London Managed Clinical Networks for Cancer Evaluation
Research Assistant: Rachael Addicott
The 'managed network' model has been developed within NHS cancer services as a novel way of organising and developing cancer services. It is an important management innovation within health care, yet there has been little independent evaluation of the strengths and weakness of this approach. The overall aim of this study was to provide an evaluative commentary on the creation, development and impact of the five managed clinical Networks for cancer in London. This study provided an organisational analysis of managed clinical Networks.
This qualitative study was based on the methods of organisational process research, defined as the dynamic study of behaviour within organisations. Process research uses comparative case studies, which are tracked through over time and selected to explore variation in outcome. Data collection methods thus included: (i) analysis of key local policy documents; (ii) a range of semi-structured interviews across the various stakeholders identified, and; (iii) observation at key meetings.
The case studies focused on Network wide activities and targeted two specific tumour types - gynaecology and urology. The case studies examined three specific issues (or 'tracers') in order to gain some insight into the operation of managed clinical Networks for cancer. These tracers were: centralisation of services; budget / resource allocation, and; education and training.
The case studies provided an analytic description of the Networks and examined the growth of the Networks as a whole. The case studies focused on the two tumour groups identified and detailed the 'story so far' regarding their development, successes and disappointments. Further, the case studies provided feedback in response to 16 specific success criteria that were identified through a Delphi study.
It was evident from this study that the five cancer Networks studied displayed a mixed pattern of performance and that there was not a clear 'top performer' which emerged across the indicators. This is a significant conclusion as it emphasises the complexity in identifying and diffusing high performance. Rather, this study suggests that high performance was spread across a whole set of organisations in rather different ways. There was clearly some discrepancy between what the 'remote centre' considered to be indicators of success of cancer Networks, versus the viewpoints of those delivering direct patient care. However, there is little time, resources or flexibility within the current regime to focus on a strategic direction or developments for the Network that are not part of the central edict.