Understanding the impetus for major systems change: A multiple case study of decisions and non-decisions to reconfigure emergency and urgent care services

Simple item page
dc.contributor.authorMcHugh, Sheena M.
dc.contributor.authorDroog, Elsa
dc.contributor.authorFoley, Conor
dc.contributor.authorBoyce, Maria B.
dc.contributor.authorHealy, O.
dc.contributor.authorBrowne, John P.
dc.contributor.funderHealth Research Boarden
dc.date.accessioned2019-10-29T05:57:57Z
dc.date.available2019-10-29T05:57:57Z
dc.date.issued2019-06-01
dc.description.abstractObjective The optimal organisation of emergency and urgent care services (EUCS) is a perennial problem internationally. Similar to other countries, the Health Service Executive in Ireland pursued EUCS reconfiguration in response to quality and safety concerns, unsustainable costs and workforce issues. However, the implementation of reconfiguration has been inconsistent at a regional level. Our aim was to identify the factors that led to this inconsistency. Methods Using a multiple case study design, six case study regions represented full, partial and little/no reconfiguration at emergency departments (EDs). Data from documents and key stakeholder interviews were analysed using a framework approach with cross-case analysis. Results The impetus to reconfigure ED services was triggered by patient safety events, and to a lesser extent by having a region-specific plan and an obvious starting point for changes. However, the complexity of the next steps and political influence impeded reconfiguration in several regions. Implementation was more strategic in regions that reconfigured later, facilitated by clinical leadership and “lead-in time” to plan and sell changes. Conclusion While the global shift towards centralisation of EUCS is driven by universal challenges, decisions about when, where and how much to implement are influenced by local drivers including context, people and politics. This can contribute to a public perception of inequity and distrust in proposals for major systems change.en
dc.description.sponsorshipHealth Research Board (CARG/2012/28)en
dc.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationMcHugh, S., Droog, E., Foley, C., Boyce, M., Healy, O. and Browne, J.P., 2019. Understanding the impetus for major systems change: A multiple case study of decisions and non-decisions to reconfigure emergency and urgent care services. Health Policy, 123 (8), 728-736. DOI:10.1016/j.healthpol.2019.05.018en
dc.identifier.doi10.1016/j.healthpol.2019.05.018en
dc.identifier.eissn872-6054
dc.identifier.endpage736en
dc.identifier.issn0168-8510
dc.identifier.issued8en
dc.identifier.journaltitleHealth Policyen
dc.identifier.startpage728en
dc.identifier.urihttps://hdl.handle.net/10468/8907
dc.identifier.volume123en
dc.language.isoenen
dc.publisherElsevier Ireland Ltden
dc.relation.urihttps://www.sciencedirect.com/science/article/pii/S0168851018303683
dc.rights© 2019 The Authors. Published by Elsevier B.V. This is an open access article under the CCBY-NC-ND licenseen
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/en
dc.subjectReconfigurationen
dc.subjectQualitative researchen
dc.subjectDelivery of healthcareen
dc.subjectEmergency careen
dc.subjectCase studyen
dc.subjectContexten
dc.subjectImplementationen
dc.titleUnderstanding the impetus for major systems change: A multiple case study of decisions and non-decisions to reconfigure emergency and urgent care servicesen
dc.typeArticle (peer-reviewed)en
Files
Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
1-s2.0-S0168851018303683-main.pdf
Size:
1.33 MB
Format:
Adobe Portable Document Format
Description:
Published version
Download
License bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
license.txt
Size:
2.71 KB
Format:
Item-specific license agreed upon to submission
Description:
Download
Collections
Public Health - Journal Articles