Journal of Health Services Research & Policy最新文献

{"title":"Strategies to reduce waiting times in outpatient rehabilitation services for adults with physical disabilities: A systematic literature review.","authors":"Frédérique Dupuis,&nbsp;Julien Déry,&nbsp;Fabio Carlos Lucas de Oliveira,&nbsp;Ana Tereza Pecora,&nbsp;Rose Gagnon,&nbsp;Katherine Harding,&nbsp;Chantal Camden,&nbsp;Jean-Sébastien Roy,&nbsp;Josiane Lettre,&nbsp;Anne Hudon,&nbsp;Marie Beauséjour,&nbsp;Anne-Marie Pinard,&nbsp;Brenna Bath,&nbsp;Simon Deslauriers,&nbsp;Marie-Ève Lamontagne,&nbsp;Debbie Feldman,&nbsp;François Routhier,&nbsp;François Desmeules,&nbsp;Luc J Hébert,&nbsp;Jordan Miller,&nbsp;Angel Ruiz,&nbsp;Kadija Perreault","doi":"10.1177/13558196211065707","DOIUrl":"https://doi.org/10.1177/13558196211065707","url":null,"abstract":"<p><strong>Objective: </strong>Identifying effective strategies to reduce waiting times is a crucial issue in many areas of health services. Long waiting times for rehabilitation services have been associated with numerous adverse effects in people with disabilities. The main objective of this study was to conduct a systematic literature review to assess the effectiveness of service redesign strategies to reduce waiting times in outpatient rehabilitation services for adults with physical disabilities.</p><p><strong>Methods: </strong>We conducted a systematic review, searching three databases (MEDLINE, CINAHL and EMBASE) from their inception until May 2021. We identified studies with comparative data evaluating the effect of rehabilitation services redesign strategies on reducing waiting times. The Mixed Methods Appraisal Tool was used to assess the methodological quality of the studies. A narrative synthesis was conducted.</p><p><strong>Results: </strong>Nineteen articles including various settings and populations met the selection criteria. They covered physiotherapy (<i>n</i> = 11), occupational therapy (<i>n</i> = 2), prosthetics (<i>n</i> = 1), exercise physiology (<i>n</i> = 1) and multidisciplinary (<i>n</i> = 4) services. The methodological quality varied (<i>n</i> = 10 high quality, <i>n</i> = 6 medium, <i>n</i> = 3 low); common flaws being missing information on the pre-redesign setting and characteristics of the populations. Seven articles assessed access processes or referral management strategies (e.g. self-referral), four focused on extending/modifying the roles of service providers (e.g. to triage) and eight changed the model of care delivery (e.g. mode of intervention). The different redesign strategies had positive effects on waiting times in outpatient rehabilitation services.</p><p><strong>Conclusions: </strong>This review highlights the positive effects of many service redesign strategies. These findings suggest that there are several effective strategies to choose from to reduce waiting times and help better respond to the needs of persons experiencing physical disabilities.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"27 2","pages":"157-167"},"PeriodicalIF":2.4,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39778528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Person-centred care and measurement: The more one sees, the better one knows where to look.","authors":"Brendan McCormack","doi":"10.1177/13558196211071041","DOIUrl":"https://doi.org/10.1177/13558196211071041","url":null,"abstract":"Determining the quality of a health system is a complex and challenging endeavour. The variety of perspectives needed to determine quality means that increasingly complex measurement frameworks are often employed. Providing the best possible health care has always been a priority for health system leaders, individual professions and individual professionals. But the importance and significance of measuring quality has increased since the evolution of quality-improvement methodologies for health-care quality standardisation in the 1990s. Audit and feedback systems evolved into quality-control methods with the increased industrialisation of health systems. As the patient voice became increasingly important, with the rise in advocacy groups and patient-representative organisations, the focus on controlling the quality of services through a managerialist ideology was challenged. Broader, more inclusive, approaches to quality were embraced. Quality-improvement methodologies aim to adopt an inclusive approach to ongoing quality enhancement, ensuring that services are continuously developed and improved. This evolutionary context is important when considering the measurement methods that dominate health systems. To some extent, it could be argued that while health care cultures have shifted their focus from one of control to improvement, approaches to measurement continue to privilege standardised, quantifiable data and information that can be used for quality standardisation. Despite more than 30 years of developments in patient-centred and then person-centred care, the focus on quantitative measurement has continued to dominate, even though it does little to inform stakeholders about the person-centredness of a health system. The person-centred care movement is not new in health care and there are some who would argue that other approaches, such as relationship-centred care, have superseded person-centredness. The lack of concept clarification and theory-driven methodologies by researchers in the field has done little to help this situation. This failure has also been reflected in approaches to measurement and evaluation. The paper by Cribb in this issue of the Journal of Health Services Research & Policy highlights this problem precisely, that is, the interchangeable use of patientand person-centred care and a lack of definition of either! In 2017, Dewing and McCormack highlighted the problem of researchers evaluating person-centredness without defining what they mean. After more than 20 years of research in this field, including the publication of concepts, models, theories and frameworks, it is unacceptable not to present a clear definition as a basis of an evaluation methodology. This lack of precision carries on through the focus on person-centred care as an isolated activity associated with providing care to patients – as if somehow person-centred care practices can be isolated from the context in which they exist. Previously, Laird et al. argue","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"27 2","pages":"85-87"},"PeriodicalIF":2.4,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39863423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An evaluation of five regional health information technology-based programmes to improve health and social care coordination: A quasi-experimental controlled before/after mixed design.","authors":"Louis-Rachid Salmi,&nbsp;Tamara Roberts,&nbsp;Thomas Renaud,&nbsp;Sophie Buffeteau,&nbsp;Sandrine Cueille,&nbsp;Emmanuelle Fourneyron,&nbsp;Aurélie Gaillard,&nbsp;Maelys Abraham,&nbsp;Nora Arditi,&nbsp;Mathieu Castry,&nbsp;Fabien Daniel,&nbsp;N'deye Fatou N'gom,&nbsp;Orlane Guéry,&nbsp;Yannick L'Horty,&nbsp;Stéphane Pincemail,&nbsp;Sonia Purgues,&nbsp;Franz Thiessard,&nbsp;Viviane Ramel,&nbsp;Emmanuel Langlois,&nbsp;Florence Saillour-Glénisson,&nbsp;Matthieu Sibé,&nbsp;Jérôme Wittwer","doi":"10.1177/13558196211065704","DOIUrl":"https://doi.org/10.1177/13558196211065704","url":null,"abstract":"<p><strong>Objectives: </strong>Health information technology (HIT) can help coordinate health and social actors involved in patients' pathways. We assess five regional HIT-based programmes ('<i>Territoires de Soins Numériques</i>' or TSN) introduced in France, covering the period 2012-2018.</p><p><strong>Methods: </strong>This was a quasi-experimental controlled before/after mixed design. We used data from the French National Health Insurance database, qualitative and quantitative surveys, and information extracted from project documents and databases. We assessed the impact of TSN using four main impact indicators: emergency room visits, unplanned hospitalizations, avoidable hospitalizations and rehospitalization within 30 days. We also collected qualitative and secondary quantitative data covering perceived needs, knowledge, use, satisfaction, adoption and understanding of projects, pathway experience, impact on professional practices and appropriateness of hospitalizations.</p><p><strong>Results: </strong>TSN implemented a heterogeneous mix of HIT. Implementation was slower than expected and was not well documented. Users perceived the HIT as having a positive but weak overall effect. There were no significant differences in trends for the main impact indicators, nor on the appropriateness of hospitalizations, but favourable trends on secondary polypharmacy indicators.</p><p><strong>Conclusions: </strong>If similar innovations take place in future, they should be based on a logical framework that defines causal, measurable links between services provided and expected impacts.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"27 2","pages":"122-132"},"PeriodicalIF":2.4,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39916595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The contribution of professions to the governance of integrated care: Towards a conceptual framework based on case studies from Denmark.","authors":"Viola Burau,&nbsp;Ellen Kuhlmann,&nbsp;Loni Ledderer","doi":"10.1177/13558196211055652","DOIUrl":"https://doi.org/10.1177/13558196211055652","url":null,"abstract":"<p><strong>Objective: </strong>Good governance of integrated care is key to better health care, but we know little about how professions can help make this happen. Our aim is to introduce a conceptual framework to analyse how professions contribute to the governance of integrated care, and to apply the framework to a secondary analysis of selected case studies from Denmark.</p><p><strong>Methods: </strong>We developed a framework, which identified the <i>what</i>, <i>how</i> and <i>why</i> of the contribution professions make to the governance of integrated care. We included five qualitative Danish studies, using coordination as an indicator of integrated care. We adopted a thematic approach in our analysis, combining deductive and inductive elements.</p><p><strong>Results: </strong>Health professions engage in highly diverse activities, which fall into closely connected clusters of more formal or more informal coordination. Professions apply many different adaptive mechanisms at different levels to fit coordination into local contexts. Professions are driven by interlocking rationales, where a common focus on patients connects organizational and professional concerns.</p><p><strong>Conclusions: </strong>Our analytical framework emerges as a useful tool for analysis. The contribution of professions to the governance of integrated care needs greater attention in health policy implementation as it can promote more effective governance of integrated care.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"27 2","pages":"106-113"},"PeriodicalIF":2.4,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39747557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to early detection and management of oral cancer in the Asia Pacific region.","authors":"Sin Wi Ng,&nbsp;Sharifah Nur Syamim Syed Mohd Sobri,&nbsp;Rosnah Binti Zain,&nbsp;Thomas George Kallarakkal,&nbsp;Rahmi Amtha,&nbsp;Felix A Wiranata Wong,&nbsp;Jyotsna Rimal,&nbsp;Callum Durward,&nbsp;Chanbora Chea,&nbsp;Ruwan Duminda Jayasinghe,&nbsp;Patravoot Vatanasapt,&nbsp;Nor Saleha Binti Ibrahim Tamin,&nbsp;Lai Choo Cheng,&nbsp;Siti Mazlipah Binti Ismail,&nbsp;Chher Tepirou,&nbsp;Zainal Ariff Bin Abdul Rahman,&nbsp;Senthilmani Rajendran,&nbsp;Jananezwary Kanapathy,&nbsp;Chee Sun Liew,&nbsp;Sok Ching Cheong","doi":"10.1177/13558196211053110","DOIUrl":"https://doi.org/10.1177/13558196211053110","url":null,"abstract":"<p><strong>Objective: </strong>Oral cancer is amenable to early detection but remains a prominent cause of mortality in the Asia Pacific region. This study aimed to identify barriers to early detection and management of oral cancer in the Asia Pacific region.</p><p><strong>Methods: </strong>A mixed-methods approach was employed triangulating findings from a survey and focus groups. The survey was conducted among seven representative members of the Asia Pacific Oral Cancer Network (APOCNET) across six countries. Focus groups were conducted to gain deeper insights into the findings of the survey.</p><p><strong>Results: </strong>The identified barriers were a lack of national cancer control strategies and cancer registries and the limited availability of trained health care professionals. Overcoming these challenges in the Asia Pacific region where resources are scarce will require collaborative partnerships in data collection and novel approaches for continuous professional training including eLearning. Further, to overcome the lack of trained health care professionals, innovative approaches to the management of oral potentially malignant lesions and oral cancer including telemedicine were suggested.</p><p><strong>Conclusion: </strong>The findings of this study should be taken into account when charting national cancer control plans for oral cancer and will form the basis for future collaborative studies in evaluating effective measures to improve oral cancer detection and management in low- and middle-income countries.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"27 2","pages":"133-140"},"PeriodicalIF":2.4,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39713011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'It's possibly made us feel a little more alienated': How people from ethnic minority communities conceptualise COVID-19 and its influence on engagement with testing.","authors":"Tushna Vandrevala, Lailah Alidu, Jane Hendy, Shuja Shafi, Aftab Ala","doi":"10.1177/13558196211054961","DOIUrl":"10.1177/13558196211054961","url":null,"abstract":"<p><strong>Objectives: </strong>The cultural beliefs, practices and experiences of ethnic minority groups, alongside structural inequalities and the political economy play a critical, but overlooked role in health promotion. This study aimed to understand how ethnic minority groups in the United Kingdom conceptualised COVID-19 and how this influenced engagement in testing.</p><p><strong>Method: </strong>Black (African and Caribbean) and South Asian (Indian, Pakistani and Bangladeshi) community members were purposefully recruited from across the UK. Fifty-seven semi-structured interviews were conducted and analysed using principles of grounded theory.</p><p><strong>Results: </strong>We found that people of Black and South Asian ethnicity conceptualised COVID-19 as a disease that makes them visible to others outside their community and was seen as having more severe risk and suffering worse consequences, resulting in fear, stigmatisation and alienation. Views about COVID-19 were embedded in cultural beliefs, relating to culturally specific ideas around disease, such as ill-health being God's will. Challenges brought about by the pandemic were conceptualised as one of many struggles, with the saliency of the virus contextualised against life experiences. These themes and others influenced engagement with COVID-19 testing. Testing was less about accessing timely and effective treatment for themselves and more about acting to protect the family and community. Testing symbolised a loss of income, anxiety and isolation, accentuated by issues of mistrust of the system and not being valued, or being treated unfairly.</p><p><strong>Conclusion: </strong>Health communications should focus on counterbalancing the mistrust, alienation and stigmatisation that act as barriers to testing, with trust built using local credible sources.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"27 2","pages":"141-150"},"PeriodicalIF":2.4,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0c/fa/10.1177_13558196211054961.PMC8948536.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39781757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What counts as a voiceable concern in decisions about speaking out in hospitals: A qualitative study.","authors":"Mary Dixon-Woods, Emma L Aveling, Anne Campbell, Akbar Ansari, Carolyn Tarrant, Janet Willars, Peter Pronovost, Imogen Mitchell, David W Bates, Christian Dankers, James McGowan, Graham Martin","doi":"10.1177/13558196211043800","DOIUrl":"10.1177/13558196211043800","url":null,"abstract":"<p><strong>Objectives: </strong>Those who work in health care organisations are a potentially valuable source of information about safety concerns, yet failures of voice are persistent. We propose the concept of 'voiceable concern' and offer an empirical exploration.</p><p><strong>Methods: </strong>We conducted a qualitative study involving 165 semi-structured interviews with a range of staff (clinical, non-clinical and at different hierarchical levels) in three hospitals in two countries. Analysis was based on the constant comparative method.</p><p><strong>Results: </strong>Our analysis shows that identifying what counts as a concern, and what counts as a occasion for voice by a given individual, is not a straightforward matter of applying objective criteria. It instead often involves discretionary judgement, exercised in highly specific organisational and cultural contexts. We identified four influences that shape whether incidents, events and patterns were classified as voiceable concerns: certainty that something is wrong and is an occasion for voice; system versus conduct concerns, forgivability and normalisation. Determining what counted as a voiceable concern is not a simple function of the features of the concern; also important is whether the person who noticed the concern felt it was voiceable by them.</p><p><strong>Conclusions: </strong>Understanding how those who work in health care organisations come to recognise what counts as a voiceable concern is critical to understanding decisions and actions about speaking out. The concept of a voiceable concern may help to explain aspects of voice behaviour in organisations as well as informing interventions to improve voice.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"27 2","pages":"88-95"},"PeriodicalIF":2.4,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8950712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39783074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of inpatient spending and readmission rates for patients treated by male versus female physicians in China: An observational study.","authors":"Menghan Shen,&nbsp;Linyan Li,&nbsp;Yushan Wu,&nbsp;Yuanfan Yang","doi":"10.1177/13558196211058974","DOIUrl":"https://doi.org/10.1177/13558196211058974","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether there are significant differences in costs of treatment and readmission rates for hospital consultations undertaken by female versus male physicians in China.</p><p><strong>Methods: </strong>Using data from the Urban Employee Basic Medical Insurance program from January 2018 through October 2019, we investigated spending patterns and clinical outcomes for patients at tertiary hospitals in one of the largest cities in China by the gender of the attending physician. Our sample included 79,085 hospitalizations treated by 3993 physicians in internal medicine departments. We examined the association between physician gender and visit cost using a multivariable linear model. We examined the association between physician gender and 30-days readmission rates using a multivariable probability model. We adjusted for a rich set of patient characteristics, primary diagnosis fixed effects, and hospital fixed effects. In addition, we used patient fixed effects in a robustness analysis.</p><p><strong>Results: </strong>Adjusting for primary diagnosis fixed effects, spending per visit was 4.1% higher for patients treated by male physicians than for those treated by female physicians, a statistically significant difference (95% CI [1.5%, 6.7%]). This pattern persisted after further adjusting for hospital fixed effects (3.2% [1.2%, 5.2%]), patient characteristics (3.2% [1.2%, 5.1%]), and patient fixed effects (4.2% [1.8%, 6.7%]). The difference is mainly driven by higher spending on drugs (8.7% [3.9%, 13.6%]) and out-of-pocket costs (3.9% [1.7%, 6.0%]). No statistically significant differences were observed in the readmission rates of patients treated by male and female physicians in any of our three model specifications.</p><p><strong>Conclusions: </strong>Spending per visit was significantly higher among patients treated by male physicians than among those treated by female physicians, with the difference mainly driven by spending on drugs and out-of-pocket costs. No significant difference was observed in the hospital readmission rates of patients treated by male and female physicians. These findings have important implications for gender equality in medicine and health care quality and efficiency in developing countries.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"27 2","pages":"114-121"},"PeriodicalIF":2.4,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39775229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring with quality: the example of person-centred care","authors":"A. Cribb, T. Woodcock","doi":"10.1177/13558196211054278","DOIUrl":"https://doi.org/10.1177/13558196211054278","url":null,"abstract":"Qualitative data analysis should be embedded in routine health service measurement, management and organizational practices. The rigorous use of such analyses should become an institutional norm, comparable to the routine use of quantitative data. Our case is intended to have general relevance, but we develop it by reference to person-centred care and patient-centred outcome measures (PCOMs). The increased use of qualitative data analysis of individualized PCOMs is a crucial complementary counterweight to steps towards the standardization of PCOMs. More broadly, our argument is that health care organizations cannot make confident judgements about whether they are offering appropriate care without collecting qualitative data on what matters to individual patients. Introducing properly supported and conducted qualitative data analyses is important in its own right, and also helps underpin the validity and usefulness of quantitative measurement.","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"19 1","pages":"151 - 156"},"PeriodicalIF":2.4,"publicationDate":"2022-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89634462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceived impact of formulating, implementing and enacting national mental health policies recommendations in practice: An exploratory qualitative study within child and adolescent mental health services in Scotland","authors":"M. Toma, JulieAnne Anderson, Sarah Forster, Paula Shiels, S. Windsor, Nicola M. Gray","doi":"10.1177/13558196211072472","DOIUrl":"https://doi.org/10.1177/13558196211072472","url":null,"abstract":"Objective: To understand the process of formulating, implementing and enacting national recommendations into practice, by exploring the interactions between government policymakers and national and local organisations supporting and delivering policy implementation within a Child and Adolescent Mental Health Service (CAMHS) context in Scotland. Methods: Data collection involved 16 semi-structured individual and four focus group interviews with a purposeful sample of policymakers, national health and social care stakeholders and local outpatient and inpatient CAMHS teams representing three NHS health boards in Scotland. Results: Study participants highlighted the challenges of navigating through evolving and often conflicting policy agendas, seen to not acknowledging the current evidence base or experiential learning from services and prior evaluations. Accounts of transformation fatigue often emerged from increased expectations for staff to adopt new approaches to accommodate constantly changing recommendations. Participants also reported a lack of integration and implementation support from national health and social care organisations, leading to duplication of effort and gaps in provision or waste. Policy recommendations were perceived as sometimes vague, lacking clarity about how to deliver service transformation using a whole-system approach. The collective narratives reflected increased tension between the need for local autonomy to innovate and the limitations created vertically by the relative inflexibility of policy recommendations, and horizontally by the proliferation of national organisations delivering the same transformation aims using different approaches in a resource-constrained environment. Conclusion: The findings contribute to the wider literature by offering an exploration of importance of evaluation and evidence uptake in policy formulation; the roles and remits in supporting the implementation of policy recommendations; and how the dynamics of central control and local autonomy might impact on the local enactment of policy recommendations.","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"39 1","pages":"203 - 210"},"PeriodicalIF":2.4,"publicationDate":"2022-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77938654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}