MCN National Workshop, Manchester, 090204

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The Universities of Dundee and St Andrews
Delivering health care through managed clinical
networks (MCNs) lessons from the North National
workshop to share and discuss research findings
into clinical networks Research team Professor
Bruce Guthrie, Professor Huw Davies, Professor
Matt Sutton, Dr Brian Williams, Dr Rosemary
Rushmer, Dr Isabel Walter, Dr Gail Greig, Dr
Joanne Coyle, John Connaghan
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Effective Clinical Networks Research Views

• A Delphi Process

Dr Rosemary Rushmer Senior Research Fellow
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Road Testing the Case Study Findings

• Clinical Networks face similar issues - BUT often
  respond in different ways
• The choices they make account for some of the
  variation in their form, function and (possibly)
  their impact
• Some of these responses may be more (or less)
  effective than others
• Linked to the theoretical ideas of complexity
  (Plsek and Greenhalgh 2001) wicked problems
  (Polyani 1966) and realistic evaluations (Pawson
  and Tilley 1997)

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Research Questions

• What do experts believe are the effective ways of
  organising clinical networks?
• Are these sources of variation between networks
  in areas of crucial importance?

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A Delphi Process

• Aim To seek consensus in views from an expert
  audience
• Method
• 12 contextual and organisational themes were
  identified
• A modified Behaviourally Anchored Rating Scale
  (BARS) was used (Smith and Kendall 1963 Campbell
  et al 1973)
• Round 1
• Sent to
• Returns
• Round 2
• Completed in the National Dissemination Workshop

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Crucial -- 60 Important -- 35 Peripheral -- 5
Q1
Effective clinical networks mainly improve
service provision by influencing senior managers
and commissioners of services
Effective clinical networks mainly improve
service provision through the relationships they
build with clinicians and frontline managers
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Crucial -- 35 Important -- 52 Peripheral -- 13
Q2
An effective clinical network is one that has a
clear focus on one clinical condition
An effective clinical network is one that engages
other networks to ensure broader co-ordination of
patient care
8
Crucial -- 46 Important -- 44 Peripheral -- 10
Q3
An effective clinical network sets its priorities
relatively independently of the NHS organisations
it works with
An effective clinical network aligns its
priorities to those of the NHS organisations it
works with
9
Crucial -- 38 Important -- 40 Peripheral -- 22
Q4
An effective clinical network requires key
doctors to be signed-up
An effective clinical network can operate
successfully by working round key doctors who are
difficult to sign-up
10
Crucial -- 52 Important -- 41 Peripheral -- 6
Q5
Clinical networks are effective because they
standardise services to provide an equitable
service to all
Clinical networks are effective because they
streamline services to reduce duplication and
increase co-ordination for all
11
Crucial -- 32 Important -- 56 Peripheral -- 13
Q6
An effective clinical network is led by one
clinical person
An effective clinical network shares leadership
across several clinicians and managers
12
Crucial -- 35 Important -- 56 Peripheral -- 10
Q7
Effective clinical networks provide a forum to
discuss services
Effective clinical networks are a mechanism for
getting things done to directly improve services
13
Crucial -- 40 Important -- 54 Peripheral -- 6
Q8
Effective clinical network activity is largely
driven by locally shared clinical aims
Effective clinical network activity is largely
driven by policy directives, national guidelines
and external standards
14
Crucial -- 30 Important -- 56 Peripheral -- 14
Q9
Clinical network success depends upon securing
sufficient resources
Resources are useful but the clinical network is
not reliant upon them for success
15
Crucial -- 21 Important -- 51 Peripheral -- 29
Q10
Effective clinical networks have a clear identity
as a new form of NHS organisation
Effective clinical networks are simply groups of
clinicians who have agreed to work co-operatively
16
Crucial -- 49 Important -- 46 Peripheral -- 5
Q11
An effective clinical network works to implement
the existing priorities of its clinical and
frontline management members
An effective clinical network challenges existing
assumptions to set new priorities for its
clinical and frontline management members
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Crucial -- 51 Important -- 35 Peripheral -- 14
Q12
Clinical networks will remain important in the
future
Clinical networks are unlikely to endure and will
be replaced by other forms of organisation in the
future