Funded by: NHS National Institute for Health Research
Led by: Professor John Storey (The Open University Business School)
The Open University Business School has been awarded a major research grant by the National Institute of Health Research (NIHR). The grant award is £475,000 and the study will take place over 3 years (December 2013 to November 2016).
Clinical Commissioning Groups (CCGs) have been given control over a large part of the total budget for the NHS in England. The CCGs were the central component of the Health & Social Care Act and the rationale for their creation was to enable clinical leadership. This in turn was seen as crucial to facilitate service redesign and improvement. The project will investigate the ways in which clinical leadership is realised and enacted and with what consequences.
The scope of the study will extend across primary care, acute hospital care, community services and social care including the work of local authorities. The ways in which these bodies with the aid of clinical engagement and leadership can rethink and redesign health and social services is the core of the study.
This research project is designed to examine the variety of ways and the extent to which CCGs address the challenge of engaging clinicians and deploying clinical leadership in the redesign of services. We are in search of effective practice. In particular, it will assess the extent to which these efforts lead to successful inroads into the achievement of integrated care which cuts across legacy boundaries.
Additionally, the ways in which CCGs seek to maintain and develop services based on existing clinical clusters or networks and /or create new arrangements and relationships is a focal area of interest.
The prime purpose of the project is to help identify and clarify the behaviours and circumstances which enable the contribution of effective clinical leadership to service design and delivery in the new context. The project is of equal relevance to managers as it is to clinicians. The research will seek out the views of Health and Wellbeing Boards and patients as well as clinicians and managers.
These objectives can be expressed as a series of Research Questions:
The overall aim is to assess and clarify the extent, nature and effectiveness of clinical engagement and leadership in and around the CCGs. It may transpire that much clinical leadership activity takes place outside or only on the peripheries of CCGs. This overall aim can be broken down into four main research questions:
RQ1. What is the range of clinical engagement and clinical leadership modes being used in CCGs?
RQ2. What is the extent and nature of the scope for clinical leadership and engagement in service redesign that is possible and facilitated by commissioning bodies, particularly the CCGs and the HWBs?
RQ3. What is the range of benefits being targeted through different kinds of clinical engagement and leadership?
RQ4. What are the forces and factors that serve to either enable or block the achievement of benefits in different contexts, and how appropriate are different kinds of clinical engagement and leadership for achieving effective service design?
In order to answer these questions the project has been designed to proceed in a series of phases. These include first, a pilot phase of initial case studies; second a baseline national telephone sample of CCGs; third, building on the results from this initial survey, a series of in-depth case studies of CCGs. When the data from the case studies and the lessons learned have been thoroughly analysed, the insights will be used as a basis to generalise that knowledge. This will lead to the next stage of the research plan which is to test-out the applicability of the findings across the English NHS as a whole. The methods are thus qualitative and quantitative.
Data analysis from both the case studies and the two national surveys will be triangulated and integrated, resulting in write-up and dissemination, which include a report for practitioners, academic articles and the production of a guidance document for CCGs and Health & Wellbeing Boards on approaches to engaging clinicians and achieving the benefits of service redesign.
The research team is led by Professor John Storey, the co-investigators are Dr. Richard Holti and Professor Jean Hartley, the fourth member of the team is Professor Martin Marshall who is a practising GP and the Professor of Healthcare Improvement at UCL and the Lead for Improvement Science London.
CORE TEAM RESEARCHERS:
John Storey (Chief Investigator, The Open University)
Richard Holti (The Open University)
Jean Hartley (The Open University)
Tatum Matharu (The Open University)
Martin Marshall (UCL and Lead for Improvement Science London)