Search results

The purpose of this paper is to present the findings arising from a three year research project which investigated a major system-wide change in the design of the NHS in England. The radical policy change was enshrined in statute in 2012 and it dismantled existing health authorities in favour of new local commissioning groups built around GP Practices. The idea was that local clinical leaders would “step-up” to the challenge and opportunity to transform health services through exercising local leadership. This was the most radical change in the NHS since its inception in 1948.

The research methods included two national postal surveys to all members of the boards of the local groups supplemented with 15 scoping case studies followed by six in-depth case studies. These case studies focused on close examination of instances where significant changes to service design had been attempted.

The authors found that many local groups struggled to bring about any significant changes in the design of care systems. But the authors also found interesting examples of situations where pioneering clinical leaders were able to collaborate in order to design and deliver new models of care bridging both primary and secondary settings. The potential to use competition and market forces by fully utilising the new commissioning powers was more rarely pursued.

The findings carry practical implications stemming from positive lessons about securing change even under difficult circumstances.

The paper offers novel insights into the processes required to introduce new systems of care in contexts where existing institutions tend to revert to the status quo. The national survey allows accurate assessment of the generalisability of the findings about the nature and scale of change.

Contemporary organisational realities challenge consultants to develop: more up‐to‐date motivational knowledge; the ability and willingness to work with change agents unsympathetic to applied social science; and, facility with methodologies for both cultural and structural change. Changes over the last two decades have resulted in a more diverse motivational picture than the 1950s to 1970s humanistic motivational theories that underlie most organisational development theory and practice. In response, consultants need to develop a portfolio of consultancy methods that enable them to address not only cultural changes (e.g. attitudinal and change) but also structural changes (e.g. organisational design). Today, most clients who hire organisational consultants do so to complement technological and strategic changes anticipated or already undertaken. OD practitioners need to increase their ability to understand and work with change managers, and their consultants, who see the world predominantly through technological and economic eyes.

The purpose of this paper is to explore the various ways in which clinical executive directors and non‐clinical executive directors are interpreting and responding to the extensive reforms and restructuring in the UK health service.

The paper draws upon detailed research in two very large teaching hospital organizations in order to understand how actors crucial to the delivery of this vision are responding. Schedule‐structured interviews with executive directors were conducted, recorded, transcribed and coded.

The clinical and non‐clinical directors of these organizations engaged in a process of active sense‐making are found, which is leading to significant changes to the service and also changes to identity. The clinical directors are revealing a willingness to assume accountability for devolved profit centres in their service lines. The non‐clinical directors are supportive of this idea in broad terms but are cautious about releasing “too much” central control.

The paper is based on just two case studies and the analyses are made through the perspectives of the executive teams in each case.

Changes to healthcare environments of this kind are occurring in many countries, but such is the extent and intensity of these changes in the UK that the government's aspiration is high – it sees this set of reforms leading to a peerless world class health service. The way in which the actors make sense of and navigate their way through the cross cutting principles and the layered reforms is a critical issue.

There have been few systematic studies of the practical reality involved in the enactment of profit centre and service line management initiatives in acute hospital settings and the ways these are understood and negotiated at executive team level.

Describes a weekend workshop on contemporary organizational consultancy, held in April 1992. Themes explored included types and levels of consultation; styles of intervention; consultation as a facilitation, as education, as a political process; changing needs of organizational clients; and competences required of consultants. Highlights the value of time spent in reflective thought rather than in activity. Discusses how The Tavistock Institute in the UK has instituted new courses and seminars designed to cater to practising organizational consultants wanting to enhance their professionalism. Details the content and aims of a new programme which runs from October 1993 to May 1995.

As firms struggle to cope with an increasingly turbulent and uncertain economic environment there is widespread recognition of the importance of organisational learning. One option is to look at the potential of shared learning between firms, where common interests and interdependence provide motivation for experience sharing and other forms of synergy in learning. A particular version of inter‐firm learning is the use of supply chains as a mechanism for upgrading and transferring “appropriate practice” and this article reports on exploratory research on this theme. It draws on a literature survey and a detailed study of six UK supply chains at various stages of implementing supply chain learning.

In Canada, integrated care pilot projects are often implemented as a local reform strategy to improve the quality of patient care and system efficiencies. In the qualitative study reported here, the authors explored the experiences of healthcare professionals when first implementing integrated care pilot projects, bringing together physical and mental health services, in a community hospital setting.

Engaging a qualitative descriptive study design, semi-structured interviews were conducted with 24 healthcare professionals who discussed their experiences with implementing three integrated care pilot projects one year following project launch. The thematic analysis captured early implementation issues and was informed by an institutional logics framework.

Three themes highlight disruptions to established logics reported by healthcare professionals during the early implementation phase: (1) integrated care practices increased workload and impacted clinical workflows; (2) integrating mental and physical health services altered patient and healthcare provider relationships; and (3) the introduction of integrated care practices disrupted healthcare team relations.

Study findings highlight the importance of considering existing logics in healthcare settings when planning integrated care initiatives. While integrated care pilot projects can contribute to organizational, team and individual practice changes, the priorities of healthcare stakeholders, relational work required and limited project resources can create significant implementation barriers.