ArticleJournal of health services research & policy2016
Lessons for major system change: centralization of stroke services in two metropolitan areas of England.
Article in Journal of health services research & policy, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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Who cites it
38 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Early Intervention in Psychosis services: A systematic review and narrative synthesis of the barriers and facilitators to implementation.European psychiatry : the journal of the Association of European Psychiatrists · 2021Pooled it
- Systematic review of experiences and perceptions of key actors and organisations at multiple levels within health systems internationally in responding to COVID-19.Implementation science : IS · 2021Pooled it
- The contribution of political skill to the implementation of health services change: a systematic review and narrative synthesis.BMC health services research · 2021Pooled it
- Relationship between primary stroke center volume and time to endovascular thrombectomy in acute ischemic stroke.European journal of neurology · 2021Trial
- Have changes in practice in response to COVID-19 been sustained? A qualitative study of experiences and perceptions of health system stakeholders in Colombia.Health research policy and systems · 2026Article
- Implementation, Experiences, Impact, and Costs of Artificial Intelligence in Chest Diagnostics: Protocol for a Mixed Methods Evaluation.JMIR research protocols · 2025Article
- Applying the major system change framework to evaluate implementation of rapid healthcare system change: a case study of COVID-19 remote home monitoring services.Implementation science communications · 2025Article
- A collaborative endeavour to integrate leadership and person-centred ethics: a focus group study on experiences from developing and realising an educational programme to support the transition towards person-centred care.BMC health services research · 2024Article
- "Everything was much more dynamic": Temporality of health system responses to Covid-19 in Colombia.PloS one · 2024Article
- 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 & policy · 2023Article
- Implementing a perioperative care of older people undergoing surgery (POPS) service: findings from a multi-site qualitative implementation study.Age and ageing · 2023Article
- Article
- Understanding the Political Skills and Behaviours for Leading the Implementation of Health Services Change: A Qualitative Interview Study.International journal of health policy and management · 2022Article
- Loss associated with subtractive health service change: The case of specialist cancer centralization in England.Journal of health services research & policy · 2022Article
- Inter-organisational collaboration enabling care delivery in a specialist cancer surgery provider network: A qualitative study.Journal of health services research & policy · 2022Article
- Article
- Implementing COVID-19 surveillance through inter-organizational coordination: a qualitative study of three cities in Colombia.Health policy and planning · 2022Article
- Transformational Change in maternity services in England: a longitudinal qualitative study of a national transformation programme 'Early Adopter'.BMC health services research · 2022Review
- How to Cost the Implementation of Major System Change for Economic Evaluations: Case Study Using Reconfigurations of Specialist Cancer Surgery in Part of London, England.Applied health economics and health policy · 2021Article
- Alignment in implementation of evidence-based interventions: a scoping review.Implementation science : IS · 2021Article
Corrections and comments
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Authors and funding
11 authors.
Funding
Abstract
objectivesOur aim was to identify the factors influencing the selection of a model of acute stroke service centralization to create fewer high-volume specialist units in two metropolitan areas of England (London and Greater Manchester). It considers the reasons why services were more fully centralized in London than in Greater Manchester.
methodsIn both areas, we analysed 316 documents and conducted 45 interviews with people leading transformation, service user organizations, providers and commissioners. Inductive and deductive analyses were used to compare the processes underpinning change in each area, with reference to propositions for achieving major system change taken from a realist review of the existing literature (the Best framework), which we critique and develop further.
resultsIn London, system leadership was used to overcome resistance to centralization and align stakeholders to implement a centralized service model. In Greater Manchester, programme leaders relied on achieving change by consensus and, lacking decision-making authority over providers, accommodated rather than challenged resistance by implementing a less radical transformation of services.
conclusionsA combination of system (top-down) and distributed (bottom-up) leadership is important in enabling change. System leadership provides the political authority required to coordinate stakeholders and to capitalize on clinical leadership by aligning it with transformation goals. Policy makers should examine how the structures of system authority, with performance management and financial levers, can be employed to coordinate transformation by aligning the disparate interests of providers and commissioners.
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