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Osipovič D, Allen P, Sanderson M, Moran V, Checkland K. The regulation of competition and procurement in the National Health Service 2015-2018: enduring hierarchical control and the limits of juridification. HEALTH ECONOMICS, POLICY, AND LAW 2020; 15:308-324. [PMID: 31488231 PMCID: PMC7525100 DOI: 10.1017/s1744133119000240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 05/03/2019] [Accepted: 06/16/2019] [Indexed: 11/17/2022]
Abstract
Since 1990, market mechanisms have occurred in the predominantly hierarchical National Health Service (NHS). The Health and Social Care Act 2012 led to concerns that market principles had been irrevocably embedded in the NHS and that the regulators would acquire unwarranted power compared with politicians (known as 'juridification'). To assess this concern, we analysed regulatory activity in the period from 2015 to 2018. We explored how economic regulation of the NHS had changed in light of the policy turn back to hierarchy in 2014 and the changes in the legislative framework under Public Contracts Regulations 2015. We found the continuing dominance of hierarchical modes of control was reflected in the relative dominance and behaviour of the sector economic regulator. But there had also been a limited degree of juridification involving the courts. Generally, the regulatory decisions were consistent with the 2014 policy shift away from market principles and with the enduring role of hierarchy in the NHS, but the existing legislative regime did allow the incursion of pro market regulatory decision making, and instances of such decisions were identified.
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Affiliation(s)
- Dorota Osipovič
- Department of Health Services Research and Policy, LSHTM, London, UK
| | - Pauline Allen
- Department of Health Services Research and Policy, LSHTM, London, UK
| | - Marie Sanderson
- Department of Health Services Research and Policy, LSHTM, London, UK
| | - Valerie Moran
- Luxembourg Institute of Socio-Economic Research, Esch-sur-Alzette, Luxembourg
| | - Kath Checkland
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
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Price C, Green W, Suhomlinova O. Twenty-five years of national health IT: exploring strategy, structure, and systems in the English NHS. J Am Med Inform Assoc 2019; 26:188-197. [PMID: 30597001 PMCID: PMC6351974 DOI: 10.1093/jamia/ocy162] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 11/09/2018] [Indexed: 11/14/2022] Open
Abstract
Objective There is global interest in implementing national information systems to support healthcare, and the National Health Service in England (NHS) has a troubled 25-year history in this sphere. Our objective was to chronicle structural reorganizations within the NHS from 1973 to 2017, alongside concurrent national information technology (IT) strategies, as the basis for developing a conceptual model to aid understanding of the organizational factors involved. Materials and Methods We undertook an exploratory, retrospective longitudinal case study by reviewing strategic plans, legislation, and health policy documents, and constructed schemata for evolving structure and strategy. Literature on multi-organizational forms, complexity, national-level health IT implementations, and mega-projects was reviewed to identify factors that mapped to the schemata. Guided by strong structuration theory, these factors were superimposed on a simplified structural schema to create the conceptual model. Results Against a background of frequent NHS reorganizations, there has been a logical and emergent NHS IT strategy focusing progressively on technical and data standards, connectivity, applications, and consolidation. The NHS has a complex and hierarchical multi-organization form in which restructuring may impact a range of intra- and inter-organizational factors. Discussion NHS-wide IT programs have generally failed to meet expectations, though evaluations have usually overlooked longer-term progress. Realizing a long-term health IT strategy may be impeded by volatility of the implementation environment as organizational structures and relationships change. Key factors influencing the strategy-structure dyad can be superimposed on the tiered NHS structure to facilitate analysis of their impact. Conclusion Alignment between incremental health IT strategy and dynamic structure is an under-researched area. Lessons from organizational studies and the management of mega-projects may help in understanding some of the ongoing challenges.
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Affiliation(s)
- Colin Price
- Management and Organisation Division, University of Leicester, School of Business, University Road, Leicester LE1 7RH, UK
| | - William Green
- Innovation, Technology and Operations Division, University of Leicester, School of Business, University Road, Leicester LE1 7RH, UK
| | - Olga Suhomlinova
- Management and Organisation Division, University of Leicester, School of Business, University Road, Leicester LE1 7RH, UK
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3
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Sanderson J, Lonsdale C, Mannion R. What's Needed to Develop Strategic Purchasing in Healthcare? Policy Lessons from a Realist Review. Int J Health Policy Manag 2019; 8:4-17. [PMID: 30709098 PMCID: PMC6358649 DOI: 10.15171/ijhpm.2018.93] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 09/11/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In the context of serious concerns over the affordability of healthcare, various authors and international policy bodies advise that strategic purchasing is a key means of improving health system performance. Such advice is typically informed by theories from the economics of organization (EOO). This paper proposes that these theories are insufficient for a full understanding of strategic purchasing in healthcare, because they focus on safeguarding against poor performance and ignore the coordination and adaptation needed to improve performance. We suggest that insights from other, complementary theories are needed. METHODS A realist review method was adopted involving 3 steps: first, drawing upon complementary theories from the EOO and inter-organizational relationships (IOR) perspectives, a theoretical interpretation framework was developed to guide the review; second, a purposive search of scholarly databases to find relevant literature addressing healthcare purchasing; and third, qualitative analysis of the selected texts and thematic synthesis of the results focusing on lessons relevant to 3 key policy objectives taken from the international health policy literature. Texts were included if they provided relevant empirical data and met specified standards of rigour and robustness. RESULTS A total of 58 texts were included in the final analysis. Lessons for patient empowerment included: the need for clearly defined rights for patients and responsibilities for purchasers, and for these to be enacted through regular patientpurchaser interaction. Lessons for government stewardship included: the need for health strategy to contain specific targets to incentivise purchasers to align with national policy objectives, and for national government actors to build close, trusting relationships with purchasers to facilitate access to local knowledge about needs and priorities. Lessons for provider performance included: provider decision autonomy may drive innovation and efficient resource use, but may also create scope for opportunism, and interdependence likely to be the best power structure to incentivise collaboration needed to drive performance improvement. CONCLUSION Using complementary theories suggests a range of general policy lessons for strategic purchasing in healthcare, but further empirical work is needed to explore how far these lessons are a practically useful guide to policy in a variety of healthcare systems, country settings and purchasing process phases.
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Affiliation(s)
- Joe Sanderson
- Birmingham Business School, University of Birmingham, Birmingham, UK
| | - Chris Lonsdale
- Birmingham Business School, University of Birmingham, Birmingham, UK
| | - Russell Mannion
- Health Services Management Centre, University of Birmingham, Birmingham, UK
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Ryynänen SP, Harisalo R. A strategic and good governance perspective on handling patient complaints. Int J Health Care Qual Assur 2018; 31:923-934. [DOI: 10.1108/ijhcqa-11-2016-0168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The patient complaint is one of the main procedures of exercising patient’s rights in the Finnish health care system. Such complaints typically concern the quality of care and/or patient safety. The purpose of this paper is to examine the types of patient complaints received by a specialized medical care organization and the kinds of responses given by the organization’s personnel. The organization’s strategy and good governance principles provide the framework for understanding the organization’s action.
Design/methodology/approach
This study’s data comprise patient complaints and the responses from personnel of a specialized medical care organization from the start of 2012 to the end of January 2014. The data were analyzed through qualitative data analysis.
Findings
The results show many unwanted grievances, but also reveal the procedures employed to improve health care processes. The results are related to patients’ care experiences, provision of information, personnel’s professional skills and the approach to patient complaints handling. The integrative result of the analysis was to find consensus between the patients’ expectations and personnel’s evaluation of patients’ needs.
Originality/value
Few prior studies have examined patient complaints related to both strategy and good governance. Patient complaints were found to have several confluences with an organization’s strategic goals, objectives and good governance principles. The study recommends further research on personnel procedures for patient complaints handling, with a view to influencing strategic planning and implementation of strategies of organizations.
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Altuwaijri EA, Budgen D, Maxwell S. Factors impeding the effective utilisation of an electronic patient report form during handover from an ambulance to an emergency department. Health Informatics J 2018; 25:1705-1721. [DOI: 10.1177/1460458218797984] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We investigated the reasons why the transition from paper to electronically formatted records during patient handover between ambulance crews and emergency department staff in a North East England Emergency Department has not always been viewed positively. Interviews with seven paramedics and three emergency department staff were conducted in addition to observations of 74 ambulance staff during 37 handovers in the emergency department. In just over half of the handovers (20), paramedics found it necessary to provide written information to aid emergency department staff, in addition to that recorded electronically. There were a number of issues that impeded the ready utilisation of electronic records in this context. The major factors identified as contributing to this were the choice of system architecture, the design of user interfaces, and the procurement process used by the National Health Service. We have made some suggestions about how the system could evolve from one focused on providing management information to one that also supports operational needs.
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Horrocks S, Pollard K, Duncan L, Petsoulas C, Gibbard E, Cook J, McDonald R, Wye L, Allen P, Husband P, Harland L, Cameron A, Salisbury C. Measuring quality in community nursing: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
High-quality nursing care is crucial for patients with complex conditions and comorbidities living at home, but such care is largely invisible to health planners and managers. Nursing care quality in acute settings is typically measured using a range of different quality measures; however, little is known about how service quality is measured in community nursing.
Objective
To establish which quality indicators (QIs) are selected for community nursing; how these are selected and applied; and their usefulness to service users (patients and/or carers), commissioners and provider staff.
Design
A mixed-methods study comprising three phases. (1) A national survey was undertaken of ‘Commissioning for Quality and Innovation’ indicators applied to community nursing care in 2014/15. The data were analysed descriptively using IBM SPSS Statistics 20.0 (IBM Corporation, Armonk, NY, USA). (2) An in-depth case study was conducted in five sites. Qualitative data were collected through observations, interviews, focus groups and documents. A thematic analysis was conducted using QSR NVivo 10 (QSR International, Warrington, UK). The findings from the first two phases were synthesised using a theoretical framework to examine how local and distal contexts affecting care provision impacted on the selection and application of QIs for community nursing. (3) Validity testing the findings and associated draft good practice guidance through a series of stakeholder engagement events held in venues across England.
Setting
The national survey was conducted by telephone and e-mail. Each case study site comprised a Clinical Commissioning Group (CCG) and its associated provider of community nursing services.
Participants
Survey – 145 (68.7%) CCGs across England.
Case study
NHS England national and regional quality leads (n = 5), commissioners (n = 19), provider managers (n = 32), registered community nurses (n = 45); and adult patients (n = 14) receiving care in their own homes and/or carers (n = 7).
Findings
A wide range of indicators was used nationally, with a major focus on organisational processes. Lack of nurse and service user involvement in indicator selection processes had a negative impact on their application and perceived usefulness. Indicator data collection was hampered by problematic information technology (IT) software and connectivity and interorganisational system incompatibility. Front-line staff considered indicators designed for acute settings inappropriate for use in community settings. Indicators did not reflect aspects of care, such as time spent, kindness and respect, that were highly valued by front-line staff and service user participants. Workshop delegates (commissioners, provider managers, front-line staff and service users, n = 242) endorsed the findings and drafted good practice guidance.
Limitations
Ongoing service reorganisation during the study period affected access to participants in some sites. The limited available data precluded an in-depth documentary analysis.
Conclusions
The current QIs for community nursing are of limited use. Indicators will be enhanced by involving service users and front-line staff in identification of suitable measures. Resolution of connectivity and compatibility challenges should assist implementation of new IT packages into practice. Modifications are likely to be required to ensure that indicators developed for acute settings are suitable for community. A mix of qualitative and quantitative methods will better represent community nursing service quality.
Future work
Future research should investigate the appropriate modifications and associated costs of administering QI schemes in integrated care settings.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Sue Horrocks
- Department of Nursing and Midwifery, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Katherine Pollard
- Department of Nursing and Midwifery, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Lorna Duncan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Christina Petsoulas
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Emma Gibbard
- Research Impact Manager, University of Bath, Bath, UK
| | - Jane Cook
- South West Clinical Research Network, Bristol, UK
| | - Ruth McDonald
- Centre for Primary Care and the Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Lesley Wye
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Pauline Allen
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Pete Husband
- Service user, University of the West of England, Bristol, UK
| | - Lizanne Harland
- NHS Gloucestershire Clinical Commissioning Group, Gloucester, UK
| | - Ailsa Cameron
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Chris Salisbury
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Verzulli R, Fiorentini G, Lippi Bruni M, Ugolini C. Price Changes in Regulated Healthcare Markets: Do Public Hospitals Respond and How? HEALTH ECONOMICS 2017; 26:1429-1446. [PMID: 27785849 DOI: 10.1002/hec.3435] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 07/07/2016] [Accepted: 09/08/2016] [Indexed: 05/27/2023]
Abstract
This paper examines the behaviour of public hospitals in response to the average payment incentives created by price changes for patients classified in different diagnosis-related groups (DRGs). Using panel data on public hospitals located within the Italian region of Emilia-Romagna, we test whether a 1-year increase in DRG prices induced public hospitals to increase their volume of activity and whether a potential response is associated with changes in waiting times and/or length of stay. We find that public hospitals reacted to the policy change by increasing the number of patients with surgical treatments. This effect was smaller in the 2 years after the policy change than in later years, and for providers with a lower excess capacity in the pre-policy period, whereas it did not vary significantly across hospitals according to their degree of financial and administrative autonomy. For patients with medical DRGs, instead, there appeared to be no effect on inpatient volumes. Our estimates also suggest that an increase in DRG prices had no impact on the proportion of patients waiting more than 6 months. Finally, we find no evidence of a significant effect on patients' average length of stay. Copyright © 2016 John Wiley & Sons, Ltd.
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8
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Ferlie E, Baeza JI, Addicott R, Mistry R. The governance of pluralist health care systems: An initial review and typology. Health Serv Manage Res 2017; 30:61-71. [PMID: 28539082 DOI: 10.1177/0951484816682395] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We here argue that study of governance systems within increasingly pluralist health care systems needs to be broadened beyond traditionally public sector orientated literature. We develop an initial typology of multiple governance systems within the English health care sector and derive exploratory questions to inform future empirical investigation. We add to existing literature by considering the coexistence of - and possible tensions between - multiple governance systems in a pluralised health and social care system.
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Affiliation(s)
- Ewan Ferlie
- 1 School of Management and Business, King's College London, London, UK
| | - Juan I Baeza
- 1 School of Management and Business, King's College London, London, UK
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9
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Kirkpatrick I, Altanlar A, Veronesi G. Corporatisation and the Emergence of (Under-Managered) Managed Organisations: The Case of English Public Hospitals. ORGANIZATION STUDIES 2017. [DOI: 10.1177/0170840617693273] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An enduring feature of New Public Management in many countries has been the move to create more autonomous, ‘complete’ organisations such as universities, hospitals and social service agencies. Often referred to as ‘corporatisation’, this process is assumed to be leading to the emergence of new organisational forms with dedicated management functions and a greater focus on strategy. However, these assumptions remain largely untested and rely heavily on ‘technical’ accounts of organisational re-structuring, ignoring the potential influence of institutional pressures and internal political dynamics. In this paper, we address this concern focusing on the case of acute care public hospitals that have undergone corporatisation (to become Foundation Trusts) in the English National Health Service. Using administrative data spanning six years (2007–2012), the analysis shows that corporatisation is having mixed effects. While it is associated with a shift in the focus of managers to strategic concerns, it has not led to an expansion of management functions overall. Both tendencies are found to be mediated by institutional pressures, in the form of media scrutiny, and, indirectly, by the involvement of clinical professions in management. These results advance ongoing debates about the emergence of new organisational forms in the public sector, highlighting the limitations of technical accounts of change and raising the possibility that corporatisation is leading to organisations that are both more managed and under-managered at the same time.
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10
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Allen P, Osipovič D, Shepherd E, Coleman A, Perkins N, Garnett E, Williams L. Commissioning through competition and cooperation in the English NHS under the Health and Social Care Act 2012: evidence from a qualitative study of four clinical commissioning groups. BMJ Open 2017; 7:e011745. [PMID: 28183806 PMCID: PMC5306513 DOI: 10.1136/bmjopen-2016-011745] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 11/28/2016] [Accepted: 12/01/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The Health and Social Care Act 2012 ('HSCA 2012') introduced a new, statutory, form of regulation of competition into the National Health Service (NHS), while at the same time recognising that cooperation was necessary. NHS England's policy document, The Five Year Forward View ('5YFV') of 2014 placed less emphasis on competition without altering the legislation. We explored how commissioners and providers understand the complex regulatory framework, and how they behave in relation to competition and cooperation. DESIGN We carried out detailed case studies in four clinical commissioning groups, using interviews and documentary analysis to explore the commissioners' and providers' understanding and experience of competition and cooperation. SETTING/PARTICIPANTS We conducted 42 interviews with senior managers in commissioning organisations and senior managers in NHS and independent provider organisations (acute and community services). RESULTS Neither commissioners nor providers fully understand the regulatory regime in respect of competition in the NHS, and have not found that the regulatory authorities have provided adequate guidance. Despite the HSCA 2012 promoting competition, commissioners chose mainly to use collaborative strategies to effect major service reconfigurations, which is endorsed as a suitable approach by providers. Nevertheless, commissioners are using competitive tendering in respect of more peripheral services in order to improve quality of care and value for money. CONCLUSIONS Commissioners regard the use of competition and cooperation as appropriate in the NHS currently, although collaborative strategies appear more helpful in respect of large-scale changes. However, the current regulatory framework contained in the HSCA 2012, particularly since the publication of the 5YFV, is not clear. Better guidance should be issued by the regulatory authorities.
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Affiliation(s)
- Pauline Allen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Dorota Osipovič
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Elizabeth Shepherd
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Anna Coleman
- Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
| | - Neil Perkins
- Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
| | - Emma Garnett
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Lorraine Williams
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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11
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Sheaff R, Endacott R, Jones R, Woodward V. Interaction between non-executive and executive directors in English National Health Service trust boards: an observational study. BMC Health Serv Res 2015; 15:470. [PMID: 26471938 PMCID: PMC4608305 DOI: 10.1186/s12913-015-1127-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 09/30/2015] [Indexed: 11/21/2022] Open
Abstract
Background National Health Service (NHS) trusts, which provide the majority of hospital and community health services to the English NHS, are increasingly adopting a ‘public firm’ model with a board consisting of executive directors who are trust employees and external non-executives chosen for their experience in a range of areas such as finance, health care and management. In this paper we compare the non-executive directors’ roles and interests in, and contributions to, NHS trust boards’ governance activities with those of executive directors; and examine non-executive directors’ approach to their role in board meetings. Methods Non-participant observations of three successive trust board meetings in eight NHS trusts (primary care trusts, foundation trusts and self-governing (non-foundation) trusts) in England in 2008–9. The observational data were analysed inductively to yield categories of behaviour reflecting the perlocutionary types of intervention which non-executive directors made in trust meetings. Results The observational data revealed six main perlocutionary types of questioning tactic used by non-executive directors to executive directors: supportive; lesson-seeking; diagnostic; options assessment; strategy seeking; and requesting further work. Non-executive board members’ behaviours in holding the executive team to account at board meetings were variable. Non-executive directors were likely to contribute to finance-related discussions which suggests that they did see financial challenge as a key component of their role. Conclusions The pattern of behaviours was more indicative of an active, strategic approach to governance than of passive monitoring or ‘rubber-stamping’. Nevertheless, additional means of maintaining public accountability of NHS trusts may also be required.
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Affiliation(s)
- Rod Sheaff
- School of Government, Plymouth University, Portland Villas, Drake Circus, Plymouth, PL4 8AA, UK.
| | - Ruth Endacott
- School of Nursing & Midwifery, Plymouth University, Portland Villas, Drake Circus, Plymouth, PL4 8AA, UK. .,School of Nursing & Midwifery, Monash University, Melbourne, Australia.
| | - Ray Jones
- School of Nursing & Midwifery, Plymouth University, Portland Villas, Drake Circus, Plymouth, PL4 8AA, UK.
| | - Val Woodward
- School of Nursing & Midwifery, Plymouth University, Portland Villas, Drake Circus, Plymouth, PL4 8AA, UK.
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12
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Herrero Tabanera L, Martín Martín JJ, López del Amo González MDP. Eficiencia técnica de los hospitales públicos y de las empresas públicas hospitalarias de Andalucía. GACETA SANITARIA 2015; 29:274-81. [PMID: 25869155 DOI: 10.1016/j.gaceta.2015.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 02/28/2015] [Accepted: 03/02/2015] [Indexed: 11/15/2022]
Affiliation(s)
| | - José Jesús Martín Martín
- Economía Aplicada, Facultad de Ciencias Económicas y Empresariales, Universidad de Granada, Granada, España.
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13
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Sanderson J, Lonsdale C, Mannion R, Matharu T. Towards a framework for enhancing procurement and supply chain management practice in the NHS: lessons for managers and clinicians from a synthesis of the theoretical and empirical literature. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03180] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundThis review provides intelligence to NHS managers and clinicians involved in commissioning and procurement of non-pay goods and services. It does this in the light of ongoing pressure for the NHS to save money through a combination of cost cutting, productivity improvements and innovation in service delivery, and in the context of new commissioning structures developing as a result of the Health and Social Care Act 2012 (Great Britain.Health and Social Care Act 2012. Chapter 7. London: The Stationery Office; 2012).ObjectivesWe explore the main strands of the literature about procurement and supply chain management (P&SCM); consider the extent to which existing evidence on the experiences of NHS managers and clinicians involved in commissioning and procurement matches these theories; assess how the empirical evidence about different P&SCM practices and techniques in different countries and sectors might contribute to better commissioning and procurement; and map and evaluate different approaches to improving P&SCM practice.Review methodWe use a realist review method, which emphasises the contingent nature of evidence and addresses questions about what works in which settings, for whom, in what circumstances and why. Adopting realist review principles, the research questions and emerging findings were sense-checked and refined with an advisory group of 16 people. An initial key term search was conducted in October 2013 across relevant electronic bibliographic databases. To ensure quality, the bulk of the search focused on peer-reviewed journals, though this criterion was relaxed where appropriate to capture NHS-related evidence. After a number of stages of sifting, quality checking and updating, 879 texts were identified for full review.ResultsFour literatures were identified: organisational buying behaviour; economics of contracting; networks and interorganisational relationships; and integrated supply chain management (SCM). Theories were clustered by their primary explanatory focus on a particular phase in the P&SCM process. Evidence on NHS commissioning and procurement practice was found in terms of each of these phases, although there were also knowledge gaps relating to decision-making roles, processes and criteria at work in commissioning organisations; the impact of power on collaborative interorganisational relationships over time; and the scope to apply integrated SCM thinking and techniques to supply chains delivering physical goods to the NHS. Evidence on P&SCM practices and techniques beyond the NHS was found to be highly fragmented and at times contradictory but, overall, demonstrated that matching management practice appropriately with context is crucial.ConclusionsWe found that the P&SCM process involves multiple contexts, phases and actors. There are also a wide variety of practices that can be used in each phase of the P&SCM process. Thinking about how practice might be improved in the NHS requires an approach that enables the simplification of the complex interplay of factors in the P&SCM process. Portfolio-based approaches, which provide a contingent approach to considering these factors, are recommended. Future work should focus on conflicting preferences in NHS commissioning and procurement and the role of power and politics in conflict resolution; the impact of power on the scope for collaboration in health-care networks; and the scope to apply integrated SCM practices in NHS procurement organisations.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Joe Sanderson
- Birmingham Business School, University of Birmingham, Birmingham, UK
| | - Chris Lonsdale
- Birmingham Business School, University of Birmingham, Birmingham, UK
| | - Russell Mannion
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Tatum Matharu
- Birmingham Business School, University of Birmingham, Birmingham, UK
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14
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Stewart EA, Greer SL, Wilson I, Donnelly PD. Power to the people? An international review of the democratizing effects of direct elections to healthcare organizations. Int J Health Plann Manage 2015; 31:e69-85. [DOI: 10.1002/hpm.2282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 11/28/2014] [Accepted: 12/03/2014] [Indexed: 11/08/2022] Open
Affiliation(s)
- Ellen A. Stewart
- Centre for Population Health Sciences; University of Edinburgh; Edinburgh UK
| | - Scott L. Greer
- School of Public Health; University of Michigan; Michigan USA
| | - Iain Wilson
- Politics and International Relations; University of Edinburgh; Edinburgh UK
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Abstract
This article reviews large-scale digital developments in the National Health Service in England in recent years and argues that there is a mismatch between digital and organisational thinking and practice. The arguments are based on new institutional thinking, where the digital infrastructure is taken to be an institution, which has been shaped over a long period, and which in turn shapes the behaviour of health professionals, managers and others. Many digital services are still being designed in line with a bureaucratic data processing model. Yet health services are increasingly based on a network model, where health professionals and service managers require information systems that allow them to manage risks proactively and to coordinate multiple services on behalf of patients. This article further argues that the data processing model is being reinforced by Open Data policies and by related developments in the acquisition of genomic and telehealth data, suggesting that the mismatch will persist. There is, therefore, an ongoing tension between frontline and central objectives for digital services. It may be that the tension can only be resolved when--or if--there is trust between the interested parties.
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Santos MABD, Madeira FC, Passos SRL, Bakr F, Oliveira KBD, Andreazzi MARD. [Autonomy for financial management in public and private healthcare facilities in Brazil]. CAD SAUDE PUBLICA 2014; 30:201-6. [PMID: 24627026 DOI: 10.1590/0102-311x00049413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 09/27/2013] [Indexed: 11/22/2022] Open
Abstract
Autonomy in financial management is an advantage in public administration. A 2009 National Healthcare Facility Survey showed that 3.9% of Brazil's 52,055 public healthcare facilities had some degree of financial autonomy. Such autonomy was more common in inpatient facilities (17.8%), those managed by State governments (26.3%), and in Southern Brazil (6.6%). Autonomy was mainly partial (for resources in specific areas, relating to small outlays, consumables and capital goods, and outsourced services or personnel). 74.3% of 2,264 public facilities with any financial autonomy were under direct government administration. Financial autonomy in public healthcare facilities appears to be linked to local political decisions and not necessarily to the facility's specific legal and administrative status. However, legal status displays distinct scopes of autonomy - those under direct government administration tend to be less autonomous, and those under private businesses more autonomous; 85.8% of the 45,394 private healthcare facilities reported that they were financially autonomous.
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Ovseiko PV, Heitmueller A, Allen P, Davies SM, Wells G, Ford GA, Darzi A, Buchan AM. Improving accountability through alignment: the role of academic health science centres and networks in England. BMC Health Serv Res 2014; 14:24. [PMID: 24438592 PMCID: PMC3909383 DOI: 10.1186/1472-6963-14-24] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 01/17/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND As in many countries around the world, there are high expectations on academic health science centres and networks in England to provide high-quality care, innovative research, and world-class education, while also supporting wealth creation and economic growth. Meeting these expectations increasingly depends on partnership working between university medical schools and teaching hospitals, as well as other healthcare providers. However, academic-clinical relationships in England are still characterised by the "unlinked partners" model, whereby universities and their partner teaching hospitals are neither fiscally nor structurally linked, creating bifurcating accountabilities to various government and public agencies. DISCUSSION This article focuses on accountability relationships in universities and teaching hospitals, as well as other healthcare providers that form core constituent parts of academic health science centres and networks. The authors analyse accountability for the tripartite mission of patient care, research, and education, using a four-fold typology of accountability relationships, which distinguishes between hierarchical (bureaucratic) accountability, legal accountability, professional accountability, and political accountability. Examples from North West London suggest that a number of mechanisms can be used to improve accountability for the tripartite mission through alignment, but that the simple creation of academic health science centres and networks is probably not sufficient. SUMMARY At the heart of the challenge for academic health science centres and networks is the separation of accountabilities for patient care, research, and education in different government departments. Given that a fundamental top-down system redesign is now extremely unlikely, local academic and clinical leaders face the challenge of aligning their institutions as a matter of priority in order to improve accountability for the tripartite mission from the bottom up. It remains to be seen which alignment mechanisms are most effective, and whether they are strong enough to counter the separation of accountabilities for the tripartite mission at the national level, the on-going structural fragmentation of the health system in England, and the unprecedented financial challenges that it faces. Future research should focus on determining the comparative effectiveness of different alignment mechanisms, developing standardised metrics and key performance indicators, evaluating and assessing academic health science centres and networks, and empirically addressing leadership issues.
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Affiliation(s)
- Pavel V Ovseiko
- Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | | | - Pauline Allen
- London School of Hygiene and Tropical Medicine, London, UK
| | - Stephen M Davies
- London School of Hygiene and Tropical Medicine, London, UK
- Addenbrooke’s Charitable Trust, Cambridge, UK
| | - Glenn Wells
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - Gary A Ford
- Oxford University Hospitals NHS Trust, Oxford, UK
- Oxford Academic Health Science Network, Oxford, UK
- University of Oxford, Oxford, UK
| | - Ara Darzi
- Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Alastair M Buchan
- Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
- Oxford University Hospitals NHS Trust, Oxford, UK
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Klein R. The twenty-year war over England's National Health Service: a report from the battlefield. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2013; 38:849-869. [PMID: 23645869 DOI: 10.1215/03616878-2210503] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This article analyzes the latest battle in the twenty-year war to change England's National Health Service (NHS), starting with the internal market reforms introduced by the Thatcher government and now carried one step farther by David Cameron's coalition government. The government's program of change is characterized by (1) its wide scope and the organizational upheavals involved and (2) the fact that it is being introduced at a time when the NHS faces unprecedented fiscal pressures. The legislation faced strong political, public, and professional hostility both from those who saw it as a crime against the founding principles of the NHS and from those who saw it as a disruptive blunder that created more problems than it solved. This article asks three questions. Why did the coalition government embark on a policy course guaranteed to lose it votes? How will the much-amended legislation work out in practice: what are the risks and uncertainties? What will be the program's impact: will it, like previous waves of change, disappoint both the prophets of doom and the visionaries of transformation? The conclusion drawn is that the essential, defining characteristics of the NHS are not under threat. It continues to be a publicly funded service, freely available to all. It is not being privatized. But it is moving toward the kind of pluralistic system that would have been established by Britain's last, wartime coalition government, had not Aneurin Bevan nationalized the hospital service in 1948.
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Allen P, Cao Q, Wang H. Public hospital autonomy in China in an international context. Int J Health Plann Manage 2013; 29:141-59. [DOI: 10.1002/hpm.2200] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 02/11/2013] [Accepted: 05/14/2013] [Indexed: 11/06/2022] Open
Affiliation(s)
- Pauline Allen
- Health Services Research and Policy; London School of Hygiene and Tropical Medicine; London UK
| | - Qi Cao
- Health Reform and Development Center, School of Public Administration and Policy; Renmin University of China; Beijing China
| | - Hufeng Wang
- Health Reform and Development Center, School of Public Administration and Policy; Renmin University of China; Beijing China
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Ocloo J, O'Shea A, Fulop N. Empowerment or rhetoric? Investigating the role of NHS Foundation Trust governors in the governance of patient safety. Health Policy 2013; 111:301-10. [PMID: 23764151 DOI: 10.1016/j.healthpol.2013.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 04/29/2013] [Accepted: 05/13/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Involving patients and the public in patient safety is seen as central to health reform internationally. In England, NHS Foundation Trusts are seen as one way to achieve inclusive governance by involving local communities. We analysed these arrangements by studying lay governor involvement in the formal governance structures to improve patient safety. METHODS Interviews with key informants, observations of meetings and documentary analysis were conducted at a case study site. A national survey was conducted with all acute Foundation Trusts (n=90), with a response rate of 40% (n=36). Follow up telephone interviews were conducted with seven of these. RESULTS The case-study revealed a complex governance context for patient safety involving board, safety and various sub-committees. Governors were mainly not involved in these formal mechanisms, with participation being seen to pose a conflict of interest with the governors' role. Findings from the survey showed some involvement of governors in the governance of patient safety. CONCLUSIONS This study revealed a lack of inclusivity by Foundation Trusts of lay governors in patient safety governance. It suggests action is needed to empower governors to undertake their statutory duties more effectively and particularly through clarification of their role and the provision of targeted training and support to facilitate their involvement in the governance of patient safety.
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Affiliation(s)
- Josephine Ocloo
- The King's Fund, Policy Department, 11-13 Cavendish Square, London, W1G 0AN, UK.
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Abstract
BACKGROUND Over the past three decades, a limited range of market like mechanisms have been introduced into the hierarchically structured English National Health Service ('NHS'), which is a nationally tax funded, budget limited healthcare system, with access to care for all, producing structures known as a quasi market. Recently, the Health and Social Care Act 2012 ('HSCA') has been enacted, introducing further market elements. The paper examines the theory and effects of these market mechanisms. METHODS Using neo-classical economics as a primary theoretical framework, as well as new institutional economics and socio-legal theory, the paper first examines the fundamental elements of markets, comparing these with the operation of authority and resource allocation employed in hierarchical structures. Second, the paper examines the application of market concepts to the delivery of healthcare, drawing out the problems which economic and socio-legal theories predict are likely to be encountered. Third, the paper discusses the research evidence concerning the operation of the quasi market in the English NHS. This evidence is provided by research conducted in the UK which uses economic and socio-legal logic to investigate the operation of the economic aspects of the NHS quasi market. Fourth, the paper provides an analysis of the salient elements of the quasi market regime amended by the HSCA 2012. RESULTS It is not possible to construct a market conforming to classical economic principles in respect of healthcare. Moreover, it is not desirable to do so, as goals which markets cannot deliver (such as fairness of access) are crucial in England. Most of the evidence shows that the quasi market mechanisms used in the English NHS do not appear to be effective either. This finding should be seen in the light of the fact that the operation of these mechanisms has been significantly affected by the national political (i.e. continuingly hierarchical) and budgetary context in which they are operating. CONCLUSION The organisational structures of a hierarchy are more appropriate for the delivery of healthcare in the English NHS.
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Affiliation(s)
- Pauline Allen
- London School of Hygiene and Tropical Medicine, London, UK.
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Jones L, Exworthy M, Frosini F. Implementing market-based reforms in the English NHS: bureaucratic coping strategies and social embeddedness. Health Policy 2013; 111:52-9. [PMID: 23601569 DOI: 10.1016/j.healthpol.2013.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 03/13/2013] [Accepted: 03/18/2013] [Indexed: 10/27/2022]
Abstract
This paper reports findings from an ethnographic study that explored how market-based policies were implemented in one local health economy in England. We identified a number of coping strategies employed by local agents in response to multiple, rapidly changing and often contradictory central policies. These included prioritising the most pressing concern, relabelling existing initiatives as new policy and using new policies as a lever to realise local objectives. These coping strategies diluted the impact of market-based reforms. The impact of market-based policies was also tempered by the persistence of local social relationships in the form of 'sticky' referral patterns and agreements between organisations not to compete. Where national market-based policies disrupted local relationships they produced unintended consequences by creating an adversarial environment that prevented collaboration.
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Affiliation(s)
- Lorelei Jones
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
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