Colin Palfrey

Health services management: what are the ethical dimensions?

Purpose – Sets out to examine arguments that attribute a lack of an ethical dimension to the management function.Design/methodology/approach – Discusses the role of health service managers in the context of the NHS and the political and economic contexts in which they operate.Practical implications – The challenge faced by senior managers in the NHS, i.e. trying to provide high‐quality, accessible services and to remain within budgets, is recognised as formidable and ethically complex.Originality/value – Efficiency and choice can be compatible objectives but their achievement within the NHS is likely to be more difficult than political rhetoric might suggest.

Politics and policy evaluation

Traditionally, the role of external evaluators has been based on the positivist paradigm of the ‘neutral’ researcher. It is, however, contestable whether evaluators can be or whether they ought to be politically impartial. ‘Fourth generation evaluation’ delineated by Guba and Lincoln represents a more stakeholder-focused approach to policy and programme evaluation while other writers have asserted the need to take an overtly ideological stance in order to represent marginalised groups. We contend in this article that in order to be methodologically sound, evaluation research has to be participative and democratic. Since policy making is inherently a political process, evaluators have to be able to live with the possibility of their democratically derived data being selectively used or even rejected.

What is Evaluation

‘Evaluation’ is concerned with judging merit against some yardstick. It involves the collection, analysis and interpretation of data bearing on the achievement of an organisation’s goals and programme objectives. Evaluation usually attempts to measure the extent to which certain outcomes can be validly correlated with inputs and/or outputs. The aim is to establish whether there is a cause—effect relationship.

Evaluation Research Designs and Methods

The planning of any evaluation requires careful thought about the type of investigation to be carried out, the variety of data required, how this will be collected and checked in terms of its reliability and validity and the sort of analysis necessary to produce appropriate findings. This chapter provides some insights into these areas, beginning with the design stage of an evaluation and moving on to the range of methods that can be used in undertaking evaluations in the field of health and social care.

Consumers’ Opinions and Service Evaluation

Reference has been made in this book to service users, a term which includes all the people, not least informal carers, who are intended to benefit from health and social care services. The terms ‘patients’ and ‘clients’ are giving way to ‘customers’ and ‘consumers’ as health and social care policy recognises the move towards a mixed economy of care. In the new environment of separate purchasers and providers, the ‘customer’ could well refer to the purchasing agency rather than the intended beneficiary of care. This is even more probable since devolved budgets under the case management system of community care planning and provision are unlikely to be allocated to individual users. The ‘consumer’ is, therefore, a more appropriate term for the former ‘client’ and may be preferable to ‘user’ for two reasons: 1 The term ‘user’ has associations with drug abusers. 2 ‘Consumer’, with its market-place connotations, seems a more accurate representation of the ‘active citizen’ model favoured by the present government.

Evaluating Organisational Structures and Processess

In analysing an organisation people commonly examine both the organisation’s structures — its roles and relationships — and its processes — the ways in which activities are carried out. ‘Process’ also refers to questions of motivation and leadership, interpersonal and intergroup relationships, power, organisational culture and managerial competences. These are the kinds of topics that one commonly finds as chapter headings in books on ‘Organisational Behaviour’, with different books showing variations in how the topics are grouped and related to each other and to other issues.

Evaluating Equality, Equity and Accessibility

Compared with the criteria examined in the previous chapters equality, equity and, to a lesser extent, accessibility are slippery concepts. They have been the subject of much discussion in the context of the reforms in health and social care; but the discussions are not new, and attempts to remove, or at least reduce, inequities and inequalities continue.