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dc.contributor.authorSchulmann, Katharine
dc.contributor.authorBruen, Carlos
dc.contributor.authorParker, Sarah
dc.contributor.authorSiersbaek, Rikke
dc.contributor.authorConghail, Luisne Mac
dc.contributor.authorBurke, Sara
dc.date.accessioned2024-05-30T10:02:03Z
dc.date.available2024-05-30T10:02:03Z
dc.date.issued2024-05-03
dc.identifier.pmid38702678
dc.identifier.doi10.1186/s12913-024-11048-2
dc.identifier.urihttp://hdl.handle.net/10147/641723
dc.descriptionBackground: Effective governance arrangements are central to the successful functioning of health systems. While the significance of governance as a concept is acknowledged within health systems research, its interplay with health system reform initiatives remains underexplored in the literature. This study focuses on the development of new regional health structures in Ireland in the period 2018-2023, one part of a broader health system reform programme aimed at greater universalism, in order to scrutinise how aspects of governance impact on the reform process, from policy design through to implementation. Methods: This qualitative, multi-method study draws on document analysis of official documents relevant to the reform process, as well as twelve semi-structured interviews with key informants from across the health sector. Interviews were analysed according to thematic analysis methodology. Conceiving governance as comprising five domains (Transparency, Accountability, Participation, Integrity, Capacity) the research uses the TAPIC framework for health governance as a conceptual starting point and as initial, deductive analytic categories for data analysis. Results: The analysis reveals important lessons for policymakers across the five TAPIC domains of governance. These include deficiencies in accountability arrangements, poor transparency within the system and vis-à-vis external stakeholders and the public, and periods during which a lack of clarity in terms of roles and responsibilities for various process and key decisions related to the reform were identified. Inadequate resourcing of implementation capacity, competing policy visions and changing decision-making arrangements, among others, were found to have originated in and continuously reproduced a lack of trust between key institutional actors. The findings highlight how these challenges can be addressed through strengthening governance arrangements and processes. Importantly, the research reveals the interwoven nature of the five TAPIC dimensions of governance and the need to engage with the complexity and relationality of health system reform processes. Conclusions: Large scale health system reform is a complex process and its governance presents distinct challenges and opportunities for stakeholders. To understand and be able to address these, and to move beyond formulaic prescriptions, critical analysis of the historical context surrounding the policy reform and the institutional relationships at its core are needed.en_US
dc.language.isoenen_US
dc.rights© 2024. The Author(s).
dc.rightsAttribution 4.0 International*
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/*
dc.subjectHealth governanceen_US
dc.subjecthealth system reformen_US
dc.subjectHealthcare decentralisationen_US
dc.titleThe role of governance in shaping health system reform: a case study of the design and implementation of new health regions in Ireland, 2018-2023.en_US
dc.typeArticleen_US
dc.identifier.eissn1472-6963
dc.identifier.journalBMC health services researchen_US
dc.source.journaltitleBMC health services research
dc.source.volume24
dc.source.issue1
dc.source.beginpage578
dc.source.endpage
refterms.dateFOA2024-05-30T10:02:05Z
dc.source.countryIreland
dc.source.countryIreland
dc.source.countryIreland
dc.source.countryIreland
dc.source.countryIreland
dc.source.countryIreland
dc.source.countryEngland


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