Abstract
Background: Disinvestment from inefficient health services may be a potential solution to rising healthcare costs, but there has been poor uptake of disinvestment recommendations. This Australian study aims to understand how health professionals react when confronted with a plan to disinvest from a health service they previously provided to their patients. Methods: This qualitative study took place prior to the disinvestment phase of a trial which removed weekend allied health services from acute hospital wards, to evaluate the effectiveness and cost effectiveness of the service. Observations and focus groups were used to collect data from 156 participants which was analysed thematically. Results: Initial reactions to the disinvestment were almost universally negative, with staff extremely concerned about the impact on the safety and quality of patient care and planning ways to circumvent the trial. Removal of existing services was perceived as a loss and created a direct threat to some clinicians’ professional identity. With time, discussion, and understanding of the project’s context, some staff moved towards acceptance and perceived the trial as an opportunity, particularly given the service was to be reinstated after the disinvestment. Conclusion: Clinicians and health service managers are protective of the services they deliver and can create barriers to disinvestment. Even when services are removed to ascertain their value, health professionals may continue to provide services to their patients. Measuring the impact of the disinvestment may assist staff to accept the removal of a service.
Highlights
The cost of healthcare in Western countries is rising due to aging populations, increases in chronic disease, and higher expectations of consumers.[1]
We studied the reactions of healthcare staff to a project that removed weekend allied health service for acute, medical and surgical wards
A qualitative approach with a pragmatic lens[23] was adopted because we aimed to use the focus groups as part of the change management strategy – to allow staff to discuss their concerns as well as an opportunity to explain to paucity of evidence for weekend allied health services and the safety measures included in the larger trial
Summary
The cost of healthcare in Western countries is rising due to aging populations, increases in chronic disease, and higher expectations of consumers.[1] Each year more techniques, procedures and medications are added to publicly funded health systems than are removed, contributing further to rising healthcare costs.[2] Economists have questioned the sustainability of existing models and suggested disinvestment from some healthcare services.[3] Disinvestment is defined as the complete or partial withdrawal of resources from healthcare services that are regarded as either unsafe, ineffective and/ or inefficient, with those resources shifted to health services with greater evidence of clinical or cost-effectiveness.[4]. There appears to be a double standard in the burden of evidence to support new versus existing services. New treatments usually must prove themselves safe, effective and cost effective, yet there has been little appetite for applying the same standards to existing services.[2,5] Institutions such as
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