Public Healthcare Network Functioning in Chile: Integrated delivery of services and capacity for organisational change management

Abstract

In the Latin American scenario, issues linked to fragmentation and difficulties of working in an integrated manner have been considered significant impediments for the proper functioning of health systems. In this context, the delivery of healthcare services is required to be improved, thereby guaranteeing to fulfil the community’s need. Bearing this in mind, managerial capabilities, and ways to optimise management are suggested in order to fortify the healthcare services provided to the community. In the Chilean context, it has been observed that Health Care Districts (HCDs) are still operating deficiently in terms of coordinating the healthcare network, which consists of different levels of specialisation - namely hospitals, secondary centres, and primary care. Accordingly, since an integrated scenario implies that different levels of specialisation have to work in a coordinated manner, this thesis takes into account features related to the capacity for organisational change management and examines the extent to which this topic may contribute to the improvement required. Therefore, this study explores the integration of services delivery and the scope of organisational change management capacity within the setting of the Chilean public healthcare network. Specifically, new public management backgrounds are considered as the context examined is within the public sector domain. In terms of methodology, a qualitative approach is adopted, and individual semi-structured interviews are used to gather the data required. The sample design follows a purposive heterogeneous scheme, so these semi-structured interviews are conducted with a variety of respondents involved with the Chilean public healthcare context. Thus, a group of 36 chiefs/managers/specialised-professionals concerned with healthcare network practice, and a group of 14 researchers/specialists/academics related to the fields of organisational change and public health participate. All the respondents selected (50) are connected to the healthcare setting, in terms of experience and knowledge. In order to analyse the data collected, a coding process is conducted, which allows associated themes, categories and subcategories to be obtained. The findings show the complexity of the functioning of the public healthcare network and confirm the need for, and importance of integrated working. Change management, in terms of initiatives, is associated with specific institutional experiences mainly focused on the construction of new facilities and employee reallocation. Organisational change capacity is a significant feature which must be taken into account in order to carry out integrated actions; nevertheless, organisational elements (such as culture and political concerns) may constrain its performance. The new public management scenario is associated more with specific action-related outcomes and efficiency, rather than being conceived as a robust model/paradigm explicitly introduced to manage public healthcare practices.

Date of Award	1 Aug 2022
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Kate Rowlands (Supervisor) & Christopher Rees (Supervisor)