Inga-Britt Gustafsson: Navigating Decommissioning in a Local Healthcare System: Leadership perspectives

Abstract

Decommissioning in healthcare serves multiple purposes beyond achieving economic efficiency, including the planned removal and reassessment of services to facilitate more effective care and treatments. Despite their importance, decommissioning processes face challenges due to resource scarcity and are at a higher risk of failure compared to other service changes. To understand how decommissioning programmes unfold in healthcare, more empirical studies are required. Region Dalarna in Sweden initiated a decommissioning programme with the intention of achieving budget balance, a decision driven by a long-term budget deficit. The executive leadership team empowered healthcare managers to propose changes by giving them significant decision-making opportunities. After a period of two years, the programme had achieved positive outcomes, including enhanced economic efficiency, improved patient care and increased staff motivation. The aim of this thesis was, therefore, to provide evidence on critical factors perceived by politicians, public servants, and healthcare managers crucial for the successful implementation of a large-scale decommissioning programme. The study employed a combination of qualitative and quantitative methods across four empirical studies. Study I used interviews with department managers to identify what made successful decommissioning implementation possible. Study II involved interviews with members of the executive leadership team, including six political leaders and twelve public servants, to gather insights on effective decommissioning. Study III used a cross-sectional survey to compare perceptions among department and unit managers regarding leadership, participation, and responsibility. Finally, Study IV adopted a mixed-methods approach, incorporating interviews and surveys with department managers to examine the practical application of a prioritization model during the decommissioning programme. In study I, results indicated that successful implementation relied on credible problem framing, early involvement of healthcare managers, and clinical champions in the region´s leadership. Study II identified seven critical factors for facilitating decommissioning, emphasizing robust evidence and a cultural shift toward responsible resource use. Study III revealed dissatisfaction among unit managers regarding leadership support and participation, suggesting a need for improved involvement. Study IV showed that while the prioritization model was generally perceived positively, its implementation faced challenges, including time constraints and inconsistent acceptance. Overall, the findings provide valuable insights and highlight the complexities of navigating decommissioning programmes.