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The purpose of this paper is to examine a bold and ambitious scheme known as the North East transformation system (NETS). The principal aim of the NETS is the achievement of a step-change in the quality of health services delivered to people living in the North East region of England. The paper charts the origins of the NETS and its early journey before describing what happened to it when the UK coalition government published its proposals for unexpected major structural change in the NHS. This had a profound impact on the leadership and direction of the NETS and resulted in it taking a different direction from that intended.

The research design took the form of a mixed methods, longitudinal 3.5-year study aimed at exploring transformational change in terms of content, context, process and outcomes. The sample of study sites comprised 14 NHS trusts in the North East region chosen to provide geographical coverage of the area and to reflect the scale, scope and variety of the bodies that formed part of the NETS programme. The qualitative component of the research, which the paper draws upon, included 68 semi-structured interviews, observational studies and focus groups. Data analysis made use of both deductive and inductive frameworks. The deductive framework adopted was Pettigrew et al.’s “receptive contexts for change” and four of the eight factors stood out as especially important and form the basis of the paper.

The fate of the NETS was shaped and influenced by the eight factors comprising the Pettigrew et al. receptive contexts for change framework but four factors in particular stood out as being especially significant: environmental pressure, quality and coherence of policy, key people leading change, supportive organisational culture. Perhaps the most significant lesson from the NETS is that achieving whole systems change is particularly vulnerable to the vicissitudes of politics especially where that system, like the UK NHS, is itself subject to those very same pressures. Yet, despite having an enormous influence on health policy, the political context is frequently avoided in research or not regarded as instrumental in determining the outcomes in respect of transformational change.

The chief limitation is the credibility and authenticity of the interviews captured at particular points in time. These formed the datebase for subsequent analysis. The authors sought to guard against possible bias by supplementing interviews with observational studies and focus groups as well as running two dissemination events at which emerging findings from the study were subjected to independent external scrutiny and comment. These events provided a form of validation for the key study findings.

The research findings demonstrate the importance of context for the likely outcome and success of complex transformational change initiatives. These require time to become embedded and demonstrate results especially when focused on changing culture and behaviour. But, in practice, allowing sufficient time during which the organisation may remain sufficiently stable to allow the change intervention to run its course and become embedded and sustainable is highly problematic. The consequence is that bold and ambitious efforts like the NETS are not given the space and stability to prove themselves. Too often, politics and external environmental pressures intrude in ways that may prove dysfunctional and negative.

Unless a different approach to transformational change and its leadership and management is adopted, then changing the NHS to enable it to appear more responsive to changing health care needs and expectations will remain a cause for concern. Ultimately the public will be the losers if the NHS remains insensitive to changing needs and expectations. The patient experience was at the centre of the NETS programme.

The study is original insofar as no other has sought to evaluate the NETS independently and over a reasonable time period. The research design, based on a mixed-methods approach, is unusual in evaluations of this nature. The study’s conclusions are not so original but their value lies in largely confirming and reinforcing the findings from other studies. It perhaps goes further in stressing the impact of politics on health policy and the negative consequences of constant organisational change on attempts to achieve deep change in the way the NHS is organised and led.

High-quality nursing home (NH) care has long been a challenge within the United States. For decades, policymakers at the state and federal levels have adopted and implemented regulations to target critical components of NH care outcomes. Simultaneously, our delivery system continues to change the role of NHs in patient care. For example, more acute patients are cared for in NHs, and the Center for Medicare and Medicaid Services (CMS) has implemented value payment programs targeting NH settings. As a part of these growing pressures from the broader healthcare delivery system, the culture-change movement has emerged among NHs over the past two decades, prompting NHs to embody more person-centered care as well as promote settings which resemble someone's home, as opposed to institutionalized healthcare settings.

Researchers have linked culture change to high-quality outcomes and the ability to adapt and respond to the ever-changing pressures brought on by changes in our regulatory and delivery system. Making enduring culture change within organizations has long been a challenge and focus in NHs. Despite research suggesting that culture-change initiatives that promote greater resident-centered care are associated with several desirable patient outcomes, their adoption and implementation by NHs are resource intensive, and research has shown that NHs with high percentages of low-income residents are especially challenged to adopt these initiatives.

This chapter takes a novel approach to examine factors that impact the adoption of culture-change initiatives by assessing knowledge management and the role of knowledge management activities in promoting the adoption of innovative care delivery models among under-resourced NHs throughout the United States. Using primary data from a survey of NH administrators, we conducted logistic regression models to assess the relationship between knowledge management and the adoption of a culture-change initiative as well as whether these relationships were moderated by leadership and staffing stability. Our study found that NHs were more likely to adopt a culture-change initiative when they had more robust knowledge management activities. Moreover, knowledge management activities were particularly effective at promoting adoption in NHs that struggle with leadership and nursing staff instability. Our findings support the notion that knowledge management activities can help NHs acquire and mobilize informational resources to support the adoption of care delivery innovations, thus highlighting opportunities to more effectively target efforts to stimulate the adoption and spread of these initiatives.

Fundamental hospital management reforms, enacted in 1990, focus on competition for National Health Service (NHS) contracts between public and private hospitals and the option of self‐governing trust status for NHS hospitals. The need to challenge the status quo in the NHS is discussed. Initiatives leading to self‐governance are reviewed. The Freeman Hospital′s model for the cultural change which is prerequisite to self‐governance is presented. The Freeman Hospital, Newcastle upon Tyne, a national pilot site selected by the NHS Management Executive to develop new management systems and practices, is among the first self‐governing hospital trusts in the NHS.

The purpose of this paper is to present an empirical case study which was undertaken to examine planning and change management within a UK National Health Service (NHS) multi‐site hospital.

A case study was undertaken within a UK‐based NHS hospital trust. Having reviewed the available literature, the research collated and analysed existing planning and change implementation within the hospital using multiple collection methods. This culminated in specific recommendations.

It was established that the following were all factors of influence: articulating change in the NHS; preparing for the 18‐week patient pathway; choose and book: managing patient demand; and payment by results: financial accountability at all levels. These were all high profile issues requiring specific and immediate attention, if the proposed plans and changes were to be implemented according to the objectives set.

The case study methodology applied was appropriate, generating data to facilitate discussion and to draw specific conclusions. A perceived limitation is the single case approach; however, Remenyi et al. argue that this can be enough to add to the body of knowledge.

From the research, a number of key influences were identified to have a significant impact on planning and managing change within the NHS. Specific recommendations are made.

The core contribution of the research adds to the body of knowledge about planning and the management of organisational change within healthcare.

This paper seeks to report the findings from a seven‐year study on the UK National Health Service on the introduction of an electronic health record for 50 million citizens. It explores the relationship between policy and practice in the introduction of a large‐scale national ICT programme at an estimated value of £12.4bn.

Using a longitudinal research method, data are collected on the policy‐practice nexus. The paper applies institutional theory using a conceptual model by Tolbert and Zucker on the component processes of institutionalisation.

The findings suggest that institutional forces act as a driver and an inhibitor to introducing enabling technologies in the health‐care environment. A process analysis shows that, as electronic health records force disruptive change on clinicians, healthcare managers and patients, culturally embedded norms, values and behavioural patterns serve to impede the implementation process.

This research is limited in its generalisability to national, regional and local ICT implementations due to the complexity of the policy and practical issues at stake. Despite the longitudinal research approach, the use of institutional theory can only offer a flavour of how institutionalised values, norms and behaviours influence health IT policy and practice.

The paper demonstrates the complexity of translating centralised ICT policy in healthcare to practical solutions for clinicians and other stakeholders. It shows how a large‐scale ICT programme based on procurement of technology is unlikely to succeed where important issues of user engagement and a sound “business case” have not been achieved.

This research contributes to the theoretical literature on institutionalism by addressing the dichotomy between institutional and technical environments. While technology is often discussed in isolation of an institutional process, it may become embedded in organisational practices, reaching a process of sedimentation (institutionalisation) or fail to take hold and fade from view.

Presents and discusses the findings from a research project into the impact of the NHS internal market on the merger of colleges of midwifery and nursing. Begins by briefly describing the major changes which have been introduced in the NHS since 1979 and sets these within the context of the changing nature of the public sector in the UK. Second, describes the background to the research and the methods employed. Continues with a brief review of the approaches to the change management process, which in particular draws attention to the importance of the environment in which the organization operates, and of the relationship between management styles and the different approaches to organizational change. Presents a case study of the merger of five colleges of nursing and midwifery. Follows with a discussion of the case study and the conclusions drawn from it for the process of change within the NHS.

The research on which this article is based has been carried out over a period of five years (1992‐1997). It focuses on the management of change in the National Health Service (NHS) since the reforms introduced in the 1990 NHS Act. The research comprises four case studies: two NHS Trusts providing mental health services and two colleges of nursing and midwifery. All four bodies have experienced major changes brought about, in the main, by the creation of the NHS internal market. The article attempts to map the process of managing change in these four organizations. It outlines the difficulties encountered by managers in designing and implementing effective strategies for their organizations. In particular, the article: highlights major discrepancies in linking strategic plans with the reality of managing public services and the complexities of planning for large‐scale changes in the 1990s; shows that although leadership is important, it must be appropriate to an organization’s situation; argues that organizations can make false assumptions about the immutability of the environment in which they operate and the degree of choice available. The article concludes by presenting a model of change which incorporates environmental conditions, internal cohesion, management styles and approaches to change.

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.

Considers the changes which are being implemented in primary care, and the patterns which are now beginning to emerge. Examines the changing context within which practices now function (both political and managerial), and considers the power which GPs are beginning to exert, as well as the impact which they may have on the interface between primary and secondary care. Examines the systems being developed for assuring quality in general practice. Predicts an explosion in the need for appropriate information for management and for medical audit in UK primary care, because the context within which general practitioners (GPs) deliver primary care in the NHS is changing rapidly. It is only now becoming evident that this turbulence may well offer major new opportunities to GPs, as well as permanently altering the balance of power in the NHS between primary and secondary care.

The purpose of this paper is to examine National Health Service (NHS) employee perspectives of how high performance human resource (HR) practices contribute to their performance.

The paper draws on an extensive qualitative study of the NHS. A novel two‐part method was used; the first part used focus group data from managers to identify high‐performance HR practices specific to the NHS. Employees then conducted a card‐sort exercise where they were asked how or whether the practices related to each other and how each practice affected their work.

In total, 11 high performance HR practices relevant to the NHS were identified. Also identified were four reactions to a range of HR practices, which the authors developed into a typology according to anticipated beneficiaries (personal gain, organisation gain, both gain and no‐one gains). Employees were able to form their own patterns (mental models) of performance contribution for a range of HR practices (60 interviewees produced 91 groupings). These groupings indicated three bundles particular to the NHS (professional development, employee contribution and NHS deal).

These mental models indicate employee perceptions about how health services are organised and delivered in the NHS and illustrate the extant mental models of health care workers. As health services are rearranged and financial pressures begin to bite, these mental models will affect employee reactions to changes both positively and negatively.

The novel method allows for identification of mental models that explain how NHS workers understand service delivery. It also delineates the complex and varied relationships between HR practices and individual performance.