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

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

3. The Politics of Health EHMA June 2008 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

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

5. The Politics of Health EHMA June 2008 NHS Wales Welsh Assembly Government Health Authorities (5) Trusts (17)

6. The Politics of Health EHMA June 2008 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

7. The Politics of Health EHMA June 2008 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

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

9. The Politics of Health EHMA June 2008 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

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

11. The Politics of Health EHMA June 2008 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