Realist Synthesis of Demand Management for planned care

Ray Pawson, Joanne Greenhalgh, Liz Glidewell, Cathy Brennan and Roberta Longo worked with an NHS Manager (Lisa Maginnis), clinician (Dr Hugh Sturgess), service user (Laurence Wood) and international consultant (Steve Montague) to carry out a realist synthesis of demand management for planned care.  The project was funded by the National Institute of Health Research and ran from September 2012 to February 2014.

The task of matching fluctuating demand with available capacity is a particularly pressing concern in  modern healthcare systems as increasing demand (aging and growing populations, requests for new treatments, increases in patients’ knowledge and expectations, etc.) meets stagnating supply (capacity and funding restrictions on staff, beds and services etc.).

In response to these problems a large portfolio of demand management (DM) strategies has developed to try to reduce the overall rate of referrals and ensure patients are referred to the right person at the right time and in the right setting.  The aim of the project is to chart the ideas, expectations or ‘programme theories’ that lie behind the strategies focused on managing or modifying the process of referral between primary and secondary care and within secondary care.  We will then review the empirical evidence underpinning these programme theories to examine what works, for who and under what circumstances.  We aim to produce guidance to support NHS decision makers to target demand management strategies to local circumstances. The research was funded by the NIHR HS&DR