Understanding Health Professional Responses to Service Disinvestment: A Qualitative Study

Deb Mitchell; Lisa O'Brien; Anne Bardoel; Terry Haines

doi:10.15171/ijhpm.2019.20

Understanding Health Professional Responses to Service Disinvestment: A Qualitative Study

Int J Health Policy Manag. 2019 Jul 1;8(7):403-411. doi: 10.15171/ijhpm.2019.20.

Authors

Deb Mitchell¹, Lisa O'Brien², Anne Bardoel³, Terry Haines⁴

Affiliations

¹ Monash Health Community, Monash Health, Dandenong, VIC, Australia.
² Occupational Therapy Department, School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia.
³ Department of Management and Marketing, Swinburne University of Technology, Hawthorn, VIC, Australia.
⁴ School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia.

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.

Keywords: Disinvestment; Healthcare; Service Change; Staff Reactions; Weekend Allied Health Services.

© 2019 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

MeSH terms

Attitude of Health Personnel*
Australia
Financial Support*
Focus Groups
Health Services / economics*
Interviews as Topic
Observation
Qualitative Research