Increasingly, government-funded health services are shifting to market-driven approaches. A market, whereby entry and exist of service providers is relatively easy, aims to identify providers who will deliver health services... [ view full abstract ]
Increasingly, government-funded health services are shifting to market-driven approaches. A market, whereby entry and exist of service providers is relatively easy, aims to identify providers who will deliver health services most competitively. For organisations traditionally buffered from the competitive pressures of for-profit enterprises, such as non-profits, this means demonstrating the kinds of operational efficiencies associated with the business sector. We undertook a rapid realist review to provide decision-makers with theory-driven, contextually relevant strategies to suggest how particular providers could adapt to this change, in specific circumstances. This ‘adaptive capacity’, considered one of the essential organisational capacities for enabling non-profits to achieve their mission, requires non-profits to strategically change in anticipation of, and in response to, changed circumstances and in pursuit of enhanced results. Previous research on adaptive capacity indicates that change agents have a key role to play. There is limited understanding, however, to explain the wide diversity of strategies used by change agents, specifically institutional entrepreneurs, to build adaptive capacity, in what circumstances, why, and what outcomes were generated.
In Australia, the Queensland State Government has embarked on a raft of policy and financing reforms with the aim of improving service delivery and value for money. For policy makers and practitioners, these findings generate evidence-based research, mapping policy and its emerging, real-time impacts. Given our focus, we chose an adapted rapid realist review methodology, that is, by using theory to develop initial CMO configurations, as a way of producing information for decision-makers in a timely manner, whilst also maintaining the central elements of the realist methodology. In this way, our paper takes a novel approach to the rapid realist review by drawing on an initial theory of institutional entrepreneurship to understand the interplay between strategy, context and cognitive processes in decisions to build adaptive capacity. We test this theory through an iterative process, involving searches of papers and reports from databases such as PubMed, Web of Science, PsycINFO, Scopus, EMBASE, and web-based searches of policy documents, data extraction, and data synthesis. Throughout we worked closely with a multi-disciplinary expert reference group and with key decision-makers in non-profit organisations. The reference group was particularly valuable in helping us to identify key strategies to include in the review and important contextual information. In this paper, we discuss how we incorporated theory into our synthesis and the ways in which it enhanced our understanding of the interplay between context, mechanisms, and outcomes. The next step of this research is to ‘test’ our program theory using case studies to refine our theory based on feedback and reflective shared learning.
Please select one of the following:: Realist synthesis , Please select a maximum of two themes from the following list:: Realist Impact Assessments
