具有政治敏锐性的医疗保健领导力及其在重大制度变革实施中的作用:HeLPA定性研究

J. Waring, S. Bishop, Jenelle M. Clarke, M. Exworthy, N. Fulop, J. Hartley, A. Ramsay, G. Black, B. Roe
{"title":"具有政治敏锐性的医疗保健领导力及其在重大制度变革实施中的作用:HeLPA定性研究","authors":"J. Waring, S. Bishop, Jenelle M. Clarke, M. Exworthy, N. Fulop, J. Hartley, A. Ramsay, G. Black, B. Roe","doi":"10.3310/ffci3260","DOIUrl":null,"url":null,"abstract":"\n \n The implementation of change in health and care services is often complicated by the ‘micropolitics’ of the care system. There is growing recognition that health and care leaders need to develop and use types of ‘political skill’ or ‘political astuteness’ to understand and manage the micropolitics of change.\n \n \n \n The aim of this study was to produce a new empirical and theoretical understanding of the acquisition, use and contribution of leadership with ‘political astuteness’, especially in the implementation of major system change, from which to inform the co-design of training, development and recruitment resources.\n \n \n \n The qualitative study comprised four work packages. Work package 1 involved two systematic literature reviews: one ‘review of reviews’ on the concept of political astuteness and another applying the learning from this to the health services research literature. Work package 2 involved biographical narrative interviews with 66 health and care leaders to investigate their experiences of acquiring and using political skills in the implementation of change. Work package 3 involved in-depth qualitative case study research with nine project teams drawn from three regional Sustainability and Transformation Partnerships operating in different English regions. Work package 4 involved a series of co-design workshops to develop learning materials and resources to support service leaders’ acquisition and use of political skills and astuteness.\n \n \n \n The concepts of political skills and astuteness have had growing influence on health services research, yet these have tended to emphasise a relatively individualised and behavioural view of change leadership. The interview study suggests that, although leaders certainly use individual skills and behaviours when implementing change, change processes are contingent on local contextual factors and the patterns of collective action in the forms of interlocking constellations of political interactions. The in-depth case study research further shows these interactive, contingent and collective processes in the implementation of major system change. The study finds that major system change occurs over several linked stages, each involving particular controversies for which skills, strategies and actions are needed. Informed by these findings, and through a series of co-design workshops, the study has produced a set of resources and materials and a workbook to support individuals and project teams to acquire and develop political skill.\n \n \n \n The study was complicated by the COVID-19 pandemic and there were difficulties in recruiting in-depth cases for observational research, and also recruiting patient and community groups.\n \n \n \n Health and care leaders can develop and use a range of skills, strategies and actions to understand and navigate the diverse interests that complicate change. Building on the literature, the study presents a novel empirical framework of these skills, strategies and behaviours, and shows how they are used in the implementation of major system change. This study concludes with a set of co-designed learning resources and materials to support future leaders to develop similar skills and strategies. Further evidence is needed on the contribution of the learning resources on leadership activities and to understand the contribution of political skills to other areas of service governance.\n \n \n \n This study is registered as researchregistery4020.\n \n \n \n This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 11. See the NIHR Journals Library website for further project information.\n","PeriodicalId":73204,"journal":{"name":"Health and social care delivery research","volume":" ","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Healthcare Leadership with Political Astuteness and its role in the implementation of major system change: the HeLPA qualitative study\",\"authors\":\"J. Waring, S. Bishop, Jenelle M. Clarke, M. Exworthy, N. Fulop, J. Hartley, A. Ramsay, G. Black, B. Roe\",\"doi\":\"10.3310/ffci3260\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"\\n \\n The implementation of change in health and care services is often complicated by the ‘micropolitics’ of the care system. There is growing recognition that health and care leaders need to develop and use types of ‘political skill’ or ‘political astuteness’ to understand and manage the micropolitics of change.\\n \\n \\n \\n The aim of this study was to produce a new empirical and theoretical understanding of the acquisition, use and contribution of leadership with ‘political astuteness’, especially in the implementation of major system change, from which to inform the co-design of training, development and recruitment resources.\\n \\n \\n \\n The qualitative study comprised four work packages. Work package 1 involved two systematic literature reviews: one ‘review of reviews’ on the concept of political astuteness and another applying the learning from this to the health services research literature. Work package 2 involved biographical narrative interviews with 66 health and care leaders to investigate their experiences of acquiring and using political skills in the implementation of change. Work package 3 involved in-depth qualitative case study research with nine project teams drawn from three regional Sustainability and Transformation Partnerships operating in different English regions. Work package 4 involved a series of co-design workshops to develop learning materials and resources to support service leaders’ acquisition and use of political skills and astuteness.\\n \\n \\n \\n The concepts of political skills and astuteness have had growing influence on health services research, yet these have tended to emphasise a relatively individualised and behavioural view of change leadership. The interview study suggests that, although leaders certainly use individual skills and behaviours when implementing change, change processes are contingent on local contextual factors and the patterns of collective action in the forms of interlocking constellations of political interactions. The in-depth case study research further shows these interactive, contingent and collective processes in the implementation of major system change. The study finds that major system change occurs over several linked stages, each involving particular controversies for which skills, strategies and actions are needed. Informed by these findings, and through a series of co-design workshops, the study has produced a set of resources and materials and a workbook to support individuals and project teams to acquire and develop political skill.\\n \\n \\n \\n The study was complicated by the COVID-19 pandemic and there were difficulties in recruiting in-depth cases for observational research, and also recruiting patient and community groups.\\n \\n \\n \\n Health and care leaders can develop and use a range of skills, strategies and actions to understand and navigate the diverse interests that complicate change. Building on the literature, the study presents a novel empirical framework of these skills, strategies and behaviours, and shows how they are used in the implementation of major system change. This study concludes with a set of co-designed learning resources and materials to support future leaders to develop similar skills and strategies. Further evidence is needed on the contribution of the learning resources on leadership activities and to understand the contribution of political skills to other areas of service governance.\\n \\n \\n \\n This study is registered as researchregistery4020.\\n \\n \\n \\n This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 11. See the NIHR Journals Library website for further project information.\\n\",\"PeriodicalId\":73204,\"journal\":{\"name\":\"Health and social care delivery research\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2022-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Health and social care delivery research\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.3310/ffci3260\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Health and social care delivery research","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.3310/ffci3260","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

摘要

医疗保健服务变革的实施往往因医疗保健系统的“微观政治”而变得复杂。人们越来越认识到,卫生和保健领导人需要培养和使用各种类型的“政治技能”或“政治敏锐性”来理解和管理变革的微观政治。本研究的目的是对具有“政治敏锐性”的领导力的获取、使用和贡献,特别是在实施重大制度变革时,产生新的经验和理论理解,从而为培训、发展和招聘资源的共同设计提供信息。定性研究包括四个工作包。工作包1涉及两个系统的文献综述:一个是关于政治敏锐性概念的“综述”,另一个是将从中吸取的教训应用于卫生服务研究文献。工作包2涉及对66名卫生和保健领导人的传记性叙述性采访,以调查他们在实施变革过程中获得和使用政治技能的经历。工作包3涉及深入的定性案例研究,九个项目团队来自三个在英国不同地区运作的区域可持续发展和转型伙伴关系。工作包4包括一系列共同设计讲习班,以开发学习材料和资源,支持服务领导人掌握和使用政治技能和敏锐性。政治技能和精明的概念对卫生服务研究产生了越来越大的影响,但这些概念往往强调对变革领导力的相对个性化和行为观。访谈研究表明,尽管领导人在实施变革时肯定会使用个人技能和行为,但变革过程取决于当地的背景因素和集体行动模式,其形式是相互关联的政治互动。深入的案例研究进一步展示了重大制度变革实施过程中的这些互动、偶然和集体过程。研究发现,主要的制度变化发生在几个相互关联的阶段,每个阶段都涉及到需要技能、策略和行动的特定争议。根据这些发现,并通过一系列共同设计研讨会,该研究编制了一套资源和材料以及一份工作簿,以支持个人和项目团队获得和发展政治技能。新冠肺炎大流行使这项研究变得复杂,在招募深入病例进行观察性研究以及招募患者和社区团体方面存在困难。卫生和保健领导人可以发展和使用一系列技能、战略和行动来理解和驾驭使变革复杂化的各种利益。在文献的基础上,该研究提出了一个关于这些技能、策略和行为的新颖经验框架,并展示了如何在实施重大制度变革时使用这些技能、战略和行为。本研究最后提供了一套共同设计的学习资源和材料,以支持未来的领导者发展类似的技能和策略。需要进一步证明学习资源对领导活动的贡献,并了解政治技能对服务治理其他领域的贡献。本研究注册为研究注册号4020。该项目由国家卫生与护理研究所(NIHR)卫生与社会护理提供研究计划资助,并将在《卫生与社会保健提供研究》上全文发表;第10卷第11期。有关更多项目信息,请访问NIHR期刊图书馆网站。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Healthcare Leadership with Political Astuteness and its role in the implementation of major system change: the HeLPA qualitative study
The implementation of change in health and care services is often complicated by the ‘micropolitics’ of the care system. There is growing recognition that health and care leaders need to develop and use types of ‘political skill’ or ‘political astuteness’ to understand and manage the micropolitics of change. The aim of this study was to produce a new empirical and theoretical understanding of the acquisition, use and contribution of leadership with ‘political astuteness’, especially in the implementation of major system change, from which to inform the co-design of training, development and recruitment resources. The qualitative study comprised four work packages. Work package 1 involved two systematic literature reviews: one ‘review of reviews’ on the concept of political astuteness and another applying the learning from this to the health services research literature. Work package 2 involved biographical narrative interviews with 66 health and care leaders to investigate their experiences of acquiring and using political skills in the implementation of change. Work package 3 involved in-depth qualitative case study research with nine project teams drawn from three regional Sustainability and Transformation Partnerships operating in different English regions. Work package 4 involved a series of co-design workshops to develop learning materials and resources to support service leaders’ acquisition and use of political skills and astuteness. The concepts of political skills and astuteness have had growing influence on health services research, yet these have tended to emphasise a relatively individualised and behavioural view of change leadership. The interview study suggests that, although leaders certainly use individual skills and behaviours when implementing change, change processes are contingent on local contextual factors and the patterns of collective action in the forms of interlocking constellations of political interactions. The in-depth case study research further shows these interactive, contingent and collective processes in the implementation of major system change. The study finds that major system change occurs over several linked stages, each involving particular controversies for which skills, strategies and actions are needed. Informed by these findings, and through a series of co-design workshops, the study has produced a set of resources and materials and a workbook to support individuals and project teams to acquire and develop political skill. The study was complicated by the COVID-19 pandemic and there were difficulties in recruiting in-depth cases for observational research, and also recruiting patient and community groups. Health and care leaders can develop and use a range of skills, strategies and actions to understand and navigate the diverse interests that complicate change. Building on the literature, the study presents a novel empirical framework of these skills, strategies and behaviours, and shows how they are used in the implementation of major system change. This study concludes with a set of co-designed learning resources and materials to support future leaders to develop similar skills and strategies. Further evidence is needed on the contribution of the learning resources on leadership activities and to understand the contribution of political skills to other areas of service governance. This study is registered as researchregistery4020. This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 11. See the NIHR Journals Library website for further project information.
求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
CiteScore
1.00
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信