Navigating the micro-politics of major system change: The implementation of Sustainability Transformation Partnerships in the English health and care system

Waring, Justin; Bishop, Simon; Black, Georgia; Clarke, Jenelle M; Exworthy, Mark; Fulop, Naomi J; Hartly, Jean; Ramsey, Angus; Roe, Bridget

Abstract

Objective To investigate how health and care leaders navigate the micro-politics of major system change (MSC) as manifest in the formulation and implementation of Sustainability and Transformation Partnerships (STPs) in the English National Health Service (NHS). Methods A comparative qualitative case study of three STPs carried out between 2018–2021. Data collection comprised 72 semi-structured interviews with STP leaders and stakeholders; 49h of observations of STP executive meetings, management teams and thematic committees, and documentary sources. Interpretative analysis involved developing individual and cross case reports to understand the ‘disagreements, ‘people and interests’ and the ‘skills, behaviours and practice’. Findings Three linked political fault-lines underpinned the micro-politics of formulating and implementing STPs: differences in meaning and value, perceptions of winners and losers, and structural differences in power and influence. In managing these issues, STP leaders engaged in a range of complementary strategies to understand and reconcile meanings, appraise and manage risks and benefits, and to redress longstanding power imbalances, as well as those related to their own ambiguous position. Conclusion Given the lack of formal authority and breadth of system change, navigating the micro-politics of MSC requires political skills in listening and engagement, strategic appraisal of the political landscape and effective negotiation and consensus-building.

Citation

Waring, J., Bishop, S., Black, G., Clarke, J. M., Exworthy, M., Fulop, N. J., Hartly, J., Ramsey, A., & Roe, B. (2022). Navigating the micro-politics of major system change: The implementation of Sustainability Transformation Partnerships in the English health and care system. Journal of Health Services Research and Policy, https://doi.org/10.1177/13558196221142237

• Journal Article Type: Article
• Acceptance Date: Oct 1, 2022
• Online Publication Date: Dec 14, 2022
• Publication Date: Dec 14, 2022
• Deposit Date: Oct 11, 2022
• Publicly Available Date: Oct 14, 2022
• Journal: Journal of Health Services Research & Policy
• Print ISSN: 1355-8196
• Electronic ISSN: 1758-1060
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1177/13558196221142237
• Keywords: Public Health, Environmental and Occupational Health; Health Policy
• Public URL: https://nottingham-repository.worktribe.com/output/12321574