Intended for healthcare professionals


Disinvestment in health care

BMJ 2010; 340 doi: (Published 17 March 2010) Cite this as: BMJ 2010;340:c1413
  1. Cary Cooper, distinguished professor of organisational psychology and health1,
  2. Ken Starkey, professor of management and organisational learning2
  1. 1Lancaster University Management School, Lancaster University, Lancaster LA1 4YW
  2. 2Nottingham University Business School, University of Nottingham, Nottingham NG8 1BB
  1. c.cooper1{at}

    A shared vocabulary, language, and narrative of change is needed

    Four linked BMJ articles consider disinvestment in health care.1 2 3 4 They suggest several ways in which disinvestment can be promoted, including better evidence based clinical decision making; better alignment of health services between primary and secondary care providers; better integration of the health system with the social care system and community care; new technology; a culture of collaboration rather than competition; a better managed system of skill development; changes in working practice; the empowerment of patients; reductions in administrative costs; and greater dialogue to promote knowledge and understanding, so that policy options can be better discussed and agreed between relevant stakeholders. All of these are valuable insights into possible actions to promote change. However, they tend to underestimate the factors that promote resistance to the kinds of change a …

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