Health Service Reforms Are Groundless, Say Healthcare Experts

Main Category: Public Health
Article Date: 16 Dec 2005 - 0:00 PDT

email to a friend   printer friendly   opinions  

Researchers from Oxford to Ontario to Sydney have taken aim at the constant restructuring of health systems in Britain, Australia, Canada, the USA and New Zealand.

In the December issue of the Journal of the Royal Society of Medicine (JRSM) one review argues that ongoing restructuring in health systems has achieved unclear and often negative outcomes while another undertakes a witty examination of organisation theories.

The researchers point out that there are no randomised trials or longitudinal studies of restructuring and little scientifically acceptable cross-sectional work.

One review outlines the evidence challenging the restructuring phenomenon, including:

- - Case study research into 25 NHS trusts merged between 1996 and 2001 which showed that there were considerable negative effects such as setbacks of at least 18 months in progress, problems in fusing different organisational cultures, no better recruitment and retention of clinical staff and savings below those forecast.

The article also refers to the situation in the USA, Canada, Australia and New Zealand, which restructured its health services in the 1990s along competitive lines only to re-institute a public sector model.

Professor Jeffrey Braithwaite, an academic at the Centre for Clinical Governance Research[1] and lead author on one of the papers, said: "The tectonic plates of organisational structures always seem to be moved around in healthcare but does this change the way clinicians practice or services get delivered? The evidence on balance suggests not. So it's a puzzle why ministers and senior departmental staff keep restructuring. Perhaps it's just an exercise of power more than anything else."

The Editor of JRSM, Kamran Abbasi, said the need to develop sound conceptual research designs to study structural effects is critical.

"What bothers health professionals in the UK and elsewhere is that there is an increasing onus on them to ensure that their decisions are informed by the evidence, but meanwhile politicians - as both these papers show - develop health policy and health service reforms in an evidence vacuum," Dr Abbasi said.

"That doesn't mean that those reforms are necessarily wrong but it does mean that they require better explanation and evaluation," he said.

'Restructuring as gratification', by J Brathwaite et al, and 'A surrealistic mega-analysis of redisorganisation theories', by A Oxman et al, are published in the December issue (Vol. 98) of the Journal of the Royal Society of Medicine (JRSM). JRSM is the flagship journal of the Royal Society of Medicine. It has been published continuously since 1809. Its Editor is Dr Kamran Abbasi.

[1] University of New South Wales, Sydney, Australia

Founded in 1805, the Royal Society of Medicine is an independent organisation that promotes the exchange of knowledge, information and ideas in medical science and continued improvement in human health.
www.rsm.ac.uk

• Additional
• References
• Citations