Changing the organisation of services

Implementing organisational change in health services requires substantial effort and typically needs to be driven by enthusiastic groups and individuals. There are many examples of delays in getting existing evidence into practice. The slow pace of organisational change is often seen as problematic in the drive towards an evidence based health service. However, sometimes the converse is true. Too much momentum may lead to inappropriate implementation of change before evaluation is complete. Managing this momentum offers the key to rational evaluation and implementation of changes in service organisation and delivery.

The drive for change in the way services are delivered can spring from various sources, including political imperatives, policy drivers, and enthusiasm from clinicians. Enthusiasm for improved services is desirable but can blind enthusiasts to the possible downsides of an intervention. Evidence based care may mean delaying the introduction of new treatments until robust evidence exists of their effectiveness. This approach is well suited to simple interventions aimed at individual patients, such as drugs. Here, momentum is often driven primarily by commercial imperatives. Although political …