Annabelle Mark

Organizing emotions in health care

PURPOSE To introduce the articles in this special issue, discussing emotion in the in health-care organisations. DESIGN/METHODOLOGY/APPROACH Discusses such topics as what makes health care different, editorial perspectives, how health care has explored emotion so far, and the impact of emotion on patients and the consequences for staff. FINDINGS Health care provides a setting that juxtaposes emotion and rationality, the individual and the body corporate, the formal and the deeply personal, the public and the private, all of which must be understood better if changes in expectations and delivery are to remain coherent. ORIGINALITY/VALUE The papers indicate a shared international desire to understand meaning in emotion that is now spreading across organizational process and into all professional roles within health care.

IT Systems Implementation: Research Findings from the Public Sector

The National Health Service has embarked upon major initiatives to bring in management and financial information systems capable of relating resource usage to cost and to underpin better management and effective delivery of health care. This paper identifies a range of weaknesses and impending problem areas in implementation practice. Recent research evidence from several NHS regions is utilized to support the detailed case made for changes in how computer-based projects are developed, managed and implemented within the organization. It is suggested that the evidence and analysis would seem to have implications for all those studying, experiencing, or anticipating computerization.

Modernising healthcare - is the NPfIT for purpose?

This paper responds to the findings of the research by Currie and Guah on the introduction of the National Programme for Information Technology through an institutional theory perspective. It considers both the appropriateness and applicability of the method chosen in the light of what is already known about UK healthcare organisations and the complex and changing process that is involved in both the organisation and any research that takes place. This is further confounded by an unstable political environment both nationally and locally and a failure to understand the changing location, role and status of the medical record. Only when this is resolved will a transformational change occur, in line with the new patient-focused government agenda and the external world of technology that must engage with the emotional as well as the rational role that both technology and health play in peoples lives.

Demarketing - managing demand in the UK National Health Service

This article explores what demarketing (which seeks to dissuade people from using a service) has to offer for the allocation of resources according to patient and population needs in the NHS. The authors argue that to reject demarketing as ethically unacceptable would represent the failure of the marketing discipline to recognize the imperative for such strategies within the health sector. It could provide a tool for the new purchasers of health for the community, who have so far been neglected by the marketing discipline. If implemented, demarketing would a demand‐side approach to the problem of matching need to resources.

Outsourcing therapy services. A strategy for professional autonomy.

Explores the problems and opportunities for professions allied to medicine (PAMS) in the new NHS internal market. Uses a mechanism from IT, namely outsourcing, to provide a new organizational model for the effective delivery of care by this group of professionals who are marginalized by the new role of the doctor as manager.

Where Are the Medical Managers

This article discusses the attempts by the National Health Service (NHS) to develop medical managers, following the introduction of general management in 1983. It suggests that problems have arisen because, so far, it has been organisational considerations and not those of individual career paths which have informed these developments. It is suggested that this new approach could lead to the development of the NHS as a learning organisation within the context of the original policy objectives.

Demarketing dysfunctional demand in the UK National Health Service

This article considers demarketing as a strategy to manage dysfunctional demand in the UK NHS. Demarketing seeks to persuade customers not to use a service which is provided. It appears in all four modes in the NHS as general, selective, ostensible and unintentional demarketing with an emphasis on supply-side applications. It is proposed that, as a demand-side strategy, it would allow purchasers of health care on behalf of communities, to discern values, attitudes and beliefs which predicate current behaviour through the use of the Theory of Planned Behaviour; and, subsequently, to develop appropriate demarketing alternatives to change these behaviours where they are dysfunctional for both consumer and provider. This approach is proposed for the significant behavioural changes required to manage the increases in the use of emergency services: in particular, general practitioner night calls, which are already developing evidence-based demand management strategies. Such alternative strategies need to demonstrate their acceptability to consumers rather than just the professionals. Such demand management strategies would be made more acceptable as they are drawn from both consumer and normative attitudes, values and beliefs. In this way demarketing could demonstrably provide a framework for intervention, collaboration, decentralization, explicitness and an ethical foundation to the key problem of demand management in health care.

'Nurse entrepreneurs' a case of government rhetoric?

Introduction Nursing has come to play a prominent role in government health policy since 1997. Extending the scope of nursing practice into activities previously carried out by doctors can assist a managerialist and ‘modernizing’ project of increasing National Health Service (NHS) efficiency by removing demarcations between professional groups. Methods Drawing on elements of poststructuralist linguistics, this paper presents an analysis of a key government speech in the context of a discussion of overall policy intentions. Results The speech can be seen as an example of how government has attempted to use rhetoric to make its goals attractive to nurses. Conclusion Policy-makers have to make their policies acceptable to those whom they expect to implement them. In this case, organizational efficiency, chiefly in terms of broader access to NHS services, as well as role substitution, is aligned with government policy promoting social enterprise and ‘sold’ to the nursing profession as enhancing its status compared with medicine.

Chaos and complexity--the future for health care HRM.

The need to understand chaos and complexity in organisations has particular importance for health which is bedevilled by the complexity of organisations and the sometimes chaotic nature of its core activities. This article seeks to explore these issues in the context of one of the key functions which is expected to hold together this diversity: Human Resource Management (HRM). An exploration of the nature of HRM in health care as it has evolved indicates that in order for it to have a pivotal role for the future it will need to rethink this role in the changing paradigm which is now emerging; in so doing it could develop as the organisational intelligence for health care in the future facilitating organisational learning and creativity.

Thinking through health capacity development for Fragile States

The purpose of this paper is to consider capacity development for healthcare in Fragile States and its roles, for example, in securing civil and political stability, as well as improved health, within the various contexts prevailing in fragile settings across the world. As a precursor to this, however, it is important to understand how, in rapidly changing environments, the role and contribution of different donors will have an impact in different ways. This paper sets out to interpret these issues, and what becomes apparent is the need to develop an understanding of the value base of donors, which we demonstrate through the development of a value-based framework. This highlights the separate motivations and choices made by donors, but what is apparent is that all remain within the positivist perspective perhaps for reasons of accountability and transparency. However, the emergence of new interpretations drawing on systems thinking, and followed by complexity theory more recently, in understanding contexts, suggests that the favouring of any one of these perspective can be counterproductive, without a consideration of the contexts in which they occur. In seeking an explanation of these environmental contexts, which also address the perspectives in use, we suggest the use of wider multi-ontology sense-making framework such as Cynefin. Through this approach, analytical insights can be given into the interpretation, decision and intervention processes available in these different and often changing environments, thus enabling greater coherence between donor values and recipient contexts.