In tune with much international practice, the English National Health Service has been striving t... more In tune with much international practice, the English National Health Service has been striving to transform health care provision to make it more affordable in the face of rising demand. At the heart of a set of recent radical reforms has been the launch of ‘clinical commissioning’ using the vehicle of local groups of General Practitioners (GPs). This devolves a large portion of the total healthcare budget to these groups. National government policy statements make clear that the expectation is that the groups will ‘transform’ the organisation and provision of health services. In this article, we draw upon interviews, observations and analysis of internal documents to make an assessment of the extent to which clinical leaders have seized the opportunity presented by the creation of these groups to attempt transformative service redesign.
Clinicians are in charge but what are the potential pitfalls? A research project from The Open Un... more Clinicians are in charge but what are the potential pitfalls? A research project from The Open University, funded by the National Institute for Health Research, looked into the issue. Clinical leadership is central to the rationale for establishing and for maintaining Clinical Commissioning Groups (CCGs). But the challenge of engaging clinicians from both the primary and secondary care sectors seems to be immense. One aspect of this challenge is to engage GPs actively in the process of commissioning and service redesign. A second aspect is the need to engage with secondary care clinicians in something far more meaningful than token representation.
With an increasing aging population worldwide, there is a growing need for both palliative care a... more With an increasing aging population worldwide, there is a growing need for both palliative care and geriatric medicine. It is presumed in medical literature that both specialties share similar goals about patient care and could collaborate. To inform future service development, the objective of this review was to identify what is currently empirically known about overlapping working practices. This article provides a scoping literature review on the relationship between geriatric medicine and palliative care within the United Kingdom. The review encompassed literature written between 1997 and 2019 accessed via Scopus, Web of Science, PubMed, and Google Scholar. Three themes were identified: (a) unclear boundaries between specialties, (b) communication within and between specialisms, and (c) ambiguity of how older people fit in the current health care system. We suggest that more empirical research is conducted about the overlap between palliative care and geriatric medicine to under...
Background A core component of the Health and Social Care Act 2012 (Great Britain. Health and Soc... more Background A core component of the Health and Social Care Act 2012 (Great Britain. Health and Social Care Act 2012. London: HMSO; 2012) was the idea of devolving to general practitioners (GPs) a health service leadership role for service redesign. For this purpose, new Clinical Commissioning Groups (CCGs) were formed in the English NHS. Objectives This research examined the extent to which, and the methods by which, clinicians stepped forward to take up a leadership role in service redesign using CCGs as a platform. Design The project proceeded in five phases: (1) a scoping study across 15 CCGs, (2) the design and administration of a national survey of all members of CCG governing bodies in 2014, (3) six main in-depth case studies, (4) a second national survey of governing body members in 2016, which allowed longitudinal comparisons, and (5) international comparisons. Participants In addition to GPs serving in clinical lead roles for CCGs, the research included insights from account...
Purpose The purpose of this paper is to present the findings arising from a three year research p... more Purpose The purpose of this paper is to present the findings arising from a three year research project which investigated a major system-wide change in the design of the NHS in England. The radical policy change was enshrined in statute in 2012 and it dismantled existing health authorities in favour of new local commissioning groups built around GP Practices. The idea was that local clinical leaders would “step-up” to the challenge and opportunity to transform health services through exercising local leadership. This was the most radical change in the NHS since its inception in 1948. Design/methodology/approach The research methods included two national postal surveys to all members of the boards of the local groups supplemented with 15 scoping case studies followed by six in-depth case studies. These case studies focused on close examination of instances where significant changes to service design had been attempted. Findings The authors found that many local groups struggled to b...
The British journal of general practice : the journal of the Royal College of General Practitioners, 2018
Clinical commissioning groups (CCGs) were established in England in 2013 to encourage GPs to exer... more Clinical commissioning groups (CCGs) were established in England in 2013 to encourage GPs to exert greater influence over the processes of service improvement and redesign in the NHS. Little is known about the extent and the ways in which GPs have assumed these leadership roles. To explore the nature of clinical leadership of GPs in CCGs, and to examine the enablers and barriers to implementing a policy of clinical leadership in the NHS. A qualitative multi-case study approach in six localities across England. The case studies were purposefully sampled to represent different geographical localities and population demographics, and for their commitment to redesigning specified clinical or service areas. Data were collected from the case study CCGs and their partner organisations using a review of relevant documents, semi-structured individual or group interviews, and observations of key meetings. The data were analysed thematically and informed by relevant theories. GPs prefer a coll...
This report may be freely reproduced for the purposes of private research and study and extracts ... more This report may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising.
ABSTRACT This chapter draws upon an ESRC-funded project on executive and managerial knowledge to ... more ABSTRACT This chapter draws upon an ESRC-funded project on executive and managerial knowledge to analyze the knowledge work practices of senior managers. It addresses the question: what kinds of knowledge do executives at the strategic apex of organizations use and construct? The book itself comprises selected projects from the ESRC Programme on The Evolution of Business Knowledge.
Integrating project activities: the theory and practice of managing the supply chain through clusters
Building on the results of two demonstration projects carried out in the UK, this paper develops ... more Building on the results of two demonstration projects carried out in the UK, this paper develops the notion of 'work clusters' as an organizational approach to supply chain integration and the application of concurrent engineering principles. The organizational design principles are presented together with the process used to set up clusters at project level, and the impact of the clustering arrangement on the re-engineering of the design and construction process is discussed. It is argued that the clustering arrangement ...
This paper explores the various ways in which clinical executive directors and non-clinical execu... more This paper explores the various ways in which clinical executive directors and non-clinical executive directors are interpreting and responding to the extensive reforms and restructuring in the UK health service. The key changes include devolved accountability, the introduction of some market mechanisms and incentives, some element of competition between healthcare provider organisations, more patient choice, a clearer provider-purchaser split, and increased competition from private sector and third sector providers. Changes to healthcare environments of this kind are occurring in many countries but such is the extent and intensity of these changes that the UK government sees this set of reforms leading to a peerless world class health service. The paper draws upon detailed research in two very large teaching hospital organizations in order to understand how actors crucial to the delivery of this vision are responding. We found the clinical and non-clinical directors of these organizations engaged in a process of active sense making which was leading to significant changes to the service and also changes to identity.
Evaluating performance of integrated supply arrangements 4. 1 Stakeholder evaluation as an approa... more Evaluating performance of integrated supply arrangements 4. 1 Stakeholder evaluation as an approach for measuring the performance of integrated supply 4.2 Experiences with stakeholder-based performance evaluation 4.3 Implications for future development of measurement 5 Conclusions and implications 5. 1 Conclusions on forces that shape successful innovation 5.2 Overview of the guidance material on developing supply chain integration References Appendix 1: Members of the Action Learning Club Appendix 2: Contents of the 'Building Down Barriers' handbook 4 Laing O'Rourke operates both as a main contractor and specialist concrete frame and groundworks contractor. The company has a strategy of being at the forefront of innovation in construction products and processes, including acting as a supply chain integrator. The Action Research Team's work was to support business-level innovation aimed at implementing forms of agreements with suppliers that require collaborative search for performance and profit improvement over time with sharing of risks and benefits. At the project-level, the team made considerable progress towards planning a collaborative costing framework to be used for cost planning, target setting and cost management on a series of health sector projects. This work stopped abruptly when the client decided it did not have the budget to proceed with these projects. Lend Lease Projects and the Building Design Partnership (BDP) as project manager and architects, respectively, worked together on a large city-centre retail development. Their Action Research Team focused on understanding the opportunities for improving project-level systems for integrating detailed design and procurement to be able to respond to emerging opportunities to optimise the design and deliver value to the end client. Pearce Group is a medium sized contractor operating in specialist niche markets within the public and private sector. The company recently returned to private ownership and has undertaken a major restructuring, creating client and market focused teams across its work streams. The Action Research Team looked at what would be involved in Pearce establishing a unique and unrivalled relationship with its suppliers, whereby the collaborative approach adopted becomes viewed by clients as an extension of Pearce's own service delivery. The team helped Pearce supply chain managers develop approaches for involving supply alliance partners in identifying opportunities for making process improvements and saving cost, and assessing joint performance. The change methodology set out to provide guidance for those who wish to innovate, recognising these realities of human organisation. Its purpose was to help an organisation or a set of supply partners evaluate their strategic assumptions and devise specific proposals for achieving integrated ways of working.
The context for our culture change project Strategic priorities Our approach to culture change En... more The context for our culture change project Strategic priorities Our approach to culture change Engaging leadership An evidence-based approach to culture change Knowledge exchange as an academic promotion route The Engaging Research Award Scheme The values of digital engagement Infrastructure to support digital engagement Exploring the creation of publics Exploring the impacts of engaged research Lessons learned Partnerships Impact Planning for sustainability Conclusions and recommendations References On a personal note, I am hugely grateful to a large number of Open University (OU) staff for their contributions to our Public Engagement with Research Catalyst, also to our Advisory Board, and to the other seven Catalyst universities. We have acknowledged as many of these contributors as our failing memories could recall toward the start and end of this report. Closer to home, I would like to thank Trevor Collins, Fiona McKerlie and Tim Blackman from the OU, Paul Manners and Sophie Duncan from the National Coordinating Centre for Public Engagement, and, always, Jane Perrone. When things got difficult, and of course they did, you were the people I turned to for advice.
This paper explores the various ways in which clinical executive directors and non-clinical execu... more This paper explores the various ways in which clinical executive directors and non-clinical executive directors are interpreting and responding to the extensive reforms and restructuring in the UK health service. The key changes include devolved accountability, the introduction of some market mechanisms and incentives, some element of competition between healthcare provider organisations, more patient choice, a clearer provider-purchaser split, and increased competition from private sector and third sector providers. Changes to healthcare environments of this kind are occurring in many countries but such is the extent and intensity of these changes that the UK government sees this set of reforms leading to a peerless world class health service. The paper draws upon detailed research in two very large teaching hospital organizations in order to understand how actors crucial to the delivery of this vision are responding. We found the clinical and non-clinical directors of these organizations engaged in a process of active sense making which was leading to significant changes to the service and also changes to identity.
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Papers by Richard Holti