A Gateway Framework to Guide Major Health System Changes Comment on "'Attending to History' in Major System Change in Healthcare in England: Specialist Cancer Surgery Service Reconfiguration".

Recent events - on both a global scale and within individual countries - including the lockdowns associated with COVID-19 pandemic, inflation concerns, and political tensions, have increased pressure to reconfigure social services for ongoing sustainability. Healthcare services across the world are undergoing major system change (MSC). Given the complexity and different contextual drivers across healthcare systems, there is a need to use a variety of perspectives to improve our understanding of the processes for MSC. To expand the knowledge base and develop strategies for MSC requires analysing change projects from different perspectives to distil the elements that drove the success. We offer the Gateway Framework as a collaborative transformational system tool to assess and reorganise operations, services, and systems of healthcare organisations. This framework and guiding questions, accounts for past events whilst being proactive, future orientated, and derived from externally defined and a standardised requirements to promote safe, high-quality care.

Large scale healthcare facility redevelopment: A scoping review.

Internationally, organisations are undertaking large scale facility redevelopment as a strategy for the transformation of care systems. Redeveloping facilities provides a once in a generation opportunity to transform health service delivery, typically, however, system level changes are poorly understood. To address this gap, our aim was to investigate the empirical knowledge base regarding large scale redevelopment of healthcare facilities. A scoping review was undertaken, guided by the redeveloped health service management (HSM) scoping review framework (HSM-SRF). Across 17 articles, five key concepts were identified, and they form the principles for successful redevelopment. First, establish a strong governance framework integrating diverse expertise and evidence base. Second, engage with internal and external stakeholders to build effectual relationships. Third, consult with end users, including clinicians and patients, to encourage the acceptance of the redevelopment and actively manage stakeholder dynamics, including politics and power undercurrents. Fourth, commit appropriate resources, including time, workforce, technology and finance to ensure redevelopment success. Finally, reimagine workflows through consultation with end users, including staff and consumers, allowing them to conceptualise how the space will be utilised. This scoping review is the first to synthesise the empirical knowledge base of the redevelopment of healthcare facilities.

Health system redesign: Changing thoughts, values, and behaviours for the co-production of a safety culture.

PURPOSE: Simultaneous incremental and revolutionary systems change is a norm for many health care organisations. Organisational redesign, incorporating physical redevelopments and technological innovations, drives revolutionary transformations. Redesigning health facilities provides opportunities for improving and sustaining safe, high-quality patient care. There is a need for the creation of knowledge, based on empirical research, to inform how to effectively plan, implement, and evaluate health organisational redesign, underpinned by co-production principles. FINDINGS: Using an Australian case study, we identify and discuss the opportunities and challenges, aligned with safety and quality requirements, to undertake redesign projects. Through an analysis of redesign and governance accountabilities, we identify five key foci for health leaders, and their communities, to plan, implement and evaluate organisational redesign. CONCLUSION: By rebuilding and engaging with patients and consumers to organise, manage and deliver care, the redesign process allows us to change thoughts, values, and behaviours to achieve better patient outcomes.

Building research capacity in south-west Sydney through a Primary and Community Health Research Unit.

The Primary and Community Health Research Unit was established in 2010 in south-west Sydney to build research capacity in primary and community health services and help generate evidence to underpin clinical activities. In 2011, six project teams participated in a 12-month researcher mentoring program, undertaking projects in quality improvement and service evaluation. Project teams were linked with academic mentors and participated in four research skill development workshops covering research design, research ethics, statistical analysis and academic writing. All project teams presented their work at two or more research conferences, and all are preparing manuscripts for publication in peer-reviewed journals. The Primary and Community Health Research Unit's approach to research capacity building in primary and community health services appears to be effective in supporting novice researchers to undertake research in their clinical settings. Sustainability is dependent on securing ongoing funding. Further analysis is needed to identify strengths and weaknesses of this approach.