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‘Is someone going to saw off the plank behind me?’ – Healthcare managers priorities, challenges and expectations for service delivery and transformation during economic crisis

Sarah Barry, Sara Burke, Ella Tyrrell, Steve Thomas

Objectives: To appraise health system capability for transformation during economic crisis by exploring the impact of health service managers’ priorities, challenges and expectations.

Methods: Survey of health service manager priorities and content analysis of health service manager semi-structured interviews with a final analysis of expectations using an organisational readiness lens.

Results: Government priorities for health reform, even when shared by healthcare managers, are afforded little managerial time due to the pressures of ensuring service delivery during economic crisis as well as managing multiple organisational changes. In this situation managers are challenged by negative impacts on patient care, organisational fragmentation and the weak implementation of change. Manager expectations for organisational transformation are low.

Conclusions: Health system transformation is unlikely given the range of complex priorities requiring attention from managers during economic crisis. Managers have little expectation of organisational transformation as they face considerable service delivery challenges while feeling under-resourced and unsupported. Adequate resourcing of communication and leadership for change is critical.