Abstract
BackgroundThe implementation of strategic health system change is often complicated by the informal politics and power of health systems, such as competing interests and resistant groups. Evidence from other industries shows that strategic leaders need to be aware of and manage such ‘organisational politics’ when implementing change, which involves developing and using forms of political ‘skill’, ‘savvy’ or ‘astuteness’. The purpose of this study is to investigate the acquisition, use and contribution of political ‘astuteness’ in the implementation of strategic health system change.MethodsThe qualitative study comprises four linked work packages. First, we will complete a systematic ‘review of reviews’ on the topic of political skill and astuteness, and related social science concepts, which will be used to then review the existing health services research literature to identify exemplars of political astuteness in health care systems. Second, we will carry out semi-structured biographical interviews with regional and national service leaders, and recent recipients of leadership training, to understand their acquisition and use of political astuteness. Third, we will carry out in-depth ethnographic research looking at the utilisation and contribution of political astuteness in three contemporary examples of strategic health system change. Finally, we will explore and discuss the study findings through a series of co-production workshops to inform the development and testing of new learning resources and materials for future NHS leaders.DiscussionThe research will produce evidence about the relatively under-researched contribution that political skill and astuteness makes in the implementation of strategic health system change. It intends to offer new understanding of these skills and capabilities that takes greater account of the wider social, cultural organisational landscape, and offers tangible lessons and case examples for service leaders. The study will inform future learning materials and processes, and create spaces for future leaders to reflect upon their political astuteness in a constructive and development way.Trial registrationResearchregistery4020 [23rd April 2018].
Highlights
The implementation of strategic health system change is often complicated by the informal politics and power of health systems, such as competing interests and resistant groups
With the pressing need to implement major strategic changes across the National Health Service (NHS), especially efforts to better integrate care services, we argue there is a need to better understand the acquisition and contribution of political astuteness to inform the design and content of new recruitment and learning resources for service leaders, and other change agents
WP2: Interview study with experienced and aspirant service leaders Purpose and approach This work package will address Objectives Two, Three and Four by investigating service leaders’ experiences, perceptions and reported practices of ‘political astuteness’ in different strategic and operational ‘arenas’ of health system change. It will investigate the views and experiences of NHS staff who have recently completed formal NHS leadership training to examine how political astuteness is developed through such training
Summary
The qualitative study comprises four linked work packages. We will complete a systematic ‘review of reviews’ on the topic of political skill and astuteness, and related social science concepts, which will be used to review the existing health services research literature to identify exemplars of political astuteness in health care systems. We will carry out semi-structured biographical interviews with regional and national service leaders, and recent recipients of leadership training, to understand their acquisition and use of political astuteness. We will carry out in-depth ethnographic research looking at the utilisation and contribution of political astuteness in three contemporary examples of strategic health system change. We will explore and discuss the study findings through a series of co-production workshops to inform the development and testing of new learning resources and materials for future NHS leaders
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