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Mixed methods evaluation of a hospital group model using an embedded research approach: study protocol
  1. Cecilia Vindrola-Padros1,
  2. Estela Capelas Barbosa1,
  3. Angus I G Ramsay1,
  4. Simon Turner2,
  5. Stephen Morris1,
  6. Ronald Agble3,
  7. Amy Caldwell-Nichols3,
  8. Naomi J Fulop1
  1. 1 Department of Applied Health Research, University College London, London, UK
  2. 2 School of Management, University of Los Andes, Bogota, Colombia
  3. 3 Royal Free London NHS Foundation Trust, London, UK
  1. Correspondence to Dr Cecilia Vindrola-Padros; c.vindrola{at}


Introduction Hospital group models represent an organisational form that aims to bring together multiple provider organisations with a central headquarters and unified leadership responsible for locally managed operating units, standardised systems and a value-set shared across the group. These models seek to improve outcomes by reducing unwarranted variations in care provision and reducing costs through economies of scale. There is limited evidence on the impact and processes of implementing these models, so this study aims to evaluate one case study of a hospital group model.

Methods and analysis We will conduct a formative, mixed-methods evaluation using an embedded research approach to analyse the implementation of the model and its impact on outcomes and costs. We will carry out a multisited ethnography to analyse the programme theory for model design and implementation, the barriers and facilitators in the implementation; and wider contextual issues that influence implementation using semi-structured interviews (n=80), non-participant observations (n=80 hours), ‘shadowing’ (n=20 hours) and documentary analysis. We will also carry out an economic evaluation composed of a cost-consequence analysis and a return on investment analysis to evaluate the costs of creating and running the model and balance these against the potential cost-savings.

Ethics and dissemination The study protocol was reviewed by the local R&D Office and University College London Ethics Committee and classified as a service evaluation, not requiring approval by a research ethics committee. We will follow guidelines for informed consent, confidentiality and information governance, and address issues of critical distance prevalent in embedded research. Findings will be shared at regular time points to inform the implementation of the model. The evaluation will also generate: an evaluation framework to evaluate future changes; recommendations for meaningful baseline data and measuring improvement; identification of implementation costs and potential cost-savings; and lessons for the National Health Service on implementing these models.

  • hospital group model
  • embedded research
  • multi-sited ethnography
  • cost-consequence analysis
  • return on investment analysis

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  • Contributors All contributors participated in the design of the study. CV-P and ECB: drafting of the manuscript. CV-P, ECB, AIGR, ST, RA, AC-N, SM, NJF: made significant contributions to the manuscript and approved the final version before submission.

  • Funding This work was supported by NHS England. ECB, NJF and SM were supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care North Thames at Bart’s Health NHS Trust (NIHR CLAHRC North Thames). NJF is an NIHR Senior Investigator.

  • Disclaimer The views expressed in this article are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.

  • Competing interests RA and ACN are staff members from the hospitals that are part of this evaluation and contribute to the planning and implementation of the hospital group model. CV-P is working as an embedded researcher throughout the course of the evaluation.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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