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Steffi Williams PGMDE School Cardiff University

Development and Organizational Change in Primary Care: Implications for Tomorrow’s Clinical Leaders. Steffi Williams PGMDE School Cardiff University. Context of Study. Policy aim Devolution of decision-making to health professionals at local level Rationale: Quality Improvement Efficiency

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Steffi Williams PGMDE School Cardiff University

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  1. Development and Organizational Change in Primary Care: Implications for Tomorrow’s Clinical Leaders Steffi Williams PGMDE School Cardiff University The Politics of Health EHMA June 2008

  2. Context of Study • Policy aim • Devolution of decision-making to health professionals at local level • Rationale: Quality Improvement • Efficiency • Effectiveness • Responsiveness The Politics of Health EHMA June 2008

  3. Study Design • Policy Ethnography • Case Study • 22 Primary Care Organizations (Local Health Groups) • Panel Design: 3 waves of 1:1 Interviews with Chairmen over 3 years The Politics of Health EHMA June 2008

  4. Local Health Boards in Wales The Politics of Health EHMA June 2008

  5. NHS Wales The Politics of Health EHMA June 2008

  6. Findings • Structures set up to deliver policy intentions inhibited implementation • Powers stayed centrally via WAG & HA • Trusts independence maintained • LHGs lacked clout: • Budgets • Authority • Capacity • Information The Politics of Health EHMA June 2008

  7. Some strategies proved to be more effective: • Strategic Focus: • Community’s health needs not existing services • Clinical Governance as central organizational aim • Inclusive Approach • Whole community as constituents Ideological Vision The Politics of Health EHMA June 2008

  8. Why were these approaches effective? (Institutional Politics) • Community Development • Community-wide communication channels re health needs • Relationship building to create common aims The Politics of Health EHMA June 2008

  9. Building organizational capacity • Identifying specific organizational features and capitalising on them to create unique identity and capability: • Existing state of practice development • Infrastructure Development • Exploiting Uncertainty The Politics of Health EHMA June 2008

  10. Circumventing not confronting… • Boards: developed & engaged • Quality Improvement as prime focus • Primary care needs not medical services • Community-wide power base • Learning Orientation The Politics of Health EHMA June 2008

  11. Implications • NHS Wales restructuring afresh now: • Clinical Leadership development: • Ability to tolerate & exploit ambiguity • Strategic Vision • Institutional Politics • Leveraging Assymetries: identifying & exploiting existing organizational features to build unique organizational identities • Organizational Learning • Policy implementation • Dialogue • Evaluation The Politics of Health EHMA June 2008

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