Table 5 Concepts

Use of the term disinvestment as a driver or justification for change is associated with negative connotations such as focusing on cost cutting, engendering suspicion and distrust, and getting stakeholders offside.

Do not use ‘disinvestment’ as the basis for the framework or the aim of change initiatives

Conducting disinvestment activities independently of existing systems and processes does not represent the reality of health service decision-making. It may be counterproductive: lacking incentives for change and introducing disincentives. Disinvestment should not be considered as an isolated activity, but integrated within existing systems and processes in the context of all resource allocation decisions, covering the spectrum from investment to disinvestment.

Removal or restriction of practices that are harmful or of little or no value; replacement of inferior practices with more effective or cost-effective alternatives; and reduction of organisational waste, systematic error and inappropriate use of TCPs all arise from good policy, management and clinical decisions. If these are based on evidence from research, local data and/or stakeholder views there are sound positive drivers for action. There is no need for the concept of disinvestment to be introduced as a reason for change.

Focus on the positive reasons driving removal, reduction or restriction of current practices

Use existing systems, processes, expertise, methods and tools whenever possible

It has been proposed that disinvestment activities are more likely to be successful if decisions are transparent, integrated into everyday decision-making and central to local planning rather than ad hoc decisions, individuals ‘championing’ causes or standalone projects

Disinvestment driven from a positive perspective focusing on optimisation of health care through allocation or reallocation of finite resources for maximum effectiveness and efficiency is more likely to be successful.

Existing healthcare improvement paradigms such as Knowledge Translation, Evidence Based Practice, Quality Improvement, System Redesign and Health Economics offer theories, frameworks, methods and tools for decision-making, implementation and evaluation that can be applied to disinvestment.