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A brief introduction into recent developments of the EFQM Excellence Model and the United Kingdom (UK) Government’s agenda for ensuring that quality is at the heart of all decision making is given. In view of the Government explicitly commending the use of the EFQM Excellence Model to all organisations within the National Health Service, the author decides to explore the possible reasons behind the commendation. When comparing the EFQM Excellence Model with the Government’s vision for quality, the former emerges as a more than ideal tool for any organisation wishing to commence or strengthen their journey on the road to quality and/or excellence; particularly as the EFQM Excellence Model is based on the principles of self‐assessment, continuous improvement, learning and innovation, teamwork and a culture totally focused on the customer. Finally, ten possible reasons behind the Government commending the use of the Model are given.

The purpose of this paper is to conduct an empirical study derived from the previous literature from the perspective of benefits, tools and techniques, continuous improvement (CI) and quality improvement (QI) methodologies and critical failure factors (CFFs) of Lean and Six Sigma (SS) in the national health service (NHS).

A literature review was carried out to identify previous findings, empirical data and critical variables concerning Lean and SS in healthcare for over ten years. Second, primary research in quantitative surveys and qualitative interviews was carried out with 110 participants who have experience using Lean and SS in the NHS.

Lean and SS have evolved into common practices within the NHS and now have an established list of tools and techniques frequently employed by staff. Lean and SS are considered robust CI methodologies capable of effectively delivering extensive benefits across many different categories. The NHS must overcome a sizable amount of highly important CFFs and divided organizational culture.

This paper has developed the most extensive empirical study ever produced on Lean and SS in the NHS and has expanded on previous works to create new and updated research. The findings produced in this paper will assist NHS medical directors and practitioners in obtaining up-to-date insight into Lean and SS status in the NHS. The paper will also guide the NHS to critically evaluate their current CI strategy to ensure long-term sustainability and deliver improved levels of service to patients.

The paper seeks to report on an audit undertaken in 2010 to support implementation of the Independent Safeguarding Authority (ISA) processes by National Health Service (NHS) Trusts. The ISA was set up under the Safeguarding Vulnerable Groups Act (SVGA) 2006. Concern has been expressed that some NHS employers are not familiar with their new obligations to consider making referrals to the ISA.

This audit was designed to provide an estimate of possible NHS referrals to the enhanced vetting and barring scheme run by the ISA in England and Wales; and to explore two NHS Trusts' potential decision‐making and referrals to the ISA following disciplinary action or adverse events. The two NHS Trusts that participated engaged in a detailed review of incidents and their relationship to harm as defined in the SVGA 2006.

The simple number of how many incidents have been reported to the ISA by an NHS Trust will not equate to the same number of cases of individual patients being harmed or the number of events that have placed them at risk of harm. There are considerable differences in how reporting an incident is viewed, managed and dealt with among NHS Trusts. Following this audit, the best estimate of the number of potential NHS referrals from England, Wales and Northern Ireland to the ISA over one year is estimated to be about 712.

This is a small audit of self‐selecting Trusts. The information is not examined in detail and the reasons for Trust decisions about disciplinary outcomes are not accessed or scrutinised; the indicative figures of numbers of referrals to the NHS are a simple indication of the levels of referrals that might be expected.

The audit results suggest a need for further work on what is most helpful in making the differential decisions about the type of harm that has occurred from an incident. NHS Trusts may need to assure themselves that their duties under the SVGA are fully understood and implemented.

The strength of the audit, and, therefore, this paper, is that a sample of Trusts have supplied a level of detail about their staff and Human Resource matters that is not generally available, as access to the DATIX system is not generally sought or permissions given.

The NHS in the UK has recently adopted a new Performance Assessment Framework (PAF), aiming to provide a broader view of performance within the NHS. The PAF is not only a multi‐stakeholder approach reflecting various stakeholders’ interests across six dimensions, but is also used by the Government as a strategic management tool to link national strategies with local operation activities. The Government claims that the PAF is a “balanced scorecard” approach. This study discusses the concepts of the BSC underlying the NHS PAF.

The NHS in 1991 launched an equality programme for women, setting eight goals to be achieved by 1994. Shows that at least some of the goals are not being met and suggests reasons falling into four categories. First is the NHS context, including trusts′ autonomy which is incompatible with a national equality plan. Second, there is a failure of implementation, Third, the programme is inherently flawed: Its business rationale is less than convincing to many health professionals who attach a high value to ethics, Fourth, the reasons for failure relate to all equality programmes for women, including a value system which sees the male career pattern as the norm. Concludes that movement towards equality for women in the NHS is only likely to be made if a different approach to goal setting is adopted.

The success ofIn this paper, key changes taking in the development of the UK health sector from the 1940s to the mid‐1990s are briefly sketched. The changes originating from a variety of socio‐economic and political circumstances have largely been responsible for the current shape and position of the NHS. In a forthcoming paper, we will review the status of the NHS under the new Labour Government and examine implications of new changes for the future of the NHS.

The use of the balanced scorecard has been subject to increasing scrutiny and criticism in academic literature. The purpose of this paper is to explore the limitations of, and implications for, the Performance Assessment Framework (PAF) as a balanced scorecard approach in the NHS. Although Kaplan and Norton suggested that the balanced scorecard can be adapted for strategic performance management purposes in the public sector, this study aims to argue that such claims fail to give sufficient weight to the political context in which a public sector organization operates.

Semi‐structured interviews were employed to investigate the perceptions about the PAF of local managers and whether and how they incorporated central government's performance targets into their local operations within two health authorities. Furthermore, in order to examine these two health authorities' performance measurement practices, documents relating to their internal performance reports and local delivery plans were analysed.

Empirical findings drawn from local health authorities indicate that the use of the PAF was primarily for legitimacy seeking purposes rather than for rational performance improvement. For central government, the PAF was used to make the performance of the NHS visible to the public so that the public would receive the signal that central government has attempted to deliver government mandates. For local health authority managers, in order to seek legitimacy from central government, imposed performance indicators were incorporated into their local performance measurement practice. However, the use of the PAF was symbolic and ceremonial and had little impact on improving performance valued by local managers in NHS.

This study agrees with institutional theorists' argument that the use of performance measurement systems should take into account politics and power faced by an organization. In the NHS, performance measurement might be used by local NHS organizations primarily as a ceremonial means of demonstrating their symbolic commitment for legitimacy seeking purposes.

The purpose of this paper is, for English acute NHS hospitals, to investigate how they operate their governance systems in the area of secondary care contracting and identify the key determinants of relationship building within the contacting/commissioning of secondary care focusing upon non‐price competitive behaviour.

A survey instrument was designed and mailed to a sample of all acute NHS hospitals in England of whom 35 per cent responded. This survey was then analysed using logit techniques.

The analysis suggests that: those NHS Trusts offering volume discounts, non‐price competitive incentives or having a strong belief in performance being by “payment by results” criteria are significantly more likely to offer augmented services to secondary care purchasers over and above contractual minima; those NHS Trusts strongly believing in the importance of non‐price factors (such as contract augmentation or quality) in the contracting process are more likely to offer customisation of generic services; and those NHS Trusts using cost‐sharing agreements to realign contracts when negotiating contracts or who strongly believe in the importance of service augmentation in strengthening relationships, or that increased hospital efficiency is the most important aspect of recent NHS reform are more likely to utilise default measures to help realign contracts.

This paper fills a gap in the area of non‐price competition in English NHS acute secondary care contracting.

Patient process recognition and re‐engineering (PPR) has become a major concern of recent health care development and management. This paper discusses the position of the National Health Service (NHS) in the UK; where it is at present and where it aims to be. It suggests that the work of the current government in developing community care is central to the work of both the Leicester Royal Infirmary and the Peterborough Hospitals NHS Trust, when building relationships between primary (community) and secondary (hospital) health care provision. This paper aims to examine whether and how PPR can improve patient processes in the NHS. It does this through a case study of PPR in Peterborough Hospital.

The NHS began life in 1948 with the noble intention of providing free health care for all from cradle to grave. Today the NHS is the largest employer in Europe employing in excess of one million people and it has commonly been held that, since the NHS is an organisation committed to treating and providing care to patients, those working for the NHS are generally perceived to hold, in the main, altruistic values. Over the last two decades NHS managers have been given the responsibility for the implementation of the various NHS reforms which have been aimed at making the NHS more efficient, effective, accountable and business like. This paper explores the extent to which the managers in this role as change agents believe that they hold core values that are in line with the altruistic service ethos of the NHS and as a result the extent to which they believe they are seen to be performing and behaving in a socially responsible manner. Furthermore this study also provides an insight into understanding the managers' perceptions of their public image and assesses the extent to which this has an impact on the managers’ psyche, performance and commitment to the NHS ethos. Twenty eight managers from two Acute Care and one Community Care NHS Trusts in London were interviewed, after completing questionnaires, with a view to understanding their perceptions of their managerial culture and their public image. It appeared that managers generally believed that all NHS workers, themselves included, share altruistic values and demonstrated a collective commitment to the altruistic service ethos of the NHS. This therefore demonstrates the managers' commitment to behaving and performing in a socially responsible manner. As far as the managers’ perceived public image is concerned the research revealed that the majority of the managers, despite holding values that were altruistic in nature and similar to those held by clinicians, appeared to be convinced that the general public believed that doctors and nurses are the only professionals in the NHS who are motivated by a desire to serve/provide care to society and that these groups alone have an altruistic ethos. The managers indicated that they felt the public viewed them in a generally poor light and did not confer upon them the service driven values that were ascribed to clinicians. It is in the context of being the main change agents within the NHS that NHS managers appear to have become unpopular with the general public who tend to hold the view that “a service which managers are trying to make ever more efficient, rational and controlled cannot at the same time be caring and people centred” [Learmonth, 1997, pg. 219]. Whilst the NHS managers were aware of this negative view held by the public, they felt certain that this public perception was misguided and driven by several unfair and politically motivated agendas. They do not appear to have allowed this perceived negative public opinion to affect how they view their own role and in fact offered various reasons to explain why this public opinion was misguided and misinformed. This paper considers the implications of these views as regards the managers' role and commitment to the NHS.