reflections on longitudinal action research with the english national health service
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Journal of Purchasing & Supply Management 14 (2008) 136–145
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Notes and Debates
Reflections on longitudinal action research with the English NationalHealth Service
Helen Walkera,�, Christine Harlanda, Louise Knighta, Chris Udenb, Samantha Forrestb,1
aCentre for Research in Strategic Purchasing and Supply, University of Bath School of Management, Claverton Down, Bath BA2 7AY, UKbNHS PASA, Premier House, 60 Caversham Road, Reading RG1 7EB, UK
Received 23 May 2005; received in revised form 28 February 2008; accepted 29 February 2008
Abstract
This paper reflects on a longitudinal collaborative action research programme between the Centre for Research in Strategic Purchasing
and Supply and the UK National Health Service Purchasing and Supply Agency that has operated since 1995. During the collaboration,
research has changed practice and practice has changed research. A framework for analysing change is introduced as a means of
examining how supply strategy has changed during the course of the research. The framework is applied to three supply strategy cases
of prosthetics, clinical waste and cardiology, illustrating how practice and research have changed and influenced the production of
knowledge over time. The methodological, theoretical and managerial implications of such longitudinal action research programmes are
reflected on.
r 2008 Elsevier Ltd. All rights reserved.
Keywords: Supply strategy; Longitudinal; Action; Collaborative; Research
1. Introduction
There is increasing interest in the subject of researchers andpractitioners working together to produce knowledge (Ama-bile et al., 2001; Mohrman et al., 2002). Government policyand organisations such as the Academy of Management(Bazerman, 2005; Rynes et al., 2001) are calling for manage-ment research focused on developing actionable knowledgethat impacts practice and makes a difference to nationalcompetitiveness and the quality of public services. The view isthat management research will be strengthened by effectivecollaboration between researchers and practicing managers.
This paper gives an account of an ongoing actionresearch programme that has operated since 1995. The aimis to reflect on the implications of this long-term researchcollaboration in terms of theory, practice and methodol-
e front matter r 2008 Elsevier Ltd. All rights reserved.
rsup.2008.02.003
ing author. Tel.: +441225 383151; fax: +44 1225 383233.
esses: [email protected] (H. Walker), C.M.Har-
k (C. Harland), [email protected] (L. Knight),
asa.nhs.uk (C. Uden), [email protected]
8 980 8600; fax: +44 118 980 8653.
ogy. It is hoped that these reflections will have resonancefor academics, policy makers and practitioners participat-ing in collaborative research in purchasing and supplymanagement. Throughout the paper we draw on literatureon developing effective research collaborations, to considerwhether aspects of the research partnership have followedsuggested good practice.The paper is structured as follows. In the next section,
the context and set up of the research partnership isdescribed. A conceptual model is then introduced andapplied to three supply strategy cases of prosthetics,clinical waste and cardiology. The conceptual frameworkreveals how content, context and process of research andpractice have changed, influenced by both collaborators.Next, the methodological, theoretical and managerialimplications of this sort of longitudinal research partner-ship are considered. Finally, conclusions are drawn forthose considering long-term partnerships.
1.1. The NHS PASA/CRiSPS research collaboration
This research is based in the UK public health sector,which is composed of the National Health Service (NHS)
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and its suppliers. In 1991, a special health authority, theNHS Supplies Authority (NHS Supplies), was establishedto improve and coordinate supply management by provid-ing a national contracting and logistics service and a localsupplies operation service, in and for English NHS hospitaltrusts. In April 2000, the core purchasing and strategyfunctions of this Authority were formed into the new NHSPurchasing and Supply Agency (NHS PASA), an executiveagency of the UK government’s Department of Health(DH), providing policy steering to the English NHS onmatters relating to purchasing and supply.
The research partnership was formed in 1995, when theChief Executive of NHS Supplies contacted the Centre forResearch in Strategic Purchasing and Supply (CRiSPS),requesting research on supply strategy. One of the authorswas recruited to conduct this research. Following discus-sions a research partnership was established based on a 3-year rolling contract. The partnership includes educationand research, and funds three research staff and oneadministrator. Research themes are reviewed each year,and reflect developments in theory and practice.
A study of research–practitioner collaborations foundthey tend to be influenced by external factors such ascorporate instability, indicating that the managementprocesses themselves need to be flexible enough to copewith change (Barnes et al., 2002). The research partnershiphas continued through the change from NHS Supplies toNHS PASA and numerous changes in organisationalstructure in between, and has been reviewed and continuedwith the appointment of two new Chief Executives and twoacting Chief Executive Officers. Successful collaborationshave leaders who voice strong support for the researchproject and its goals, and have practitioners willing tochampion the project (Capper et al., 1996). We have beenfortunate to have several champions within NHS PASAover the course of the partnership.
The research partnership has four main objectives:
1.
Research agenda in supply strategy linked to PASA andDH strategic objectives2.
Disseminate/exploit outputs 3. Educate staff within PASA and NHS on the theory andpractice in field of supply strategy
4. Strategic planning consultancyThe research themes are reviewed annually. Currentresearch themes include:
�
Developing supply strategy � Evidence-based purchasing and innovation � Collaborative procurement � International comparative research � Sustainable procurementBoth sides of the partnership are responsible for thedissemination of outputs. Activities have included:
�
Evening seminars � Annual digest of research findings � Workbooks and tools to support supply strategydecision making
� Developing an MBA level supply strategy educationprogramme
� Lunch time exchange, a forum for presenting researchfindings to NHS PASA staff
� Research application group, that meets quarterly todiscuss how research can be exploited in the wider NHS
In the next sections we employ a conceptual model inorder to reflect more closely on the changes we haveobserved during this 13-year partnership. We subsequentlyfocus on three specific cases of developing supply strategyto illustrate these changes, and how practice has influencedresearch and vice versa.
1.2. Reflecting on change: the context–content–process
model
During the course of our research, the nature andcontext of researching purchasing and supply managementissues has changed. This has been an iterative process, aswe have responded both to the changing academic zeitgeistand to the needs of the practitioner context in NHS PASA.Both sides have influenced the collaboration and the focusof the research.In order to illustrate this, in this paper we draw examples
from the research theme of ‘Developing supply strategy’.This theme has remained relevant and of interest to NHSPASA over the last 13 years, but the setting, subject andmethod for developing supply strategy has evolved. In thefollowing sections, we described three case studies and usethem to illustrate how the nature of researching supplystrategy has changed, and how this has been influenced byboth researchers and practitioners.To assess how developing supply strategy has evolved
during this longitudinal research, we use Pettigrew’s (1987)context–content–process (CCP) framework. Pettigrew(1985) has argued that much research on organisationchange is ahistorical, aprocessual, and acontextual incharacter. Few studies allow the change process to revealitself in any substantially temporal or contextual manner.It has been suggested that collaborative research partner-ships are most effective when researchers see the value ofcontextualising their work, and decision-makers see howthis work can help them accomplish their purpose at hand(Golden-Biddle et al., 2003).We utilise the CCP framework to review the ‘what’ of
supply strategy change by analysing content, the ‘why’ ofchange is derived from an analysis of inner and outercontext, and the ‘how’ of change can be understood froman analysis of process (Pettigrew, 1987, p. 658).The CCP model was developed by Pettigrew et al. as a
means of framing strategic change over long timescales incomplex organisations, and therefore seems suitable for
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analysing the evolution of supply strategy in the NHS. Itwould, for example, be meaningless to compare supplystrategies developed in the mid-1990s with very recentstrategies without appreciating how the context in whichthey were developed has also changed. The CCP modelemphasises recursive influences between elements of themodel. In our case, efforts in the 1990s to adopt a morestrategic approach to the management of supply havehelped to shape ‘inner context,’ which in turn hasinfluenced the strategy development process and subse-quent strategies.
Finally, as shown below, we find the model helps us todifferentiate between, and yet be aware of convergencebetween, the changing context, content and process ofNHS supply strategising and the context, content andprocess of researching supply strategy. We show howduring our collaboration research and practice haveintertwined.
1.3. Supply strategy cases
In order to reflect on changes over the course of theresearch partnership, we report on three specific supplystrategy cases in Table 1. These are prosthetics, clinicalwaste management and cardiology. These have beenchosen to illustrate changes in developing supply strategy,and each case is subject to an analysis of inner and outerCCP.
1.3.1. Outer context
All public sector services are provided in the macro-environment, containing political, economic, societal andtechnological factors (Porter, 1980). During the course ofour research programme, our research themes havereflected changes in the macro-environment. There hasbeen a change in government during the course of theresearch programme, and associated changes in supplypolicy. The change from compulsory to voluntary compe-titive tendering of certain services (including catering,laundry, and hotel services) became apparent as govern-ment policy on outsourcing in the public sector changed.Subsequently, an outsourcing research strand began.Similarly, in line with economic policy, there has been achange in onus from cost cutting to achieving value formoney, to the pursuit of efficiency savings. Greater concernwithin society with issues such as fair trade, ethical supplyand child labour is reflected in the government’s sustain-able development agenda, and has led to a research themeon sustainable procurement. Technological advances haveled to the growth of e-business, and the strategic case for e-business has emerged as a further research theme.
From an academic perspective, developments in theacademic purchasing and supply research community havebeen an ‘outer context’ for us as researchers, acknowl-edging our part in the action research process and theacademic macro-environment influencing us.
Turning to the specific supply strategies reported inTable 1, each shows changes in the outer context that haveaffected supply strategy development. Technologicalchanges are apparent in prosthetics with the advent ofCADCAM assisting in fitting prosthetics and siliconcosmesis assisting in the appearance of prosthetics, and incardiology with the introduction of drug alluting stents.These advances have changed the range of products andservices available, leading to a need to reformulate supplystrategies.Supply strategies have been developed in response to
Minister’s questions or adverse media necessitating astrategic review of a product or service. In clinical wastemanagement, media stories of inappropriate disposal ofwaste caused Health Ministers to demand a review ofclinical waste management in the NHS.
1.3.2. Inner context
For the purposes of this paper, we choose ‘Inner’ tomean within NHS PASA. The role of the Agency changedwhen it became an executive Agency of the DH. FormerlyNHS Supplies prior to April 2000, it went from beingconcerned with more operational and management con-tracting activities to concern with strategy and policy. Italso changed from conducting fee-based contracting tobeing part of the civil service, with a remit as a centre forexcellence for the NHS in purchasing and supply.The organisation of supply structure has changed, from
Supplies staff throughout the NHS being employed byNHS Supplies, to decentralisation of their jobs to NHSHospital Trusts. In 2003, regional NHS Supplies Confed-erations were piloted, which are co-operative purchasinggroups of NHS Trusts. In 2005, the DH subsidised afurther wave of co-operative purchasing groups called‘collaborative hubs’. Whereas NHS Supplies and Logisticswere previously viewed as providers of operational logisticsservices, now there is a greater acceptance of the strategicvalue of supply. NHS PASA leads supply policy andstrategy in the NHS, and regional confederations andcollaborative hubs have taken over some of the moreoperational aspects. They can more effectively commit tovolumes, engage with Trust Board leads and withclinicians.A further example of change in inner context is the
change from viewing supply strategising as the remit of asmall strategy team within NHS Supplies in the late 1990s,to increasingly seeing co-ordination of supply strategyacross the NHS as important, engaging supplies managersfrom trusts in co-developing supply strategy. This may inpart reflect government calls for more ‘joined up thinking’across the public sector, and a change in leadership style atNHS PASA, with a culture of inclusiveness emerging.Inner context was also affected in 2004 when externalconsultants brought into NHS PASA by the DH con-ducted a supply strategy review of products/services, andintroduced the Supply Chain Excellence Programme(SCEP).
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Table 1
Supply strategy cases analysed by inner and outer context, content and process
Case Prosthetics Clinical waste management Cardiology
Description Prosthetics are artificial limbs. Disablement
Services Centres provide treatment, fitting
and services, often with suppliers on site.
Clinical waste has been in touch with bodily
fluids e.g. swabs, bandages. Clinical waste
can be disposed of by incineration or ultra
high temperature treatment.
Cardiology products are needed for heart,
valve and vascular operations, such as
stents that hold veins around the heart
open.
Features of
product/
service
High value low volume products, specialist
services, very proactive user group.
Service needs to be provided daily to
hospitals.
High value low volume products, suppliers
close to clinicians.
Few suppliers, and potential mergers.
Outer
context
Promotion by celebrity amputee increasing
awareness.
EU environmental policy has strict
guidelines regarding the safe disposal of
clinical waste. Adverse media incidents
drew attention of government ministers
(e.g. lorries left in road lay-bys, or waste
disposed of near populated areas).
Sustainable procurement policy has
heightened attention to waste management
generally.
Suppliers have developed a new technology,
drug alluting stents, is more effective yet
more expensive.
Technological advances include CADCAM
for fitting, and silicon cosmesis for more
skin-like prostheses.
Hospitals are negotiating different prices
for stents, suppliers use cross-subsidisation
across trusts.
Drive within the NHS to improve
coordination and develop shared services.
Inner
context
NHS PASA has a strong rehab team, and
one buyer is a user of services.
NHS PASA seconded a Senior Buyer. The
DH and NHS PASA have introduced a new
regional ‘confederation’ level of purchasing,
that necessitates reviewing supply strategy
for different levels.
Inclusive approach to supply strategy
indicative of a cultural change of greater
openness within NHS PASA. Initial
momentum was lost with the advent of a
new work program and reorganisation in
NHS PASA in 2004.
Content A strong effective supply stakeholder
network set the standard for clinician and
user engagement and supply strategy
implementation. The Prosthetics Strategic
Supply Group (PSSG) has led change, and
the content of supply strategy has evolved
with changing policy and context.
Most hospitals outsource clinical waste
management. With few suppliers, concern
over scarcity of supply in the future, and
supplier dominance. The supply strategy
looked at options regarding co-ordinating
outsourcing clinical waste management at a
regional level.
Supply strategy has sought to make savings
and drive the market by getting Trust
supplies managers and clinicians engaged in
supply strategy development at different
levels through the workshop.
Process Supply strategy was initially developed in
1996 using the 1st workbook. One of the
authors has participated in the PSSG for 8
years. Supply strategy development is
episodic and ongoing.
Supply strategy was developed using the
2nd workbook in 2002. One of the authors
plus five purchasing managers spent 112days
on workbook.
Supply strategy was developed utilising the
workshop methodology in 2003. One of the
authors plus 20 supplies managers spent 1
day at workshop.
H. Walker et al. / Journal of Purchasing & Supply Management 14 (2008) 136–145 139
With the three specific cases in Table 1, the inner contexthas varied within NHS PASA over time. For a number ofyears there has been a strong rehab team engaged with theProsthetics Strategic Supply Group, and this seems set tocontinue. Clinical waste management became a morecritical issue following a ministerial query, and subse-quently a Senior Buyer within NHS PASA was committedto review supply strategy. Cardiology had great initialimpetus, but this reduced possibly due to diversion ofresources with the introduction of the SCEP programmeand the reorganisation of NHS PASA.
For the academic research partners working with NHSPASA, we have had the good fortune to have severalsupporters within the organisation who have remainedwith the organisation for the duration of the 13-yearperiod. Our engagement with staff over time has shiftedfrom working with the top management team, to workingacross portfolios within NHS PASA, to engaging with staffacross the NHS. This has been particularly helpful in
addressing concerns that the benefits of the research werenot shared across and beyond the organisation. Similarly,NHS PASA staff have extended their engagement beyondthe immediate academics involved in the programme toinclude most staff at CRiSPS.
1.3.3. Content
The content of the supply strategies has changed overtime, and supply strategies were co-produced for differentproducts and services in 1996, 2002 and 2003. The cases wepresent in this paper are drawn from each of the differentperiods. The choice of content has been influenced to alarge extent by NHS PASA, with the academics respondingto their suggestions. We benefited from investigatingdifferent sorts of cases to illustrate NHS supply strategis-ing, which have fed into writing and education.At the start of the research partnership, supply strategy
formulation was undertaken in 3 months over the summerof 1996. Academics worked with senior members of each
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Broad level strategy - timeline
Complete opportunity assessment (inc. benchmark: good contract etc)
Develop process for moving trusts up to ‘good contract’ (business case)
Create cardiology procurement networkRetain national contracts for now
Create further leverage through confed/cardio network contracts
Develop confed/cardio network contracts to ensure balance between innovation and VFMId
entif
y ro
les
and
activ
ities
at e
ach
leve
l e.g
. for
PA
SA
Medium term
Short term
Gain better understanding of capacity problem, implication of HRGs, technology affordability problem (e.g. drug-eluting stents)
Long termWork out roles for procurement (connection to outcomes?, links with PCTs? links with TCs? links with NICE?
Work out implications for national contracts5
year
s
Build knowledge and capability in network (local and national)
Fig. 1. Cardiology strategy developed from levels workshop 2003.
H. Walker et al. / Journal of Purchasing & Supply Management 14 (2008) 136–145140
portfolio including pharmaceuticals, food and nutrition, ITand office services, medical and surgical, facilities andutilities, professional and financial services, diagnosticmedical equipment and rehabilitation services (includingprosthetics). In 2002, supply strategies were jointly pre-pared for clinical waste management, decontamination, andwheelchair hardware. In 2003, supply strategies were co-developed for cardiology, sutures, pathology, and enteralfeeds.
Supply strategy implementation has reached differentstages for different products and services, and the out-comes are varied. As part of the prosthetics supplystrategy, the Prosthetics Strategic Supply Group wasestablished with representatives from all stakeholders inthe prosthetics service. This provides interorganisationalcoordination and facilitates the strategic development ofthe service. Of the three cases, this is probably the supplystrategy that has progressed furthest and had the largestimpact on supply networks, and is used as an exemplar byboth NHS PASA and the academics.
The clinical waste supply strategy focused on consideringregional co-ordination of services, and securing futuresupply in a constricted supply market. The supply strategywas implemented with some success, and will be subject toongoing review. The cardiology supply strategy is sum-marised in Fig. 1, which describes supply activities over a 5-year timeline. The supply strategy focuses on engagingclinicians in supply decision-making, to reduce theinfluence of suppliers who have traditionally marketeddirect to clinicians. It also involves co-ordination acrossNHS trusts to prevent suppliers manipulating the market.The success of the cardiology supply strategy has beenlimited by organisational changes within NHS PASA
taking resources from its implementation. This illustrateshow changes in inner context can affect the content ofchange.
1.3.4. Process
The process for developing supply strategy has evolved.Two workbooks, the Supply Strategy Workbook (1996)and the ‘Appropriate Levels for Supply Workbook’ (2002)have been developed during the course of the partnership,and a workshop (2003) has been developed, based on thesecond workbook. Each iteration has been led by theacademics, drawing on latest theory, tools and techniquesfor formulating supply strategy. Each new process fordeveloping supply strategy has also been a response tochanging circumstances and needs within NHS PASA.The first workbook (1996) had four main phases in
supply strategy formulation, and drew on a variety oftechniques to assist in the process. The second workbook(2002) assessed the current ‘as-is’ context and capabilities,and evaluated appropriate levels for supply, using thesupply interventions matrix. The different levels ofpotential supply strategy activity ranged across interna-tional, national, regional, local trust, team and individuallevels Future ‘to-be’ scenarios were outlined to choose themost appropriate strategic direction. The workshopmethodology (2003) marked a further iteration in theprocess of developing supply strategy, and drew on avariety of tools (e.g., assessment of the power balancebetween customer and supplier, risk assessment, andcompetences) and engaged stakeholders. The evolution ofthe steps in the workbooks and workshop are illustrated inFig. 2.
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1996 - SUPPLY STRATEGY WORKBOOK1. Strategic context2. Situation review3. Supply strategy formulation4. Supply strategy implementation
2002 - APPROPRIATE LEVELS FOR SUPPLY WORKBOOK1. Describe current situation2. Evaluate current situation3. Describe future scenarios4. Decide appropriate supply actions5. Make recommendations
2003 - LEVELS WORKSHOP1. ‘As-is’ facts and figures (collated prior to workshop)2. Drivers and influences3. Critical assessment – moving from ‘as-is’ to ‘to-be’4. Strategy development5. Implementation issues and levels of activity6. Drafting of strategy for communications7. Embedding of strategy and levels decisions in workplans
Fig. 2. The evolution of steps in workbooks and workshop.
H. Walker et al. / Journal of Purchasing & Supply Management 14 (2008) 136–145 141
The methods have been co-adapted with NHS PASAand came about as a response to their changing needs,assisting the organisation in the change process. Theseprocesses evolved in the form that they did at the point intime when they did partly because of (1) the changing roleof the Agency, (2) an Agency desire to re-launch andrefresh supply strategy, (3) the Agency liking a ‘workbook’or ‘toolkit’ approach, and (4) a subsequent need for a‘workshop’ process to enable stakeholder engagement. Thevarious iterations also came about due to changes incontext, the 2002 workbook coinciding with a change inDH policy leading to a new regional level for supply, andthe workshop signifying an increasing Agency role ingreater stakeholder engagement in supply strategy in theNHS.
The process of developing supply strategy has increas-ingly had an emphasis on implementation issues, andembedding the supply strategies into workplans. Develop-ing supply strategy takes a significant amount of time andfacilitation, whether it involves a team using a workbookor a group attending a workshop.
The CCP model has allowed a structured analysis ofchanges in supply strategy over the course of the partner-ship. Changes in inner and outer context, in process andcontent are apparent in all three cases, and show how thenature of research and practice in supply strategy has co-evolved.
2. Reflections
In this section, we reflect on developing supply strategyand the research partnership more broadly, consideringmethodological, theoretical and managerial implications.
Some researchers are proponents of reflexivity inresearch, a process in which research collaborators reflectupon their experiences and perceptions and discuss theirgroup process to make sense of their own assumptions andmotives (Easterby-Smith and Maina, 1999). It has beensuggested that the perceived usefulness of a collaboration isrelated to perspective taking, the process whereby academicresearchers and the practitioners come to understand eachother’s thought-worlds (Mohrman et al., 2002). We had anopportunity to reflect on the research partnership recently,as two of the authors (one practitioner and one academic)were invited to speak to Commercial Directors from acrossgovernment on the benefits of the research partnership(Uden and Walker, 2007). Some of the implicationsdiscussed below draw on that presentation.
2.1. Methodological implications
There are several methodological observations thatemerge from reflecting on the long-term research partner-ship. The cases illustrate how the role and context of publicprocurement is changing, requiring a much more sophis-ticated and complex view of supply. This view includes theconsideration of multiple stakeholders in complex net-works, long timescales, and changing objectives andcriteria underpinning decisions, which have all influencedsupply strategy. It has been argued that in changingcontexts there is an increasing need for closer workingbetween researchers and practitioners (Rynes et al., 2001).Successful research collaborators should exhibit a desire
to learn about and relate to the practitioner environment(Capper et al., 1996). We have been in the fortunateposition of having a continuing research partnership withNHS PASA, allowing us to adopt a longitudinal approach.
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In such changing and complex research settings, when newresearchers have joined the programme they have describedfeeling ‘dropped into the ocean’. It takes some time to findones bearings and understand the challenges and complex-ities of purchasing in the health sector.
The appropriateness of a research approach derives fromthe nature of the social phenomenon to be explored(Morgan and Smircich, 1980). Action research (West-brook, 1995) is often used to address strategy developmentand practical implementation challenges, so has been suitedto our working closely with practitioners in developingsupply strategy. ‘Longitudinal means a lonnnnnnnng time’(Saldana, 2003, p. 1). For our research partnership it hasbeen 13 years and counting, although neither side wouldhave anticipated the length of the collaboration at theoutset. Saldana identifies the three foundational principlesof qualitative longitudinal research as duration, time andchange, emphasising the importance of time and changeprocesses as contextual. He has a flexible notion of whatchange means: ‘I feel we should be flexible and allow adefinition of change to emerge as a study proceeds and itsdata are analysed. Ironically yet fittingly, we should permitourselves to change our meaning of change as a studyprogresses’ (Saldana, 2003, p. 12). Some of the concepts wehave worked with have changed over the period. Long-itudinal research brings the additional dimension of time,process and change to the centre of the research (Pettigrew,1995).
The changing nature of the NHS supply context madetime a key variable, so longitudinal research enabled thetracking of those changes over time in a deep way, asadvocated by Pettigrew, 1987. Other researchers of supplystrategy may not have the opportunity for longitudinalresearch, but reflecting on time and change is still possiblefor a time-constrained project. Researchers could constructa timeline of events, describe the strategy formulationprocess and set strategy formulation in its context,preventing supply strategy research from being ahistoricalaprocessual, and acontextual (Pettigrew, 1985).
The role of the researcher is not static, and has includedthe roles of educator, advisor and advocate through tomore subtle roles such as bringing a new ‘supply strategylanguage’ or discourse to supply management staff in theNHS. It is rewarding to hear terminology and conceptsdeveloped within the research programme, being adoptedby practitioners. Language and terminology flows the otherway too, and is adopted from practitioners by theresearchers, especially when sketching out new researchthemes to be both scholarly and relevant to current NHS‘policy-speak.’ The outcome is that there is less room formisunderstanding and it therefore results in a moreeffective debate and faster conclusions.
In a sense, this exchanging of language is due to thelongitudinal nature of the research, but shows howimmersed in a setting a researcher can become. Centralto participant observation is both involvement anddetachment—too much detachment and the researcher is
not immersed in the setting. Too much involvement andresearchers ‘go native’ or ‘become the phenomenon’; it israrely possible to remain uninvolved (Jorgenson, 1989).There is need for constructive challenge from both sides ofthe partnership so that it does not become too cosy.Researchers decode one culture whilst recoding it into
another, in terms their research peers will understand(Barthes, 1972). From a social constructionist perspective,people are seen as socially constructing the meaning andsignificance of their realities, ordering, structuring andmaking sense of the world around them (Berger andLuckmann, 1966). This resonates with the concept of sense-making in organisations (Weick, 1995). As longitudinalaction researchers, we acknowledge our part in this sense-making, in the context of developing the supply strategyconcept.As a final methodological observation, in our research
we have often chosen NHS PASA (previously NHSSupplies) as the focal organisation and unit of ana-lysis. Inevitably, change at other systems levels (e.g.Department of Health policy, regional confederations,hospitals, etc.) has affected and been affected by NHSPASA. We have found a supply strategy matrix (Walker etal., 2006) helps tease out supply strategy at different systemlevels.
2.2. Theoretical implications
During the course of our research, the concept of supplyhas evolved to be more holistic, strategic and collaborative.The conceptual development has been parallel to changingorganisational arrangements and the status of procurementwithin the NHS, with each iteratively feeding the other.From what was originally, in 1995 in the NHS SuppliesAuthority, a more operational, logistics-oriented role, theNHS Purchasing and Supply Agency has taken on a ‘headoffice’ policy and strategy role for and on behalf of theentire NHS confederation. Members of the NHS Confed-eration now work together in collaborative consortiaenabling collective strategy formulation and implementa-tion. In this way, public procurement within the NHS isbecoming more proactive and strategic, rather thanreactive to the commercial actions of suppliers. Thecommitment to collective strategy encouraged the research-ers to develop the concept of supply strategy to addressorganisational levels of intervention in the total supplysystem. Using the developed concept to formulate strategyat these different levels enabled the practitioners tointervene in a collective, strategic way.As research in the field of purchasing and supply and
operations management has developed, so too has the waywe have conceptualised and defined supply strategy in thislongitudinal action research programme. The conceptualdevelopment of supply strategy and its trajectory arerepresented in Fig. 3. It is not intended to present thecausation of change as linear or singular; explanations ofchange are bound to be holistic and multi-faceted
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1996 Trajectory2000
Multi-level
Supply strategy in broader public sector context
From dyads to chains and networks
From contracting & operations to strategy & policy
Appropriate levels for supply
From reactive to proactive interventions
Roles in supply networks
Public procurement as lever for government reform
Development of generic supply strategies
Fig. 3. The conceptual development of supply strategy and its trajectory.
H. Walker et al. / Journal of Purchasing & Supply Management 14 (2008) 136–145 143
(Pettigrew, 1990). It gives an indication of how ourapproach has evolved recursively through various levelsof analysis, and through the changing context, content andprocess of supply strategy development. As, over time, theengagement and commitment of the public procurementpractitioner partners to the research has increased, the‘joining up’ of decision-making within the action researchhas been possible. This collective, rather than organisa-tional procurement decision-making, has enabled publicprocurement to be used as a lever of reform in a proactiveway.
Practical knowledge is ‘‘not a timid and stuttering formof science. One deprives oneself of all means of under-standing if one tries to reduce it to a moment or stage intechnical and scientific evolution’’ (Levi-Strauss, 1966). ‘‘Awider and deeper form and range of engagement betweenmanagement researchers and practitioners would entailexperimentation with the co-funding, co-production andco-dissemination of knowledge’’ (Pettigrew, 2001). Theconcept of ‘Mode 2’ research (Gibbons et al., 1994) entailsboth the production of enduring and reliable knowledge,and engaging and usually solving some ‘live’ problem forthose for whom the research is produced (Burgoyne andJames, 2006). ‘‘Engaged scholarship’’ (Van De Ven andJohnson, 2004) is a way for academics to put their theoriesinto practice and managers to put their practice intotheory. This style of research is highly appropriate forpublic procurement because of its complex, practical anddynamically changing nature, and also because tax payersand citizens deserve to have their money spent strategicallyand wisely.
In terms of academic outputs, we have published over100 journal articles, book chapters, and conference papersthat draw on the research partnership. We have alsoengaged in policy development, and the authors havesat on numerous government task forces and think tanks.We have had a great opportunity to conduct researchthat is both scholarly and relevant, and to work with
mature research partners with realistic expectations aboutconducting research.
2.3. Managerial implications
In this section, we consider the implications of theresearch for practice, first focusing on practitionersinterested in developing and implementing supply strategy.Next, a broader view is taken on the implications of theresearch partnership for NHS PASA.For practitioners developing supply strategy, we have
observed several changes during the course of the research.There have been moves towards including more stake-holders in the supply strategy formulation process, and to afocus on outcomes and implementation. Across severalsupply strategies there has been an increasing need toengage with stakeholders, such as clinicians and serviceusers in the prosthetics case. The need to embed supplystrategy in business plans and focus on implementation andoutcomes has emerged in later iterations of the process ofdeveloping supply strategy. Several enablers and barriersto supply strategy formulation have been identifiedthrough the course of the research, which are summarisedin Table 2. These may also have resonance for othersresearching and practicing supply strategy.From recent discussions with colleagues at NHS PASA,
it seems that formulating and evaluating supply strategiesat different levels still very much resonates in the currentcontext, so the ‘Appropriate Levels for Supply’ workbookmay be revisited and redeveloped. Future interest includesdeveloping ‘generic’ supply strategies, evolving a contin-gent approach to supply strategy and moving into newresearch areas affecting the policy landscape such as thecommissioning of health and social care services.Ross et al. (2003) distinguish between three models of
practitioner involvement in research—formal supporter,responsive audience, and integral partner. The role of NHSPASA involvement could be termed integral partner, in
ARTICLE IN PRESS
Table 2
Barriers and Enablers to Supply Strategy Formulation
Enablers Barriers
� Have a champion to keep
momentum
� Have independent facilitation
� Choose an appropriate issue,
product/ service or supply
market to focus on
� Prepare and circulate market
data collection activities prior to
developing supply strategy
� Identify key factors affecting
appropriateness of interventions
� Have a staggered and increasing
involvement of NHS
Confederations and NHS Trusts
� Once supply strategy is drafted,
gain commitment by consulting
widely across the NHS supply
management community
� Use wider group as a basis for
establishing a supply strategy
network
� Taking on too complex or
nebulous an issue or supply
market—it may be easier to
break categories down so that
supply strategies are developed
for different products/services
� Focusing too tightly on a
product and ignoring the service
aspects (e.g., wheelchair
hardware)
� Underestimating resource and
time requirements
� Neglecting implementation
issues and embedding in
workplans
� Neglecting clinical engagement
� Neglecting capabilities and skills
H. Walker et al. / Journal of Purchasing & Supply Management 14 (2008) 136–145144
that they are a significant partner in the research processand help to shape the research process and outcomes. Wehave worked together so that the research and its outputshave been embedded in practice over the last 13 years.NHS PASA have also benefited from access to aninternational network of researchers, working papers,MBA students for project work, and research in othersectors.
NHS PASA colleagues have said they enjoy the kudos ofbeing associated with cutting edge research, and of beingseen to lead the public sector procurement community inacademic engagement. We have also consulted for NHSPASA on many strategic issues over the last decade. NHSPASA have benefited from the education aspect of thepartnership, as over 150 procurement staff have completedthe MBA-accredited ‘Developing Supply Strategy’ course.There is also increasingly wide engagement of practitionersfrom across the NHS in different aspects of the research.The research outputs have been disseminated within theNHS and more broadly in practitioner, policy andacademic communities.
3. Conclusions
This paper has reflected on a longitudinal collaborativeresearch partnership in the health sector. We have usedPettigrew’s CCP model (1985) to analyse three cases toillustrate how the outer and inner context, and the processand content of supply strategy has evolved over time. Wehave also reflected on the methodological, theoretical andmanagerial implications of such longitudinal researchpartnerships.
It has been observed that good university–industryrelations require that an appropriate balance be achievedbetween academic objectives and industrial priori-ties (Barnes et al., 2002). Successful projects are viewedas rational by both collaborators and will have outputsuseful in the context of both organisations (Capper et al.,1996).In our partnership both sides see it as beneficial, greater
than the sum of its parts, and challenging. The partner-ship would not have achieved so much if it had been aseries of short projects rather than a long term collabo-ration. Our programme would not have been possiblewithout the commitment of both partners, and it tooka little time to gain return on investment. Building aresearch partnership between two organisations takesan investment of time and resources on both sides. Theaim is to create repeated opportunities to work togetherand establish an environment of open communica-tion, mutual respect and trust (Goering et al., 2003).Research partners need to progressively develop a good-will trust relationship that will endure (Davenport et al.,1999). In our partnership, the people most closely invol-ved have become essentially colleagues, and there hasbeen fluidity in roles over time and across organisationalboundaries.Looking at some of the difficulties, it is possible that
working closely with one organisation may lead tostagnation on both sides. Our creativity has been encour-aged, however, by annually reviewing and sometimeschanging themes. There is also the difficulty of becomingso immersed in a research situation that one ‘goes native’; itis important to retain the balance between objectivity andsubjectivity in such partnerships and challenge one anotherso as not to get too cosy. Both partners require differentthings from the collaboration, and that can presentdifficulties. There are inevitably tensions between researchand practice, thought versus action, and problem solvingversus theory building (Rynes et al., 2001). ‘Mode 2’researchers are often torn between contributing to theorydevelopment and meeting the needs of their practitionerpartners (Burgoyne and James, 2006). NHS PASA havehad ideas and practices supportively challenged by us,which can sometimes be uncomfortable, especially if theyare under pressure to do things. We have also beenchallenged to not disappear into our ‘ivory towers’ and nottalk in ‘academic speak’. Research also has uncertainoutcomes, which can require a leap of faith on both sides.Research conclusions can undergo sanitisation of complex-ities and uncertainties, making research findings lesscredible to practitioners who live and work in ‘messy’worlds (Rynes et al., 2001).We would advocate the benefits of longitudinal research
collaborations for the purchasing and supply managementcommunity. In the collaborative programme described inthis paper, practice changed the research and researchchanged practice. Significant progress has been made, andmore is needed.
ARTICLE IN PRESSH. Walker et al. / Journal of Purchasing & Supply Management 14 (2008) 136–145 145
Acknowledgements
The authors would like to express their gratitude to theNHS Purchasing and Supply Agency for sponsoring thecollaborative research programme that has operated since1995.
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