Harnessing a clinician-led governance model to overcome healthcare tribalism and drive innovation: a case study of Northumbria NHS Foundation Trust.

PURPOSE: Healthcare tribalism refers to the phenomenon through which different groups in a healthcare setting strictly adhere to their profession-based silo, within which they exhibit stereotypical behaviours. In turn, this can lead to deleterious downstream effects upon productivity and care delivered to patients. This study highlights a clinician-led governance model, implemented at a National Health Service (NHS) trust, to investigate whether it successfully overcame tribalism and helped drive innovation. DESIGN/METHODOLOGY/APPROACH: This was a convergent mixed-methods study including qualitative and quantitative data collected in parallel. Qualitative data included 27 semi-structured interviews with representatives from four professional groups. Quantitative data were collected through a verbally administered survey and scored on a 10-point scale. FINDINGS: The trust arranged its services under five autonomous business units, with a clinician and a manager sharing the leadership role at each unit. According to interviewees replies, this equivalent authority was cascaded down and enabled breaking down professional siloes, which in turn aided in the adoption of an innovative clinical model restructure. PRACTICAL IMPLICATIONS: This study contributes to the literature by characterizing a real-world example in which healthcare tribalism was mitigated while reflecting on the advantages yielded as a result. ORIGINALITY/VALUE: Previous studies from all over the world identified major differences in the perspectives of different healthcare professional groups. In the United Kingdom, clinicians largely felt cut off from decision-making and dissatisfied with their managerial role. The study findings explain a governance model that allowed harmony and inclusion of different professions. Given the long-standing strains on healthcare systems worldwide, stakeholders can leverage the study findings for guidance in developing and implementing innovative managerial approaches.

Addressing health inequalities by using Structural Funds. A question of opportunities.

Making up a third of the EU budget, Structural and Investment Funds can provide important opportunities for investing in policies that tackle inequalities in health. This article looks back and forward at the 2007-2013 and 2014-2020 financial periods in an attempt to inform the development of health equity as a strand of policy intervention under regional development. It combines evidence from health projects funded through Structural Funds and a document analyses that locates interventions for health equity under the new regulations. The map of opportunities has changed considerably since the last programming period, creating more visibility for vulnerable groups, social determinants of health and health systems sustainability. As the current programming period is progressing, this paper contributes to maximizing this potential but also identifying challenges and implementation gaps for prospective health system engagement in pursuing health equity as part of Structural Funds projects. The austerity measures and their impact on public spending, building political support for investments as well as the difficulties around pursuing health gains as an objective of other policy areas are some of the challenges to overcome. European Structural and Investment Funds could be a window of opportunity that triggers engagement for health equity if sectors adopt a transformative approach and overcome barriers, cooperate for common goals and make better use of the availability of these resources.

European hospital reforms in times of crisis: aligning cost containment needs with plans for structural redesign?

Hospitals have become a focal point for health care reform strategies in many European countries during the current financial crisis. It has been called for both, short-term reforms to reduce costs and long-term changes to improve the performance in the long run. On the basis of a literature and document analysis this study analyses how EU member states align short-term and long-term pressures for hospital reforms in times of the financial crisis and assesses the EU's influence on the national reform agenda. The results reveal that there has been an emphasis on cost containment measures rather than embarking on structural redesign of the hospital sector and its position within the broader health care system. The EU influences hospital reform efforts through its enhanced economic framework governance which determines key aspects of the financial context for hospitals in some countries. In addition, the EU health policy agenda which increasingly addresses health system questions stimulates the process of structural hospital reforms by knowledge generation, policy advice and financial incentives. We conclude that successful reforms in such a period would arguably need to address both the organisational and financing sides to hospital care. Moreover, critical to structural reform is a widely held acknowledgement of shortfalls in the current system and belief that new models of hospital care can deliver solutions to overcome these deficits. Advancing the structural redesign of the hospital sector while pressured to contain cost in the short-term is not an easy task and only slowly emerging in Europe.

Keeping capital supple for future flexibility.

In a follow-up to a paper published in Health Estate Journal in February, Capitalising in the long term, Bernd Rechel, Stephen Wright, Barrie Dowdeswell, Nigel Edwards, and Martin McKee report on the findings of a research project into the financing, design and building of innovative European hospitals. One of the key conclusions was the need to build into new healthcare facilities, from the outset, sufficient flexibility to cater for fast-changing care patterns and evolving technologies.

Capitalising in the long term.

Bernd Rechel, Stephen Wright, Nigel Edwards, Barrie Dowdeswell and Martin McKee report on an international study on improving the effectiveness of health capital investment which analyses innovative European capital projects and examines the key issues that arise. The study, by the European Observatory on Health Systems and Policies and the European Health Property Network/European Centre for Health Assets & Architecture, suggests that hospital design that takes into account facility management costs results in significant efficiency gains.

Capital investment for health: case studies from Europe

Capital investment in European health systems has to take account of the demographic and epidemiological transitions associated with an ageing population; advances in medical technologies and pharmaceuticals; rising public expectations; and persistent health inequalities. This volume presents 11 case studies from across Europe of capital investment in health facilities, in the form of seven individual projects, two health systems, one corporate investor and one financing approach. They include hospitals or medical centres in the Netherlands, Norway, Sweden, Finland, Germany, Poland and Spain, and regional planning and a financing initiative in the United Kingdom and Italy. This book offers policy-makers, planners, architects, financiers and managers practical illustrations of how health services can be translated into capital assets and aims to expand the evidence base on how to improve the long-term sustainability of capital investment.

Investing in hospitals of the future

Despite considerable investments in health facilities worldwide, little systematic evidence is available on how to plan, design and build new facilities that maximize health gain and ensure that services are responsive to the legitimate expectations of users. This book brings together current knowledge about key dimensions of capital investment in the health sector. A number of issues are examined, including new models of long-term care, capacity planning, the impact of capital investment on the health care workforce, markets and competition, systems used for procurement and financing, the whole life-cycle of health facilities, facility management, the wider impact of capital investment on the local community and economy, how care models can be translated into capital asset solutions, and issues of therapeutic and sustainable design. This book is of value to those interested in the planning, financing, construction, and management of new health facilities. It identifies critical lessons that increase the chances that capital projects will be successful.