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Using a complexity-informed approach, we aim to understand why introduction of a mobile service delivery model for osteoporosis across diverse organisational and country contexts in the UK National Health Service (NHS) met with variable success.

Six comparative case studies; three prospectively in Scotland using an action research-informed approach; and three retrospectively in England with variable degrees of success. The Non-adoption, Abandonment, Scale-up, Spread and Sustainability framework explored interactions between multi-level contextual factors and their influence on efforts to introduce and sustain services.

Cross-boundary service development was a continuous process of adaptation and evolution in rapidly shifting healthcare context. Whilst the outer healthcare policy context differed significantly across cases, inner contextual features predominated in shaping the success or otherwise of service innovations. Technical and logistical issues, organisational resources, patient and staff actions combined in unpredictable ways to shape the lifecycle of service change. Patient and staff thoughts about place and access to services actively shaped service development. The use of tacit “soft intelligence” and a sense of “chronic unease” emerged as important in successfully navigating around awkward people and places.

“Chronic unease” and “soft intelligence” can be used to help individuals and organisations “tame” complexity, identify hidden threats and opportunities to achieving change in a particular context, and anticipate how these may change over time. Understanding how patients think and feel about where, when and how care is delivered provides unique insights into previously unseen aspects of context, and can usefully inform development and sustainability of patient-centred healthcare services.

This study has uniquely traced the fortunes of a single service innovation across diverse organisational and country contexts. Novel application of the NASSS framework enabled comparative analysis across real-time service change and historical failures. This study also adds to theories of context and complexity by surfacing the neglected role of patients in shaping healthcare context.

The purpose of this paper is to report the findings of a study that examined the development of an assessment framework for public involvement.

The paper has adopted a multi‐method approach that includes: a focused review of literature relating to tools that might be used to provide valid and reliable assessments of public involvement; key informant interviews with people with experience from various perspectives of efforts to involve the public in the planning and development of health services; and a detailed study of a specific public involvement initiative involving a range of “stakeholder” interviews.

The paper finds that there are uncertainty and a lack of consensus about how assessment of public involvement should be undertaken. The findings emphasise the need to recognise the diverse nature of public involvement, which may require assessment to be employed flexibly at each individual NHS Board level.

The paper is a small‐scale study, in which it was only possible to probe a limited number of stakeholders' views due to practical and time restrictions.

The paper adds value to the discussions taking place at Scottish Government level as to the best approach in assessing public involvement in health service decision making.

The organization of the corporate marketing function has attracted increasing attention from marketers in the 1990s. This reflects both the significant conceptual developments in marketing theory and a questioning of the role of the centralized marketing department to organizations operating in post‐industrial service economies. Drawing on data from a broader research project into marketing activity in the acute health care sector in the United Kingdom, the paper examines the organizational solutions adopted by self‐governing hospitals in managing the marketing function. The core theme to emerge from the research is the imperative for such professional service organizations to facilitate the development of flexible, project focused marketing teams, effectively mirroring the notion of the buying centre, capable of integrating core technical professionals directly into the marketing process. Coupled to this is the notion of marketing professionals having to abdicate ownership, and even dominance, of the corporate marketing process.

This paper seeks to present findings from a longitudinal action research study aimed at exploring one such innovation. Little is known about the micro‐level impact of health service innovations over time.

The paper shows that action research is a participatory approach ideally suited to monitoring the process and outcomes of change. Over 20 months, an action researcher studied the work of four interprofessional care co‐ordinators (IPCCs), whose role was intended to speed patient through‐put within a London teaching hospital general medical directorate. The action researcher kept regular participant observation field notes and supplemented these data with a profile of IPCC patients (n=407), in‐depth interviews (n=37) and focus groups (n=16) with staff. Throughout the study, findings were regularly fed back to participants to inform practice developments.

The findings in this paper show that, in spite of the original intention for this role to provide clerical support to the multidisciplinary team, over time the role shifted beyond its implementation into practice to take on more complex work from registered nurses. This raised actual and potential governance issues that were not attended to by service managers. A complex and turbulent context disrupted managers' and practitioners' abilities to reflect on and respond to these longer‐term role shifts.

This paper argues that the complex nature of the innovation and the setting in which it operated account for the role shift and the lack of attention to issues of governance. Current innovation literature suggests that implementation into routine practice represents the end‐point of an innovation's journey. These findings suggest that certain innovations may in fact continue to shift in nature even after this “end‐point”. The conclusions drawn are likely to be of global interest to those interested in complex health service innovations.

The purpose of this paper is to examine power asymmetries in the delivery of genetics healthcare that inhibit knowledge sharing across sector, organisational and professional boundaries.

The paper is a longitudinal comparative case study approach, which encompasses semi‐structured interviews and observation.

The paper finds politics to be significant in its influence on knowledge sharing across sector, organisational and professional boundaries, but this can be mediated by attending to human and social aspects of the context in which knowledge sharing was expected to take place.

The paper encourages research that evaluates the effect of increased emphasis on human and social aspects of organisational change in pursuit of the “dream” of spanning boundaries and improving knowledge sharing within the NHS.

The paper shows that structural change appears to be of limited effect in promoting knowledge sharing. Organisational and individual development, career management and performance systems are worthy of attention for the purpose of managing knowledge.

The paper exposes this assumption as managerialist. Policy‐makers assume that professionals are willing and able to share knowledge when delivering healthcare through networks.

The purpose of this paper is to investigate the impact of accounting on clinical practices.

This paper reviews existing studies of clinical budgeting; analyses publicly available data on cost‐effectiveness recommendations for the NHS; analyses publicly available data on the influence of accounting in medical dilemmas.

The paper finds that there is limited evidence of clinical budgeting dominating clinical decisions, but there is some evidence of central agency directions on appropriateness of treatments, but this is on a cost‐effectiveness basis. Numerous examples of adverse medical outcomes are cited in this paper – but with limited influence of accounting in these decisions.

The paper shows that the combination of accounting and medical data in a topical matter makes this an original and distinctive study.

The purpose of the paper is to examine the policy and organizational implications of gender imbalance in management, which research suggests exists in the NHS.

The research in this paper involved a qualitative approach with an analysis of élite interviews conducted with a non‐random sample of officials involved in health policy and interviews with a random sample of senior managers in NHS Scotland. The research formed part of a larger study, which explored the enablers and inhibitors to female career progression in various Scottish sectors.

The paper finds that gender imbalance in management exists in the NHS. This is manifested in a masculine organizational context, leadership and policy decision‐making process, which have implications for female career advancement opportunities and subsequently access to macro policy decisions.

The paper involved a sample (30 percent) of senior managers and examined policy processes in NHS Scotland. To improve the external validity of the findings further research should be conducted in NHS organizations in England and Wales.

The findings in the paper suggest that gender imbalance in management and a masculine organizational context and leadership style within the NHS create a less than conducive environment for female employees. This has practical implications in terms of levels of part‐time employment, career progression and attrition rates.

The paper adds to the debate of gender and organizational studies by examining the health sector, which has high levels of female employment but low levels of female representation at senior management levels. The paper therefore adds to an often‐neglected area of study, women in leadership and senior managerial positions. The paper is original in its approach by examining the micro and meso organizational dimensions which impact on women's ability to influence macro health policy.

The purpose of this paper is to show that networks are emerging as a new, innovative organisational form in the UK public sector. The emergence of more network‐based modes of organisation is apparent across many public services in the UK but has been particularly evident in the health sector or NHS. Cancer services represent an important and early example, where managed clinical networks (MCNs) for cancer have been established by the UK National Health Service (NHS) as a means of streamlining patient pathways and fostering the flow of knowledge and good practice between the many different professions and organisations involved in care. There is very little understanding of the role of power in public sector networks, and in particular MCNs. This paper aims to explore and theorise the nature of power relations within a network model of governance.

The paper discusses evidence from five case studies of MCNs for cancer in London.

The findings in this paper demonstrate that a model of bounded pluralism can be used to understand power relations within London MCNs. However, power over the development of policy and strategic direction is instead exerted in a top‐down manner by the government (e.g. Department of Health) and its associated national bodies.

The paper supports the argument that the introduction of rhetoric of a more collaborative approach to the management of public services has not been enough to destabilise the embedded managerialist framework.

This paper uses empirical data from five case studies of managed clinical networks to theorise the nature of power relations in the development and implementation of network reform in cancer services. Also, there is limited understanding of the nature of power relations in network relationships, particularly in relation to the public sector.

The purpose of this paper is to consider the issues which emerge when an autonomous, professional, member‐led organisation attempts to demonstrate its accountability to patients through lay involvement in its standard‐setting processes.

The paper reports a project, which is still in progress and could be described as action research. Data were collected through participant observation in a series of discussions and working groups. A limited literature search was carried out at the start of the initiative but found little which relates to lay involvement in professional bodies.

The paper finds that patient involvement in a professional body is unlikely by itself to be a useful mechanism for delivering greater professional accountability.

The paper is a single case study and can only suggest hypotheses for further research.

The paper shows that professional bodies of various types are increasingly being asked to demonstrate public involvement in their decision making. It is important to identify the most effective mechanisms for this and the limitations inherent in the structures of organisations, which are accountable primarily to their members.

The paper shows that individual doctors are held to account through a number of mechanisms, but little attention has been given to how medical professional bodies can be made more accountable for the collective power they hold. Patient involvement is interpreted within a consumerist model, which focuses on the doctor‐patient relationship and ignores the considerable strategic influence which medical royal colleges exercise within the health service.