Factors that shape the successful implementation of decommissioning programmes: an interview study with clinic...

Area of Science:

• Healthcare Management
• Organizational Change
• Public Health Policy

Background:

• Region Dalarna implemented a restructuring and decommissioning program in 2015 to address budget deficits.
• The program aimed for a balanced budget by 2019, with clinical implementation led by managers and staff.
• Initial implementation was deemed successful, improving finances without negatively impacting patient safety or care quality.

Purpose of the Study:

• To investigate clinic managers' experiences with factors enabling successful implementation of a healthcare decommissioning program.
• To identify critical success factors from the perspective of those managing the change at the clinical level.

Main Methods:

• An interview study was conducted with 26 strategically selected clinic managers (psychiatry, primary care, surgery, medicine) in 2018.
• A deductive content analysis was applied to interview data, guided by a framework of implementation factors.
• The study identified key enabling factors for the decommissioning program's success.

Main Results:

• Crucial factors included: creating a clear rationale for change, securing executive leadership with clinical champions, and early involvement of clinic managers.
• Decisions needed to be evidence-based, prioritizing quality and patient safety.
• The process required preparing the organization for emotional responses, communicating benefits, addressing cultural change, and transparent evaluation.

Conclusions:

• Successful decommissioning programs necessitate that clinic managers and healthcare professionals assume responsibility for both the process and its outcomes.
• Empowering clinical leaders is essential for navigating complex organizational changes in healthcare settings.