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