WAG & HA– Trusts independence

maintained– LHGs lacked clout:

• Budgets

• Authority

• Capacity

• Information

The Politics of Health EHMA June 2008

Some strategies proved to be more effective:

Strategic Focus: Community’s health needs not existing services

Clinical Governance as central organizational aim

Inclusive ApproachWhole community as constituents

Ideological Vision

The Politics of Health EHMA June 2008

Why were these approaches effective? (Institutional Politics)

• Community Development – Community-wide

communication channels re health needs

• Relationship building to create common aims

The Politics of Health EHMA June 2008

Building organizational capacity

• Identifying specific organizational features and capitalising on them to create unique identity and capability:– Existing state of

practice development– Infrastructure

Development– Exploiting Uncertainty

The Politics of Health EHMA June 2008

Circumventing not confronting…

• Boards: developed & engaged

• Quality Improvement as prime focus

• Primary care needs not medical services

• Community-wide power base

• Learning Orientation

The Politics of Health EHMA June 2008

Implications

• NHS Wales restructuring afresh now:– Clinical Leadership development:

• Ability to tolerate & exploit ambiguity• Strategic Vision • Institutional Politics• Leveraging Assymetries: identifying &

exploiting existing organizational features to build unique organizational identities

• Organizational Learning– Policy implementation

• Dialogue• Evaluation