Title: Knowledge exchange in healthcare commissioning: case studies of the use of commercial not-for-profit and public sector agencies 2011-2014
Funder: Department of Health (England)

Abstract: The implementation of the White Paper Liberating the NHS brought about significant changes in the NHS commissioning landscape. Some commissioning responsibilities were transferred to clinical commissioning groups while Public Health transferred to local authorities. Greater use of commercial and not for profit agencies has been encouraged and Primary Care Trust (PCT) managers changed roles. So there are several players on the commissioning stage including clinical commissioners private and not for profit management consultants public health practitioners and former PCT commissioning managers all with potentially different approaches to commissioning. How healthcare commissioners decide whether and when to call on external support what information they want and how they use and apply this information in making commissioning decisions is key to the success of the current NHS reforms In addition all this is set against extremely challenging financial cuts in public sector services.Recent history suggests that there will always be some mix of public sector clinician and private sector involvement in healthcare commissioning even if the balance may shift under successive governments. Given recent events this study has exceptional relevance since it offers a great opportunity to study the role of external providers and healthcare commissioners as the NHS moves from largely public sector commissioning to a more mixed economy. The findings from this study will provide understanding about the role of boundary spanners from the public and private sectors in commissioning healthcare. Most importantly it will illuminate how healthcare commissioners access use and act on knowledge for commissioning decisions in a climate in which commissioning needs to be smarter faster and cheaper than ever before. In turn this knowledge can inform those working with clinical consortia how to better package and present their messages. This study is underpinned by several theoretical frameworks including Weick’s analyses of collective ‘organizational sense-making’ where context and understanding are mutually enacted; Gabbay and Le May’s work on collective mindlines and the notion of a ‘community of general practice’ and Brown and Duguid’s ideas on the importance of local knowledge and the role of social networks in grounding knowledge in potential contexts.To understand more about the processes by which healthcare commissioners use clinical and managerial research evidence and other sources of knowledge from private providers and PCTs we have designed a qualitative study. This will take place in clinical consortia two commercial organisations and one not for profit. Using case study methodology we will collect data through interviews observations and documentary analysis from five case sites. Because we are interested in knowledge flows between healthcare commissioners and private providers we will only select case sites where commercial or not for profit agencies are contracted. Each case study will entail:•semi-structured interviews with key external staff (e.g. CEOs directors lead consultants working on the ground)•semi-structured interviews with healthcare commissioners and PCT staff working with external providers•observe healthcare commissioners and external providers working together •collection and analysis of documents such as procurement contracts reports briefing papers Because we are using theoretical sampling we will select successive cases based on the hypotheses that emerge from the findings from the previous case(s). However the approaches to data collection and analysis will be the same across all case studies. Throughout the study we will be using linkage and exchange and other knowledge transfer strategies to identify and disseminate key messages for target professional audiences such as clinical commissioners commissioning managers external providers and the Department of Health. The study team draws on the expertise of senior NHS professionals and experienced academics from two universities (Bristol and Southampton) with strong research backgrounds in health service organisation knowledge translation management ethnographic techniques and policy. The study will run from November 2010-February 2014 and cost about £300000.Because we are using theoretical sampling we will select successive cases based on the hypotheses that emerge from the findings from the previous case(s). However the approaches to data collection and analysis will be the same across all three case sites. Throughout the study we will be using linkage and exchange and other knowledge transfer strategies to identify and disseminate key messages for target professional audiences such as clinical commissioners PCT staff external providers and the Department of Health. The study team draws on the expertise of senior NHS professionals including a PCT special projects director and a GP with extensive commissioning experience. The team also includes experienced academics from two universities (Bristol and Southampton) with strong research backgrounds in health service organisation knowledge translation management ethnographic techniques and policy. The study will run from November 2010-February 2014 and cost about £300000.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE