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

Iestyn Williams²  Jenny Harlock²  Glenn Robert¹ 

[1] National Nursing Research Unit, Florence Nightingale Faculty of Nursing & Midwifery, King¿s College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, England;Health Services Management Centre, School of Social Policy, Park House, University of Birmingham, Edgbaston, Birmingham B15 2RT, England

关键词: Access to services, Rationing;    Healthcare quality;    Disinvestment;    De-implementation;    Delphi study;    Decommissioning;   

Others  :  1146460
DOI  :  10.1186/s13012-014-0123-y

 received in 2014-04-30, accepted in 2014-09-01,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 Robert et al.; licensee BioMed Central Ltd.

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