Stakeholder perspectives on new ways of delivering unscheduled health care: the role of ownership and organisational identity

Haddow, G., O'Donnell, C. and Heaney, D. (2006) Stakeholder perspectives on new ways of delivering unscheduled health care: the role of ownership and organisational identity. Journal of Evaluation in Clinical Practice, 13(2), pp. 179-185. (doi:10.1111/j.1365-2753.2006.00667.x)

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Publisher's URL: http://dx.doi.org/10.1111/j.1365-2753.2006.00667.x

Abstract

<b>Rationale, aims and objectives</b>: To explore stakeholder perspectives of the implementation of a new, national integrated nurse-led telephone advice and consultation service (NHS 24), comparing the views of stakeholders from different health care organisations. <b>Methods</b>: Semi-structured interviews with 26 stakeholders including partner organisations located in primary and secondary unscheduled care settings (general practitioner (GP) out-of-hours co-operative; accident and emergency department; national ambulance service), members of NHS 24 and national policymakers. Attendance at key meetings, documentary review and email implementation diaries provided a contextual history of events with which interview data could be compared. <b>Results</b>: The contextual history of events highlighted a fast-paced implementation process, with little time for reflection. Key areas of partner concern were increasing workload, the clinical safety of nurse triage and the lack of communication across the organisations. Concerns were most apparent within the GP out-of-hours co-operative, leading to calls for the dissolution of the partnership. Accident and emergency and ambulance service responses were more conciliatory, suggesting that such problems were to be expected within the developmental phase of a new organisation. Further exploration of these responses highlighted the sense of ownership within the GP co-operative, with GPs having both financial and philosophical ownership of the co-operative. This was not apparent within the other two partner organisations, in particular the ambulance service, which operated on a regional model very similar to that of NHS 24. <b>Conclusions</b>: As the delivery of unscheduled primary health care crosses professional boundaries and locations, different organisations and professional groups must develop new ways of partnership working, developing trust and confidence in each other. The results of this study highlight, for the first time, the key importance of understanding the professional ownership and identity of individual organisations, in order to facilitate the most effective mechanisms to enable that partnership working.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:O'Donnell, Professor Kate and Haddow, Dr Gill
Authors: Haddow, G., O'Donnell, C., and Heaney, D.
Subjects:R Medicine > RA Public aspects of medicine
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care
College of Medical Veterinary and Life Sciences
Journal Name:Journal of Evaluation in Clinical Practice
Publisher:Blackwell
ISSN:1356-1294
Copyright Holders:Copyright © 2006 Blackwell
First Published:First published in Journal of Evaluation in Clinical Practice 13(2):179-185
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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