Navigating the micro-politics of major system change: The implementation of Sustainability Transformation Partnerships in the English health and care system

Justin Waring*, Simon Bishop, Georgia Black, Jenelle M Clarke, Mark Exworthy, Naomi J Fulop, Jean Hartley, Angus Ramsay, Bridget Roe

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

OBJECTIVE: To investigate how health and care leaders navigate the micro-politics of major system change (MSC) as manifest in the formulation and implementation of Sustainability and Transformation Partnerships (STPs) in the English National Health Service (NHS).

METHODS: A comparative qualitative case study of three STPs carried out between 2018-2021. Data collection comprised 72 semi-structured interviews with STP leaders and stakeholders; 49h of observations of STP executive meetings, management teams and thematic committees, and documentary sources. Interpretative analysis involved developing individual and cross case reports to understand the 'disagreements, 'people and interests' and the 'skills, behaviours and practice'.

FINDINGS: Three linked political fault-lines underpinned the micro-politics of formulating and implementing STPs: differences in meaning and value, perceptions of winners and losers, and structural differences in power and influence. In managing these issues, STP leaders engaged in a range of complementary strategies to understand and reconcile meanings, appraise and manage risks and benefits, and to redress longstanding power imbalances, as well as those related to their own ambiguous position.

CONCLUSION: Given the lack of formal authority and breadth of system change, navigating the micro-politics of MSC requires political skills in listening and engagement, strategic appraisal of the political landscape and effective negotiation and consensus-building.

Original languageEnglish
Article number13558196221142237
JournalJournal of Health Services Research & Policy
Early online date14 Dec 2022
DOIs
Publication statusE-pub ahead of print - 14 Dec 2022

Keywords

  • major system change
  • micro-politics
  • political skills

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