Organisational Change in the Public Services.ppt

8/9/2019 Organisational Change in the Public Services.ppt

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‘Organisational Change in the Public

Services: Does Evidence Inform Policy?’

Professor Ean !erlie

School of "anagement#oyal $olloay %niversity of &ondon

October '(()


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/he Substantive Problem

* Increased -olicy -ressure on -ublic servicemanagers to manage large scale change0

* Investment in management of change tools1"odernisation 2gency30

* 4$S Plan 1'(((3 + radical redesign of the healthservice around the -atient0 rhetoric of radical

change and organisational transformation0* Earlier local e5-eriments in the mid 677(s 14$S

/rusts30


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/he &eicester 8P# E5-eriment

* 4ational 8P# e5-eriment in &eicester#oyal Infirmary 677'96770

* 8ased on $ammer and Cham-y0* Promised ‘big bang change’ in to years

against certain benchmar,s0

* Sub;ected to an e5ternal evaluation0* "anagers there ent on to ta,e on national

leadershi- roles -ost 6770


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Issues in Organisational /heory

* !rom incremental to strategic and noorganisational transformation 1O/30

* Em-irical evidence for O/?* Structuration 1structure as ell as action3

* $o to assess O/?

* If not O/< then hat and hy?

* Im-act of -rogrammatic change strategies such as8P#?

* So some theoretical em-lacement0


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"ethods + Organisational

Process #esearch* &arge scale evaluation funded by the De-t of

$ealth 677=97>0

* ualitative and @uantitative teams0* ' senior researchers on the @ualitative side0

* > Com-arative and longitudinal case studies0

* /he cor-orate centre0

* One Division 1"edicine3

* Si5 clinical settings 12 and E + '0 gynaecology +'0 E4/0 gastro enterology3


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"ethods

* 2rchives

* Observation at meetings 1A(3 1ma;or method3

* Semi structured intervies 16==3* ‘canteen chat’

* Summative rather than formative a--roach toevaluation

* Difficult to move to dee- multi disci-linaryor,ing

* De-t of $ealth # and D ‘held the ring’


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"ethods

* 4ot action research0

* 4ot -artnershi- based research + sub;ects

not co investigators0* DO$ brief as e5-licit about this0

* I obliged to coo-erate as -art of the 4$S

finance0* /hey also elcomed inde-endent

evaluation as a learning source0


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!indings + /he Cor-orate Story

* Pre history u- to 677'0 4$S /rust status0 internal

mar,et0 big environmental -ressures0

* Phase 6: /he genesis of the reengineeringintervention at I< 677'97=

+ Pro;ect Sigma sites 1neurology3

+ &esson draing

+ Contacts ith $ammer

+ !inancial su--ort from 4$S E5ecutive


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Phase '< 2ug 7=9 !eb 7A

* #eengineering diagnostic services and out-atient

clinics0

+ "anagement consultants and internal change agents0 + 8ig bang change in ' years 1mi5 of activity0 cost0

@uality and -rocess indicators and targets3

+ Central reengineering labs0

+ Strategic management a--roach0 + Patient visit and -atient test -rocesses0

+ Some early hits0


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Phase )< ‘the clinical heartlands’

"arch + 2ug 677A* Sitch from se@uential to concurrent redesign0

* E5-ansion of labs and -ro;ects 1about B( at any

one time3* Emergency entry and -atient stay -rocesses0

* Difficult to hold together0

* Increasing evidence of variable im-act0* &ocal managers and -rofessionals0

* /ime scales lengthen0


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Phase =< Oct 7A9"ay 7B

* #eengineering Im-lementation lags the

reengineering vision

* &abs are decentralised to the directorates0* 6(( -ro;ects as of 4ov 677A0

* Some directorates slo and resistant 1eg 2 and E3

* Pro-osals to abolish directorates ere not realised0* CEO ould not confront clinicians0


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Phase B??

* ey managers moved to national level circa

677>0

* /he three &eicester hos-itals merged0

* Directorate structure retained0

* &ong term legacy?


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Phase A< une 7B9"arch 7>

* "ove to a ‘continuous reengineering’model0

* Committee structure dissolved andmanagement consultants -ull out0

* 4e -rocess management arrangements0

* Change of language 1the # ordF3* Some momentum for -rocess redesign

continued0


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Policy Im-lications

* &imits to big bang change0 move bac, to more/" style Collaboratives model0

* Differences beteen -rivate and highly com-le5 -ublic sector organisations0

* &imitations of -rogrammatic change strategies0

* Engagement of clinical -rofessionals0

* Dangers of early hy-e0

* 2&SO a brave and visible e5-eriment hichgenerated national learning0


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Im-lications for Organisation

/heory* Core finding: convergent rather than

transformational change0

* Greenood and $inings’ 677B model of archety-echange: -reci-itating and enabling dynamics0

some e5ogenous and some endogenous0

* 8ut also forces hich act to ensure the

re-roduction of e5isting organisational forms0


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Organisational #e-roduction

* !ailure to generate reformative commitment on a

ide enough scale from ,ey -oer holders0

* &ocal managers< clinicians and nurses eredefensive0

* Defence of -rofessional ;urisdictions0

*Senior management as cautious0

* "ediated through e5isting functional rather than

-rocess based forms 1directorates3


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* Counter intuitive alliances beteen local

clinicians and managers to defend ‘their’

directorates0* ‘reengineering did not mobilise sufficient

dissatisfaction ith e5isting arrangements and

commitment to a ne organising logic to overarch

or re-lace value commitments manifest in thecoe5istence of clinical s-ecialties and directorates’

1-))(3


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* 2n institutionalised order ith:

+ "any interest grou-s and dense organisational

-olitics0 + Poerful -rofessionals0

+ $igh com-le5ity and uncertainty0

+ Embedded values and ideologies0 + ‘the old sha-ed the ne’ 1structuration3


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Sedimented Change /heory

* Original -rofessional bureaucratic archety-e

* 4e vertical managerial archety-e 1677(s3 also

emerged 1including clinical directorates3* 8oth threatened by the -rocess organisation

* %ne5-ected defensive alliance beteen the to0

* /hese sedimented arrangements seem more stable

than -revious literature has suggested0* 2 stable negotiated order rather than a tem-orary

and fragile state?


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/he #esearch Policy Interface

* Does research influence -olicy 1or evenshould it3?

* 4otion of Evidence based Policy0* Cf Great Society -rogrammes in %S2 of the

67B(s 1.eiss30

* Indirect im-act0 enlightenment andutilisation models0 ,noledge cree-0

* 2--reciative communities0


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/he #esearch Policy Interface

1.eiss< '(((3* 2void evaluation im-erialism0

* Study actual uses of evaluation;

* #ecognise that evaluation cannot be

insulated from -olitics0

* "a,e evaluations more valid and

inter-retable0


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.hat ha--ened here?

* Policy shifted in a ay hich asconsistent ith research0

* #esearchers as,ed to -resent at the De-t of$ealth’s Strategy %nit0

* 8P# as not diffused nationally0

* move on to so called Service Collaboratives1more incremental0 high em-hasis onlearning0 strong on clinical involvement3


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Positive factors?

* 2 -olitical rather than a Political decision0

* Strong trac, record of evaluation in the service

redesign area: research had something to say0* I managers no in national -ositions0

* &ong -eriod of face to face contact ith the

research team0* 2n ‘a--reciative community’ or community of

-ractice as emerging?0


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Positive !actors

* Synthetic revies 1‘more cited than read’3

summarised the lessons0

* O%P research monogra-h as a source of

legitimation0

* 2 useful alibi for the limits to O/ in the

4$S Plan?


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4e "anagerial COP?

* 2round the management of change0

* 4e institutions< roles and budgets0

* 4$S "odernisation 2gency0

* Interest in learning and a--lied research0


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Criticisms of the 8oo,

* /oo academic0

* /oo long0

* Summative rather than formative:

* ‘atching -eo-le dron’

* 4o follo u- ith a D com-onent0

* 4O/ the methodology itself0


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#eflections on #esearch Style

* #eformist and !abian in tone0

* 4ot Critical but criticalF

* 8alancing rigour and relevance0* 8alancing distance and engagement0

* S-ea,ing different languages to different

audiences 12S and $S30* /he -leasure of research ith an outard facing

com-onent0 having fun in the -rocess0


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#eferences

* 8artune,< et al 1'(()3 ‘Sharing and

E5-anding 2cademic and Practitioner

noledge in $ealth Care’< > 1S'3< B'9B* In Journal of Health Services Research and

Policy, > Su--lement '< s-ecial issue on

researcher decision ma,er -artnershi-s0


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#eferences

* "c4ulty< / and !erlie< E 1'(('3

+ ‘ Reengineering Health Care: The

Complexities of OrganisationalTransformation’

+ O5ford: O5ford %niversity Press

+ Pa-erbac, in an '((=F + 2lso ‘Organisational Studies’ article a--earing

in '((=0


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#eferences

* .eiss< C$ 1'(((3 ‘/he E5-erimenting

Society in a Political .orld’< in 1Ed3

8ic,man< & ‘Halidity and SocialE5-erimentation’ &ondon: Sage

Organisational Change in the Public Services.ppt

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