Inter-organisational collaboration enabling care delivery in a specialist cancer surgery provider network: A qualitative study

Objective: To explore the processes, challenges and strategies used to govern and maintain inter-organisational collaboration between professionals in a provider network in London, United Kingdom, which implemented major system change focused on the centralisation of specialist cancer surgery. Methods: We used a qualitative design involving interviews with stakeholders (n = 117), non-participant observations (n = 163) and documentary analysis (n = 100). We drew on an existing model of collaboration in healthcare organisations and expanded this framework by applying it to the analysis of collaboration in the context of major system change. Results: Network provider organisations established shared goals, maintained central figures who could create and sustain collaboration, and promoted distributed forms of leadership. Still, organisations continued to encounter barriers or challenges in relation to developing opportunities for mutual acquaintanceship across all professional groups; the active sharing of knowledge, expertise and good practice across the network; the fostering of trust; and creation of information exchange infrastructures fit for collaborative purposes. Conclusion: Collaborative relationships changed over time, becoming stronger post-implementation in some areas, but continued to be negotiated where resistance to the centralisation remained. Future research should explore the sustainability of these relationships and further unpack how hierarchies and power relationships shape inter-organisational collaboration

Climate geoengineering: issues of path-dependence and socio-technical lock-in

As academic and policy interest in climate geoengineering grows, the potential irreversibility of technological developments in this domain has been raised as a pressing concern. The literature on socio-technical lock-in and path dependence is illuminating in helping to situate current concerns about climate geoengineering and irreversibility in the context of academic understandings of historical socio-technical development and persistence. This literature provides a wealth of material illustrating the pervasiveness of positive feedbacks of various types (from the discursive to the material) leading to complex socio-technical entanglements which may resist change and become inflexible even in the light of evidence of negative impacts. With regard to climate geoengineering, there are concerns that geoengineering technologies might contribute so-called ‘carbon lock-in’, or become irreversibly ‘locked-in’ themselves. In particular, the scale of infrastructures that geoengineering interventions would require, and the issue of the so-called ‘termination effect’ have been discussed in these terms. Despite the emergent and somewhat ill-defined nature of the field, some authors also suggest that the extant framings of geoengineering in academic and policy literatures may already demonstrate features recognizable as forms of cognitive lock-in, likely to have profound implications for future developments in this area. While the concepts of path-dependence and lock-in are the subject of ongoing academic critique, by drawing analytical attention to these pervasive processes of positive feedback and entanglement, this literature is highly relevant to current debates around geoengineering

“Attending to History” in Major System Change in Healthcare in England: Specialist Cancer Surgery Service Reconfiguration

BACKGROUND: The reconfiguration of specialist hospital services, with service provision concentrated in a reduced number of sites, is one example of major system change (MSC) for which there is evidence of improved patient outcomes. This paper explores the reconfiguration of specialist oesophago-gastric (OG) cancer surgery services in a large urban area of England (Greater Manchester, GM), with a focus on the role of history in this change process and how reconfiguration was achieved after previous failed attempts. METHODS: This study draws on qualitative research from a mixed-methods evaluation of the reconfiguration of specialist cancer surgery services in GM. Forty-six interviews with relevant stakeholders were carried out, along with ~160 hours of observations at meetings and the acquisition of ~300 pertinent documents. Thematic analysis using deductive and inductive approaches was undertaken, guided by a framework of 'simple rules' for MSC. RESULTS: Through an awareness of, and attention to, history, leaders developed a change process which took into account previous unsuccessful reconfiguration attempts, enabling them to reduce the impact of potentially challenging issues. Interviewees described attending to issues involving competition between provider sites, change leadership, engagement with stakeholders, and the need for a process of change resilient to challenge. CONCLUSION: Recognition of, and response to, history, using a range of perspectives, enabled this reconfiguration. Particularly important was the way in which history influenced and informed other aspects of the change process and the influence of stakeholder power. This study provides further learning about MSC and the need for a range of perspectives to enable understanding. It shows how learning from history can be used to enable successful change

The social and scientific values that shape national climate scenarios: a comparison of the Netherlands, Switzerland and the UK

This paper seeks to understand why climate information is produced differently from country to country. To do this, we critically examined and compared the social and scientific values that shaped the production of three national climate scenarios in the Netherlands, Switzerland and the UK. A comparative analysis of documentary materials and expert interviews linked to the climate scenarios was performed. Our findings reveal a new typology of use-inspired research in climate science for decision-making: (i) innovators, where the advancement of science is the main objective; (ii) consolidators, where knowledge exchanges and networks are prioritised; and (iii) collaborators, where the needs of users are put first and foremost. These different values over what constitutes ‘good’ science for decision-making are mirrored in the way users were involved in the production process: (i) elicitation, where scientists have privileged decision-making power; (ii) representation, where multiple organisations mediate on behalf of individual users; and (iii) participation, where a multitude of users interact with scientists in an equal partnership. These differences help explain why climate knowledge gains its credibility and legitimacy differently even when the information itself might not be judged as salient and usable. If the push to deliberately co-produce climate knowledge is not sensitive to the national civic epistemology at play in each country, scientist–user interactions may fail to deliver more ‘usable’ climate information

Loss associated with subtractive health service change: The case of specialist cancer centralization in England

OBJECTIVE: Major system change can be stressful for staff involved and can result in 'subtractive change' - that is, when a part of the work environment is removed or ceases to exist. Little is known about the response to loss of activity resulting from such changes. Our aim was to understand perceptions of loss in response to centralization of cancer services in England, where 12 sites offering specialist surgery were reduced to four, and to understand the impact of leadership and management on enabling or hampering coping strategies associated with that loss. METHODS: We analysed 115 interviews with clinical, nursing and managerial staff from oesophago-gastric, prostate/bladder and renal cancer services in London and West Essex. In addition, we used 134 hours of observational data and analysis from over 100 documents to contextualize and to interpret the interview data. We performed a thematic analysis drawing on stress-coping theory and organizational change. RESULTS: Staff perceived that, during centralization, sites were devalued as the sites lost surgical activity, skills and experienced teams. Staff members believed that there were long-term implications for this loss, such as in retaining high-calibre staff, attracting trainees and maintaining autonomy. Emotional repercussions for staff included perceived loss of status and motivation. To mitigate these losses, leaders in the centralization process put in place some instrumental measures, such as joint contracting, surgical skill development opportunities and trainee rotation. However, these measures were undermined by patchy implementation and negative impacts on some individuals (e.g. increased workload or travel time). Relatively little emotional support was perceived to be offered. Leaders sometimes characterized adverse emotional reactions to the centralization as resistance, to be overcome through persuasion and appeals to the success of the new system. CONCLUSIONS: Large-scale reorganizations are likely to provoke a high degree of emotion and perceptions of loss. Resources to foster coping and resilience should be made available to all organizations within the system as they go through major change

Crop Updates 2011 - Cereals

This session covers eleven papers from different authors: OPENING, NEW CROP VARIETIES & DECISION SUPPORT Opening 1. Overview of the 2010 season, David Bowran, Director, Practice and Systems Innovation, Department of Agriculture and Food, 2. My experience in a drought as a farmer and consultant, Bill Crabtree, Morawa, Western Australia 3. Meeting the productivity and sustainability challenges to Australian agriculture until 2030, Peter Carberry, CSIRO Sustainable Agriculture Flagship New Crop Varieties 4. National Variety Trials (NTV) wheat variety performance – captivity vs broadacre, Peter Burgess, Kalyx Agriculture 5. WALAN2289 – a new lupin variety to replace Mandelup in the system, Bevan Buirchell, Department of Agriculture and Food 6. The strengths and pitfalls of different grades of new wheat varieties in Western Australia Ben Curtis, Sarah Ellis, Brenda Shackley, Christine Zaicou, Department of Agriculture and Food, 7. Yield performance of temperate and tropical rice varieties in the Ord River Irrigation Areas (ORIA) Siva Sivapalan, Penny Goldsmith and Gae Plunkett, Department of Agriculture and Food Decision Support 8. A new phenology model (DM) for wheat, Darshan Sharma, Mario D’Antuono, Brenda Shackley, Christine Zaicou, Ben Curtis, Department of Agriculture and Food 9. PeatFax Map and the Weed Seed Wizard: tools to help with crop protection, Art Diggle1, Peter Mangano1, Sally Peltzer1, Michael Renton2, Bill Macleod1, Fumie Horiuchi1, George Wyatt1 1Department of Agriculture and Food, 2University of Western Australia 10. Soil management calculator for predicting phosphorus losses under cropping systems in Western Australia, Geoff Anderson1, Richard Bell2, Ross Brennan1 and Wen Chen2, 1Department of Agriculture and Food, 2School of Environmental Science, Murdoch University 11. Tools to assist growers understand the impacts of management decisions in the high rainfall zone, Penny Riffkin, Department of Primary Industries, Victoria, Hamilto

Crop Updates 2006 - Katanning

This session covers sixteen papers from different authors 2006 SEASONAL OUTLOOK, David Stephens and Michael Meuleners, Department of Agriculture Review of climate model summaries reported in the Department of Agriculture’s growing season outlooks, Meredith Fairbanks, Department of Agriculture Farmers commodity outlook 2006, Thomas Schulz, Department of Agriculture Why is salinity such a difficult problem for plant breeders? T J Flowers, TD Colmer, University of Western Australia Matching nitrogen supply to wheat demand in 2005, Narelle Simpson, Ron McTaggart, Wal Anderson, Lionel Martin and Dave Allen, Department of Agriculture Wheat varieties in 2006, Brenda Shackley, Department of Agriculture Performance of dwarf potential milling oat varieties in Western Australian environments, Raj Malik and Kellie Winfield, Department of Agriculture Field pea lessons for 2006, Rodger Beermir, Department of Agriculture Better returns from Durum wheat, Shahahan Miyan, Department of Agriculture Summer weeds can reduce grain yield and protein, Dr. Abul Hashem, Department of Agriculture, Dr Shahab Pathan, Department of Agriculture, Vikki Osten, Queensland Department of Primary Industries and Fisheries Management of Summer Weeds, Alex Douglas, Department of Agriculture Frost or Friction, Garren Knell, Steve Curtin, Wade Longmuir, Consult Ag Pty Ltd PROFITING FROM MARGINAL LAND SEMINAR Producing Bio-Diesel and rubber from marginal land?? Dr Henry Brockman, Department of Agriculture SGSL Producer network – on ground implementation of saltbush based pastures, Justin Hardy, Arjen Ryder, John Paul Collins and Jessica Johns, Department of Agriculture Enhancing the profitability of “Edenia” using saltbush and perenials, SGSL Producer case study, John Pepall, Jinka’s Hill LCDC Investment in saltland pastures, Allan Herbert, Department of Agricultur

Centralisation of specialist cancer surgery services in two areas of England: the RESPECT-21 mixed-methods evaluation

Background: Centralising specialist cancer surgical services is an example of major system change. High-volume centres are recommended to improve specialist cancer surgery care and outcomes. Objective: Our aim was to use a mixed-methods approach to evaluate the centralisation of specialist surgery for prostate, bladder, renal and oesophago-gastric cancers in two areas of England [i.e. London Cancer (London, UK), which covers north-central London, north-east London and west Essex, and Greater Manchester Cancer (Manchester, UK), which covers Greater Manchester]. Design: Stakeholder preferences for centralising specialist cancer surgery were analysed using a discrete choice experiment, surveying cancer patients (n = 206), health-care professionals (n = 111) and the general public (n = 127). Quantitative analysis of impact on care, outcomes and cost-effectiveness used a controlled before-and-after design. Qualitative analysis of implementation and outcomes of change used a multisite case study design, analysing documents (n = 873), interviews (n = 212) and non-participant observations (n = 182). To understand how lessons apply in other contexts, we conducted an online workshop with stakeholders from a range of settings. A theory-based framework was used to synthesise these approaches. Results: Stakeholder preferences – patients, health-care professionals and the public had similar preferences, prioritising reduced risk of complications and death, and better access to specialist teams. Travel time was considered least important. Quantitative analysis (impact of change) – only London Cancer’s centralisations happened soon enough for analysis. These changes were associated with fewer surgeons doing more operations and reduced length of stay [prostate –0.44 (95% confidence interval –0.55 to –0.34) days; bladder –0.563 (95% confidence interval –4.30 to –0.83) days; renal –1.20 (95% confidence interval –1.57 to –0.82) days]. The centralisation meant that renal patients had an increased probability of receiving non-invasive surgery (0.05, 95% confidence interval 0.02 to 0.08). We found no evidence of impact on mortality or re-admissions, possibly because risk was already low pre-centralisation. London Cancer’s prostate, oesophago-gastric and bladder centralisations had medium probabilities (79%, 62% and 49%, respectively) of being cost-effective, and centralising renal services was not cost-effective (12% probability), at the £30,000/quality-adjusted life-year threshold. Qualitative analysis, implementation and outcomes – London Cancer’s provider-led network overcame local resistance by distributing leadership throughout the system. Important facilitators included consistent clinical leadership and transparent governance processes. Greater Manchester Cancer’s change leaders learned from history to deliver the oesophago-gastric centralisation. Greater Manchester Cancer’s urology centralisations were not implemented because of local concerns about the service model and local clinician disengagement. London Cancer’s network continued to develop post implementation. Consistent clinical leadership helped to build shared priorities and collaboration. Information technology difficulties had implications for interorganisational communication and how reliably data follow the patient. London Cancer’s bidding processes and hierarchical service model meant that staff reported feelings of loss and a perceived ‘us and them’ culture. Workshop – our findings resonated with workshop attendees, highlighting issues about change leadership, stakeholder collaboration and implications for future change and evaluation. Limitations: The discrete choice experiment used a convenience sample, limiting generalisability. Greater Manchester Cancer implementation delays meant that we could study the impact of only London Cancer changes. We could not analyse patient experience, quality of life or functional outcomes that were important to patients (e.g. continence). Future research: Future research may focus on impact of change on care options offered, patient experience, functional outcomes and long-term sustainability. Studying other approaches to achieving high-volume services would be valuable. Study registration: ational Institute for Health and Care Research (NIHR) Clinical Research Network Portfolio reference 19761