Title: Improving the Absorptive Capacity (ACAP) of Commissioning Networks for Critical Review of Evidence to Reduce Unplanned Elderly Care Admissions into Acute Hospitals
Funder: Department of Health (England)

Abstract: Problem: We highlight that exploratory interviews with Clinical Commissioning Group (CCG)leads & clinical leads & managers for elderly care provision suggest that the critical review capacity of the existing & intended new commissioning networks may be relatively weak. For example CCG leads explain their position as follows: We have the intelligence & strategic intent but the challenge is how we exploit that intelligence & use it to drive transformation with the problem of moving resource from hospital-based elderly care to primary care given as an example of such strategic intent. Such a practical conception of the commissioning problem constitutes critical review capacity which in turn maps on to the four dimensions of absorptive capacity or ACAP (acquisition assimilation transformation & exploitation. We also suggest the challenge of commissioning high quality elderly care in a productive but preventative way is exemplary of a more general challenge of commissioning complex care which often encompasses more than a single disease pathway & crosses boundaries within & outside the NHS. Conceptual framework: We highlight studies of ACAP in healthcare already published (Berta et al. 2010; Easterby-Smith et al. 2008; Hotho et al. 2012) & seek to extend such studies. We seek to develop a model of knowledge mobilisation focused upon ACAP of healthcare commissioning networks but one which is transferable more widely across the healthcare system. Research Questions (RQs): Our over-arching empirical RQ is: How can we enhance ACAP of CCG led commissioning networks in healthcare to inform decisions to reduce unplanned elderly care acute hospital admissions? This breaks down over the course of the study into the following RQs: RQ1. What is the ‘state of play’ regarding ACAP of the commissioning networks immediately following their inception? RQ2: How has ACAP of the commissioning networks progressed in the first 12 months? RQ3: How is patient experience knowledge acquired & utilised to enhance ACAP of commissioning networks? RQ4: How can we ensure potential ACAP is realised in commissioning networks? Timeplan & research methods:The 4 RQs link to 7 Work Packages (WPs) carried out over 36 months (beginning 1st June 2013). There is a pre-NIHR funding research stream consisting of two projects (WP0) which represent co-investment in the NIHR funded study. The first of these is funded £30000 by NHS Institute for Innovation & Improvement (Oct 12-Mar 13) which examine 5 CCG led commissioning networks with a focus upon ACAP of the commissioning network pre-authorisation of CCGs. The second of these is funded £50000 by a Regional Transformation Fund held by a Primary Care Trust Cluster (April 13-September 13) which examines how patient experience constitutes a source of knowledge for service development within CCG led commissioning networks. Within these two studies we are carrying out literature reviews & progressed ethics & R&D approvals so that we can ‘hit the ground running’ with fieldwork at the start of the NIHR funded study we propose. Within our NIHR funded study there will be 7 Work Packages Ethics: Ethics and R&D are progressed prior to NIHR funding so we hit the ground running. Research outputs:formative organisational learning events; psychometric self-reflection tool for commissioning networks to develop critical review capacity; other structural & social interventions to enhance critical review capacity of commissioning networks developed through an action plan followed up in WP6; accessible professional corporate communications aimed at commissioning networks that are web-based & written material; peer-reviewed academic publication in policy management health services research practitioner & academic conference presentations Team expertise: Currie (PI) is a health services organisation & management expert directed translational research units (CLAHRC NDL) & acted as PI on previous successful NIHR funded resesarch studies. Kiefer (CI) is a psychologist with considerable expertise in the development of psychometric tools for organisational development. Lilford is a world leading medical scientist with expertise in interventionist methods & has directed translational research (CLAHRC BBC). Redwood & Staniszewska are experts in knowledge mobilisation around the patient experience & PPI. We have named a Research Fellow (Ogilvie a former nurse currently working on NHSI funded study of CCGs).Management: Currie manages the research programme including all WPs apart from WP3 & WP4 & Research Fellow. Kiefer has responsibility for part WP4. Lilford has particular responsibility for dissemination throughout the study & provides advice about intervention. Redwood and Staniszewska have responsibility for WP3 within which PPI is encompassed. Study Advisory Board (SAB) consisting of NHS Commissioning Board Local Area Team Leads CCG Chief Operating Officers patients/carers academic experts oversees the study & meets annually.Costs: Academic (PI & 4 CIs) time Research Fellow secretarial support laptop & recorder transcription travel learning & dissemination events including website


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