Chapter 7 Implementing a New Cancer Control Programme in Ireland: A Case of Sustainable Large-Scale Change?

Purpose – To identify the key success factors in a change process and to demonstrate how adherence to the phases of large-scale change contributed to the successful reform of the Irish cancer services and is critical to the sustainability of this large-scale change. Design – In-depth retrospective analytical case study drawing from face- to-face semi-structured interviews with key stakeholders and players. Findings – The Irish health care reform had been continually thwarted by local politics. The Irish government confronted this trend by bringing in an outside expert to head the cancer services reform project who, with government support, managed both clinician and public resistance and, based on the evidence of international best practice, led the reform. Sustainable change was achieved by attention to how large-scale change works. The leadership of the project is an important element in overcoming the path dependency that is dogged in most health care reforms. Value – This chapter provides evidence that the four key phases of large system change: understanding the need for change, framing the change, undertaking the change and sustaining the change, coupled with key success factors in relation to timing, financial viability, political will and leadership, public support, well-managed process, and technical infrastructure and capacity are critical to the implementation and sustainability of large-scale change.