System transformation in palliative and end of life care: developing a model for excellence

Alistair Hewison, Emma Hodges, Sundaravadivel Balasubramanian, Tina Swani

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    Abstract

    Purpose
    The purpose of this study is to report how the palliative and end of life care community in one region of England worked together to create a new model for integrated palliative and end of life care to respond to the challenges of changing demography, the need to reduce unnecessary hospital admissions of people nearing the end of life and to improve the quality of provision in line with current policy.

    Design/methodology/approach
    A co-production approach to system transformation was adopted involving 73 members of the palliative and end of life care community in one region of England.

    Findings
    A new model for the delivery of integrated palliative and end of life care services was produced. The breadth of membership of the co-production working party and constructive/collaborative working helped ensure a viable model was produced.

    Practical implications
    Although systems’ thinking perspectives can help address the challenges of large-scale transformation because they focus on promoting the value of relationships, recognise the nuances of context and the need to understand system behaviour over time, the potential for systems to benefit from this approach is limited by the complexity of the processes involved and the sheer number of issues to be addressed in practical terms by policy makers and change leaders.

    Originality/value
    The paper explores the contribution that theories of large-scale transformation can make to the design of palliative and end of life care services in health and social care.
    Original languageEnglish
    Pages (from-to)1008-1024
    JournalJournal of Health, Organization and Management
    Volume35
    Issue number8
    Early online date22 Jun 2021
    DOIs
    Publication statusE-pub ahead of print - 22 Jun 2021

    Keywords

    • Health services
    • Leadership
    • Organisational change
    • Systems design

    ASJC Scopus subject areas

    • Business, Management and Accounting (miscellaneous)
    • Health Policy

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