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Healthcare regulation is one means to address quality challenges in healthcare systems and is carried out using compliance, deterrence and/or improvement approaches. The four countries of the UK provide an opportunity to explore and compare different regulatory architecture and models. The purpose of this paper is to understand emerging regulatory models and associated tensions.

This paper uses qualitative methods to compare the regulatory architecture and models. Data were collected from documents, including board papers, inspection guidelines and from 48 interviewees representing a cross-section of roles from six organisational regulatory agencies. The data were analysed thematically using an a priori coding framework developed from the literature.

The findings show that regulatory agencies in the four countries of the UK have different approaches and methods of delivering their missions. This study finds that new hybrid regulatory models are developing which use improvement support interventions in parallel with deterrence and compliance approaches. The analysis highlights that effective regulatory oversight of quality is contingent on the ability of regulatory agencies to balance their requirements to assure and improve care. Nevertheless, they face common tensions in sustaining the balance in their requirements connected to their roles, relationships and resources.

The paper shows through its comparison of UK regulatory agencies that the development and implementation of hybrid models is complex. The paper contributes to research by identifying three tensions related to hybrid regulatory models; roles, resources and relationships which need to be managed to sustain hybrid regulatory models.

Organisations within healthcare increasingly operate in rapidly changing environments and present wide variation in performance. It can be argued that this variation is influenced by the capability of an organisation to improve: its improvement capability. However, there is little theoretical research on improvement capability. The purpose of this paper is to set out the current diverse body of research on improvement capability and develop a theoretically informed conceptual framework.

This paper conceptualises improvement capability as a dynamic capability. This suggests that improvement capability is comprised of organisational routines that are bundled together, and adapt and react to organisational circumstances. Existing research conceptualises these bundles as three elements (microfoundations): sensing, seizing and reconfiguring. This conceptualisation is used to explore how improvement capability can be understood, by inductively categorising eight dimensions of improvement capability to develop a theoretically informed conceptual framework.

This paper shows that the three microfoundations which make up a dynamic capability are present in the identified improvement capability dimensions. This theoretically based conceptual framework provides a rich explanation of how improvement capability can be configured.

Identifying the component parts of improvement capability helps to explain why some organisations are less successful in improvement than others. This theoretically informed framework can support managers and policy makers to identify improvement capability dimensions in need of development. Further empirical research, particularly in non-market settings, such as publicly funded healthcare is required to enhance understanding of improvement capability and its configuration.

Principal-agent theory (PAT) has been used to understand relationships among different professional groups and explain performance management between organisations, but is rarely used for research within primary care. The purpose of this paper is to explore whether PAT can be used to attain a better understanding of performance management in primary care.

Purposive sampling was used to identify a range of general practices in the North-west of England. Interviews were carried out with directors, managers and clinicians in commissioning and regional performance management organisations and within general practices, and the data analysed using matrix analysis techniques to produce a case study of performance management.

There are various elements of the principal-agent framework that can be applied in primary care. Goal alignment is relevant, but can only be achieved through clear, strategic direction and consistent interpretation of objectives at all levels. There is confusion between performance measurement and performance management and a tendency to focus on things that are easy to measure whilst omitting aspects of care that are more difficult to capture. Appropriate use of incentives, good communication, clinical engagement, ownership and trust affect the degree to which information asymmetry is overcome and goal alignment achieved. Achieving the right balance between accountability and clinical autonomy is important to ensure governance and financial balance without stifling innovation.

The principal-agent theoretical framework can be used to attain a better understanding of performance management in primary care; although it is likely that only partial goal alignment will be achieved, dependent on the extent and level of alignment of a range of factors.

Over the past decade, the establishment and growth of quality awards has stimulated organizational self‐assessment using the award models. Four new methods developed from fieldwork in the UK can be used not only to support the gathering of data required by the models, but also in stand‐alone mode to assist managers to identify and recognize the symptoms, root causes and issues that are adversely affecting their improvement process in the areas of sustainability, tools and techniques, human resources and product design and development.

Describes the combination of research methods used to investigate the process of Information Management (IM) in small firms. IM was defined as encompassing all management issues related to Information Systems (IS) and involving processes relating to planning, organization, control and technology.A large body of literature details the issues associated with IM in large organizations, assisting the understanding of the processes involved in this organizational context. This is not the case for small firms. Due to the different situational context of small firms, it is essential that the issues associated with IM be made explicit. Argues that a “between‐methods” triangulated approach is most suitable for researching IM in small firms, enabling cross‐validation of data yielded by different methods. The research approach was inductive, making use of a combination of quantitative and qualitative methods. A mailed questionnaire study was conducted to identify macro level phenomena which were investigated at a later stage by developing case studies of four companies which had participated in the questionnaire study. This second phase of the research provided rich data on phenomena which occur at the micro level. The use of multi‐site studies overcame the problems associated with the specificity of single case studies. The findings of the two research strategies were reconciled using Grounded Theory; conclusions were drawn and models generated for use by other researchers.

The development of a method of planning for computer‐integrated manufacture (CIM) used within Eaton Corporation (Truck Components Europe) which produces complex engineering products is described. The method relies heavily on a model of CIM as the basis for planning. Different types of models (the wheel model, linked models and linked and defined models) are described with their usefulness in CIM planning outlined. The development of a CIM model is beneficial for planning and the process of the model's evolution can greatly increase CIM understanding. CIM models help to focus on functions and business objectives rather than being constrained by departmental boundaries, bringing a new dimension to strategic planning.

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.

This paper analyses the role of bed managers and the processes involved in admission, stay, transfer and discharge of patients in the hospital setting. The paper seeks to begin a discussion of the difficulties entailed in the allocation of beds within the context of confined resources. This is achieved by: a review of the somewhat sparse literature on bed management and associated issues; the development of frameworks of analysis with regard to what bed managers do and the information used to support the bed management function; and an explication of results from fieldwork. This is followed by a discussion of the scope of responsibility and career role of the bed manager as well as the potential and problems of bed data. Contacts with others investigating this field and other trusts indicate that the situation in Greater Manchester may be typical of most areas.

This paper seeks to examine the impact of a leadership development programme provided for, and funded by, the NHS.

It analyses the context, process of delivery and outcomes of the programme in the light of relevant leadership research. The programme itself is described after some consideration of the literature. Although the programme was originally commissioned by the NHS Leadership Centre for Human Resource (HR) professionals from the NHS, it is now offered to any aspiring or newly‐appointed director, and aims (amongst other things) to enable NHS staff to manage people more effectively within the context of change.

The paper concludes that the programme has, to date, been successful in impacting on personal and organisational contribution, as far as individual participants, commissioners and providers are concerned, and as far as can be measured within current understanding.

The programme fits well with the most recent typologies of leadership development.

Following research on the subject of TQM, the authors decided that what was lacking was a framework for the introduction and development of the process for continuous quality improvement.