Emmanouil Gkeredakis

Evidence-based commissioning in the English NHS: who uses which sources of evidence? A survey 2010/2011.

Objectives To investigate types of evidence used by healthcare commissioners when making decisions and whether decisions were influenced by commissioners’ experience, personal characteristics or role at work. Design Cross-sectional survey of 345 National Health Service (NHS) staff members. Setting The study was conducted across 11 English Primary Care Trusts between 2010 and 2011. Participants A total of 440 staff involved in commissioning decisions and employed at NHS band 7 or above were invited to participate in the study. Of those, 345 (78%) completed all or a part of the survey. Main outcome measures Participants were asked to rate how important different sources of evidence (empirical or practical) were in a recent decision that had been made. Backwards stepwise logistic regression analyses were undertaken to assess the contributions of age, gender and professional background, as well as the years of experience in NHS commissioning, pay grade and work role. Results The extent to which empirical evidence was used for commissioning decisions in the NHS varied according to the professional background. Only 50% of respondents stated that clinical guidelines and cost-effectiveness evidence were important for healthcare decisions. Respondents were more likely to report use of empirical evidence if they worked in Public Health in comparison to other departments (p<0.0005, commissioning and contracts OR   0.32, 95%CI   0.18 to 0.57, finance OR  0.19, 95%CI 0.05 to 0.78, other departments OR 0.35, 95%CI 0.17 to 0.71) or if they were female (OR 1.8 95% CI 1.01 to 3.1) rather than male. Respondents were more likely to report use of practical evidence if they were more senior within the organisation (pay grade 8b or higher OR 2.7, 95%CI 1.4 to 5.3, p=0.004 in comparison to lower pay grades). Conclusions Those trained in Public Health appeared more likely to use external empirical evidence while those at higher pay scales were more likely to use practical evidence when making commissioning decisions. Clearly, National Institute for Clinical Excellence (NICE) guidance and government publications (eg, National Service Frameworks) are important for decision-making, but practical sources of evidence such as local intelligence, benchmarking data and expert advice are also influential. New Clinical Commissioning Groups will need a variety of different evidence sources and expert involvement to ensure that effective decisions are made for their populations.

The Constitutive Role of Conventions in Accomplishing Coordination: Insights from a Complex Contract Award Project:

This article advances understanding of how coordination is accomplished in organizations. It builds on and extends recent research, which suggests that coordination is an emergent process of situated interaction aiming to realize a collective performance. In particular, the paper focuses on deliberate efforts to coordinate and contribute to objectives of large-scale integration in practice (e.g., orchestrated, year-long delivery of a megaproject). Such efforts give rise to a novel form of interdependencies, which organizational actors experience as “external” to local activities and group interactions. Drawing on recent developments in social theory, the paper proposes a framework to study coordinative action in situations where organizational actors are faced with a multitude of task-specific and “external” interdependencies. Further, through an in-depth study of a contract award project, it sheds light on the ways ongoing project coordination was adjusted to address interdependencies arising from the deliberate pursuit of two objectives: the concerted delivery of a construction megaproject and the large-scale procurement policy coordination targeted at safeguarding market competition across the European Union. Findings highlight that the situated management of external interdependencies entailed a distinctive type of agency, mediated by formalized industry-wide and policy conventions, and concerned with developing relevant evidence of coordinated contributions. The article explains how and why actors may adjust coordination efforts by alternating between coordination modes. Implications are drawn for studying coordination dynamics in other organizational settings

Coproduction in commissioning decisions : is there an association with decision satisfaction for commissioners working in the NHS? A cross-sectional survey 2010/2011

Objectives To undertake an assessment of the association between coproduction and satisfaction with decisions made for local healthcare communities. Design A coproduction scale was developed and tested to measure individual National Health Service (NHS) commissioners’ satisfaction with commissioning decisions. Setting 11 English Primary Care Trusts in 2010–2011. Participants Staff employed at NHS band 7 or above involved in commissioning decisions in the NHS. 345/440 (78%) of participants completed part of all of the survey. Main outcome measure Reliability and validity of a coproduction scale were assessed using a correlation-based principal component analysis model with direct oblimin rotation. Multilevel modelling was used to predict decision satisfaction. Results The analysis revealed that coproduction consisted of three principal components: productive discussion, information and dealing with uncertainty. Higher decision satisfaction was associated with smaller decisions, more productive discussion, decisions where information was readily available to use and those where decision-making tools were more often used. Conclusions The research indicated that coproduction may be an important factor for satisfaction with decision-making in the commissioning of healthcare services.

Framing Innovation Opportunities While Staying Committed to an Organizational Epistemic Stance

This paper examines how an organization’s culture, and in particular its stance toward the pursuit of knowledge and innovation, matters when confronting new digitally enabled practices for generating novel insights. We draw on an in-depth interpretive study of how two innovation consulting firms encountered crowdsourcing for innovation. Our findings suggest that, although both organizations relied on a similar set of organizational arrangements in their daily consulting work, they enacted different positions vis-a-vis crowdsourcing: one firm further experimented with it, whereas the other rejected it altogether. These different positions emerged as organizational actors examined, framed, and evaluated crowdsourcing as an alternative for generating knowledge. To interpret these findings, we draw on philosophy of science and develop the concept of organizational epistemic stance, defined as an attitude that organizational actors collectively enact in pursuing knowledge. Our analysis suggests that when organ...

How does morality shape the enactment of organizational routines

This paper examines the relation between moral ideals and organizational routines. Prior research suggests that when routine participants strive for moral ideals, ongoing “endogenous changes” in or...