title: A qualitative study of diverse providers' behaviour in response to commissioners, patients and innovators in England: research protocol.
abstract: The variety of organisations providing National Health Service (NHS)-funded services in England is growing. Besides NHS hospitals and general practitioners (GPs), they include corporations, social enterprises, voluntary organisations and others. The degree to which these organisational types vary, however, in the ways they manage and provide services and in the outcomes for service quality, patient experience and innovation, remains unclear. This research will help those who commission NHS services select among the different types of organisation for different tasks.
  
  
  
  The main research questions are how organisationally diverse NHS-funded service providers vary in their responsiveness to patient choice, NHS commissioning and policy changes; and their patterns of innovation. We aim to assess the implications for NHS commissioning and managerial practice which follow from these differences.
  
  
  
  Systematic qualitative comparison across a purposive sample (c.12) of providers selected for maximum variety of organisational type, with qualitative studies of patient experience and choice (in the same sites). We focus is on NHS services heavily used by older people at high risk of hospital admission: community health services; out-of-hours primary care; and secondary care (planned orthopaedics or ophthalmology). The expected outputs will be evidence-based schemas showing how patterns of service development and delivery typically vary between different organisational types of provider.
  
  
  
  We will ensure informants' organisational and individual anonymity when dealing with high profile case studies and a competitive health economy. The frail elderly is a key demographic sector with significant policy and financial implications. For NHS commissioners, patients, doctors and other stakeholders, the main outcome will be better knowledge about the relative merits of different kinds of healthcare provider. Dissemination will make use of strategies suggested by patient and public involvement, as well as DH and service-specific outlets.
authors.affiliation: School of Government, Plymouth University, Plymouth, UK.
authors.forename: Rod
authors.initials: R
authors.lastname: Sheaff
authors.affiliation: School of Government, Plymouth University, Plymouth, UK.
authors.forename: Joyce
authors.initials: J
authors.lastname: Halliday
authors.affiliation: Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Exworthy
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Pauline
authors.initials: P
authors.lastname: Allen
authors.affiliation: Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK.
authors.forename: Russell
authors.initials: R
authors.lastname: Mannion
authors.affiliation: School of Government, Plymouth University, Plymouth, UK.
authors.forename: Sheena
authors.initials: S
authors.lastname: Asthana
authors.affiliation: School of Government, Plymouth University, Plymouth, UK.
authors.forename: Alex
authors.initials: A
authors.lastname: Gibson
authors.affiliation: School of Government, Plymouth University, Plymouth, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Clark
mesh_terms: D003153:Community Health Services / Q000458:organization & administration*; D003695:Delivery of Health Care / Q000458:organization & administration*; D004739:England; D006291:Health Policy; D006801:Humans; D009936:Organizational Innovation; D057240:Patient Preference; D036301:Qualitative Research; D011787:Quality of Health Care / Q000592:standards; D013222:State Medicine
keywords: QUALITATIVE RESEARCH