organisational change in the public services.ppt
TRANSCRIPT
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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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Organisational #e-roduction
* 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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Organisational #e-roduction
* 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