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Article
Publication date: 19 September 2020

Justin Avery Aunger, Ross Millar, Joanne Greenhalgh, Russell Mannion, Anne Marie Rafferty and Hugh McLeod

The National Health Service (NHS) is facing unprecedented financial strain. These significant economic pressures have coincided with concerns regarding the quality and…

Abstract

Purpose

The National Health Service (NHS) is facing unprecedented financial strain. These significant economic pressures have coincided with concerns regarding the quality and safety of the NHS provider sector. To make the necessary improvements to performance, policy interest has turned to encouraging greater collaboration and partnership working across providers.

Design/methodology/approach

Using a purposive search of academic and grey literature, this narrative review aimed (1) to establish a working typology of partnering arrangements for improvement across NHS providers and (2) inform the development of a plausible initial rough theory (IRF) of partnering to inform an ongoing realist synthesis.

Findings

Different types of partnership were characterised by degree of integration and/or organisational change. A review of existing theories of partnering also identified a suitable framework which incorporated key elements to partnerships, such as governance, workforce, leadership and culture. This informed the creation of an IRF of partnerships, which proposes that partnership “interventions” are proposed to primarily cause changes in governance, leadership, IT systems and care model design, which will then go on to affect culture, user engagement and workforce.

Research limitations/implications

Further realist evaluation, informed by this review, will aim to uncover configurations of mechanisms, contexts and outcomes in various partnering arrangements and limitations. As this is the starting point for building a programme theory, it draws on limited evidence.

Originality/value

This paper presents a novel theory of partnering and collaborating in healthcare with practical implications for policy makers and practitioners.

Details

Journal of Integrated Care, vol. 29 no. 2
Type: Research Article
ISSN: 1476-9018

Keywords

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Article
Publication date: 1 March 2019

Russell Mannion, Huw Davies, Martin Powell, John Blenkinsopp, Ross Millar, Jean McHale and Nick Snowden

The purpose of this paper is to explore whether official inquiries are an effective method for holding the medical profession to account for failings in the quality and…

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3438

Abstract

Purpose

The purpose of this paper is to explore whether official inquiries are an effective method for holding the medical profession to account for failings in the quality and safety of care.

Design/methodology/approach

Through a review of the theoretical literature on professions and documentary analysis of key public inquiry documents and reports in the UK National Health Service (NHS) the authors examine how the misconduct of doctors can be understood using the metaphor of professional wrongdoing as a product of bad apples, bad barrels or bad cellars.

Findings

The wrongdoing literature tends to present an uncritical assumption of increasing sophistication in analysis, as the focus moves from bad apples (individuals) to bad barrels (organisations) and more latterly to bad cellars (the wider system). This evolution in thinking about wrongdoing is also visible in public inquiries, as analysis and recommendations increasingly tend to emphasise cultural and systematic issues. Yet, while organisational and systemic factors are undoubtedly important, there is a need to keep in sight the role of individuals, for two key reasons. First, there is growing evidence that a small number of doctors may be disproportionately responsible for large numbers of complaints and concerns. Second, there is a risk that the role of individual professionals in drawing attention to wrongdoing is being neglected.

Originality/value

To the best of the authors’ knowledge this is the first theoretical and empirical study specifically exploring the role of NHS inquiries in holding the medical profession to account for failings in professional practice.

Details

Journal of Health Organization and Management, vol. 33 no. 2
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 18 October 2019

John Blenkinsopp, Nick Snowden, Russell Mannion, Martin Powell, Huw Davies, Ross Millar and Jean McHale

The purpose of this paper is to review existing research on whistleblowing in healthcare in order to develop an evidence base for policy and research.

Abstract

Purpose

The purpose of this paper is to review existing research on whistleblowing in healthcare in order to develop an evidence base for policy and research.

Design/methodology/approach

A narrative review, based on systematic literature protocols developed within the management field.

Findings

The authors identify valuable insights on the factors that influence healthcare whistleblowing, and how organizations respond, but also substantial gaps in the coverage of the literature, which is overly focused on nursing, has been largely carried out in the UK and Australia, and concentrates on the earlier stages of the whistleblowing process.

Research limitations/implications

The review identifies gaps in the literature on whistleblowing in healthcare, but also draws attention to an unhelpful lack of connection with the much larger mainstream literature on whistleblowing.

Practical implications

Despite the limitations to the existing literature important implications for practice can be identified, including enhancing employees’ sense of security and providing ethics training.

Originality/value

This paper provides a platform for future research on whistleblowing in healthcare, at a time when policymakers are increasingly aware of its role in ensuring patient safety and care quality.

Details

Journal of Health Organization and Management, vol. 33 no. 6
Type: Research Article
ISSN: 1477-7266

Keywords

Content available
Article
Publication date: 18 May 2012

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307

Abstract

Details

Journal of Health Organization and Management, vol. 26 no. 2
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 21 March 2016

Ross Millar and Helen Dickinson

– The purpose of the paper is to examine the metaphors used by senior managers and clinicians in the delivery of healthcare reform.

Abstract

Purpose

The purpose of the paper is to examine the metaphors used by senior managers and clinicians in the delivery of healthcare reform.

Design/methodology/approach

A study of healthcare reform in England carried out a series of semi structured interviews with senior managers and clinicians leading primary and secondary care organisations. Qualitative data analysis examines instances where metaphorical language is used to communicate how particular policy reforms are experienced and the implications these reforms have for organisational contexts.

Findings

The findings show how metaphorical language is used to explain the interactions between policy reform and organisational contexts. Metaphors are used to illustrate both the challenges and opportunities associated with the reform proposals for organisational change.

Originality/value

The authors provide the first systematic study of patterns and meanings of metaphors within English healthcare contexts and beyond. The authors argue that these metaphors provide important examples of “generative” dialogue in their illustration of the opportunities associated with reform. Conversely, these metaphors also provide examples of “degenerative” dialogue in their illustration of a demarcation between the reform policy proposals and existing organisational contexts.

Details

Journal of Health Organization and Management, vol. 30 no. 1
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 18 May 2012

Kelly Hall, Robin Miller and Ross Millar

The purpose of this paper is to examine the motivations behind public sector spin outs, focusing on the Right to Request policy, which enabled NHS staff to set up their…

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844

Abstract

Purpose

The purpose of this paper is to examine the motivations behind public sector spin outs, focusing on the Right to Request policy, which enabled NHS staff to set up their own social enterprises to deliver healthcare services.

Design/methodology/approach

The paper draws on empirical data gathered from 16 in‐depth interviews with individuals who had led a Right to Request proposal.

Findings

Motivations to spin out of the NHS into a social enterprise were often “empathetic” in nature, built around the good of the service for staff and users. Alongside this, some felt “pushed” out of the NHS as a result of government restructuring policy, with social enterprise offering the only hope to survive as an organisation.

Research limitations/implications

The study captures a particular point in time and there may be other perspectives that have not been included.

Social implications

The paper is of use to academics, policy makers and practitioners. It provides an important contribution in thinking about how to motivate public sector staff, especially those from a health profession, to consider spinning out into social enterprises.

Originality/value

The paper is the first to look at the motivations of healthcare spin outs through the Right to Request programme. The findings are related to previous literature on social entrepreneurship within public sector settings.

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Article
Publication date: 18 May 2012

Ross Millar

The purpose of this paper is to reflect on social enterprise as an organisational form in health organisation and management.

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1102

Abstract

Purpose

The purpose of this paper is to reflect on social enterprise as an organisational form in health organisation and management.

Design/methodology/approach

The paper presents a critique of the underlying assumptions associated with social enterprise in the context of English health and social care.

Findings

The rise of social enterprise models of service provision reflects increasingly hybrid organisational forms and functions entering the health and social care market. Whilst at one level this hybridity increases the diversity of service providers promoting innovative and responsive services, the paper argues that further inspection of the assumptions associated with social enterprise reveal an organisational form that is symbolic of isomorphic processes pushing healthcare organisations toward greater levels of homogeneity, based on market‐based standardisation and practices. Social enterprise forms part of isomorphic processes moving healthcare organisation and management towards market “norms”.

Originality/value

In line with the aim of the “New Perspectives section”, the paper aims to present a provocative perspective about developments in health and social care, as a spur to further debate and research in this area.

Details

Journal of Health Organization and Management, vol. 26 no. 2
Type: Research Article
ISSN: 1477-7266

Keywords

Content available
Article
Publication date: 21 June 2011

Helen Dickinson, Ross Millar and Michael West

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572

Abstract

Details

Journal of Health Organization and Management, vol. 25 no. 3
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 17 May 2013

Ross Millar

The purpose of this paper is to present a study of how quality improvement tools and techniques are framed within healthcare settings.

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3980

Abstract

Purpose

The purpose of this paper is to present a study of how quality improvement tools and techniques are framed within healthcare settings.

Design/methodology/approach

The paper employs an interpretive approach to understand how quality improvement tools and techniques are mobilised and legitimated. It does so using a case study of the NHS Modernisation Agency Improvement Leaders' Guides in England.

Findings

Improvement Leaders' Guides were framed within a service improvement approach encouraging the use of quality improvement tools and techniques within healthcare settings. Their use formed part of enacting tools and techniques across different contexts. Whilst this enactment was believed to support the mobilisation of tools and techniques, the experience also illustrated the challenges in distributing such approaches.

Originality/value

The paper provides an important contribution in furthering our understanding of framing the “social act” of quality improvement. Given the ongoing emphasis on quality improvement in health systems and the persistent challenges involved, it also provides important information for healthcare leaders globally in seeking to develop, implement or modify similar tools and distribute leadership within health and social care settings.

Details

Journal of Health Organization and Management, vol. 27 no. 2
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 16 May 2016

Ross Millar, Weiyan Jian, Russell Mannion and Robin Miller

The purpose of this paper is to explore recent healthcare reform in China. Reflecting on the current literature, the viewpoint argues that greater attention should be paid…

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1032

Abstract

Purpose

The purpose of this paper is to explore recent healthcare reform in China. Reflecting on the current literature, the viewpoint argues that greater attention should be paid to healthcare reform in China as a public policy process, particularly one that is built on policy experimentation.

Design/methodology/approach

The viewpoint argues that while recent efforts to understand the impact of reform have brought significant understanding of key issues and processes, such interest tends to focus on pragmatic concerns rather than pose wider theoretical and methodological questions about the nature and pace of reform.

Findings

The authors suggest that the lens of public policy is particular relevant and insightful given what has been documented elsewhere regarding China’s unique policy process characterised by “policy experimentation”. The authors discuss how a policy experiment perspective can provide a useful heuristic for understanding healthcare reform in China.

Originality/value

The viewpoint concludes by outlining possible applications of this approach and looks forward at the emerging research agenda in this area.

Details

Journal of Health Organization and Management, vol. 30 no. 3
Type: Research Article
ISSN: 1477-7266

Keywords

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