Lorna McKee

Shaping Strategic Change: The Case of the NHS in the 1980s

This article explores the question of why the management of change has become an issue in the National Health Service (NHS). It reports the results of a study which explored reasons for variability in the observed rate and pace of strategic service change in the NHS. The metaphor of ‘receptive’ and ‘non‐receptive’ contexts for change is introduced and eight ‘signs and symptoms’ of receptivity outlined. Some examples are presented. These results give us a logic and language which may enable us to understand processes of change in the NHS.

Managing Strategic Service Change in the NHS

This paper reports some early findings from a major research project which explores strategic service change in the NHS in the post-Griffiths era. We begin by briefly reviewing the relevant literature on change and general management in the NHS, and go on to outline the particular features of the research design. We then isolate some key emergent themes from a preliminary analysis of the data, highlighting two themes in greater depth. In our final section, we will attempt to reflect on some of the common factors associated with the achievement of strategic change. The project is funded by the NHSTA and a consortium of eight Regional Health Authorities.

Planning for Alternative Futures in the NHS

‘The NHS needs the ability to move much more quickly’ (The Griffiths Report, 1983, p13) This paper grew out of preliminary research undertaken for the research project on which we both work, entitled the Management of Change in the NHS. The project is based in the Centre for Corporate Strategy and Change at the University of Warwick, and is directed by Professor Andrew Pettigrew, who has previously undertaken a longitudinal study of strategic change in ICI (Pettigrew, 1985), and also a pilot study within the NHS which identified the implementation of strategic intent as the jugular problem confronting NHS managers. But a central research problem is why it is that some Health Districts manage to achieve a faster rate of change than others. Hence there was a need to trace the evolution of local systems through time, with the result that the historical analysis of changing is a key aspect of this research. The project is financed jointly by the NHSTA and a consortium of eight of the English Regions and ten case study districts are included. The research design focusses on strategic service changes in both the acute and priority group sectors and incorporates developments and contractions. The choice of strategic changes was informed by a detailed review of the most recent regional strategic plans and the review itself prompted this paper. It led us to a number of observations about the content of the change agenda. First, there is a high rate of change projected in the current strategic round and earlier studies of incrementalist approaches to change may have to be revised (Hunter, 1980; Ham, 1981). Secondly, these regional change agendas to a great extent reflect national/central policy and the pattern is one of uniformity. These standard agendas include RAWP; the construction of a DGH network; the run-down of long-stay mental illness/handicap hospitals; cost improvements and an increase in health promotion activity. Thirdly, alongside the top-down mechanisms to secure implementation of national objectives, another mode of planning emerges which more closely approaches the concept of ‘local learning’ (Glennester et al, 1983) where organisations seek to explore possible forces for change and how they might respond. Planning here is seen as a means of ‘problem-sensing’ and awareness building (Quinn, 1980) and getting new issues onto the agenda (Pettigrew, 1985). The paper will explore the content of the change agenda in detail and the nature of the planning process. It will discuss an alternative methodology, scenario-building and sketches some themes which could form the basis of future health care scenarios. It argues that the standard national agenda is reaching exhaustion and that there is inadequate succession planning for ‘sunrise issues’.

Scotland ‘Bold and Brave’? Conditions for Creating a Coherent National Healthcare Quality Strategy

Healthcare quality is an enduring and global concern, evidenced via supranational responses, such as those of the United Nation’s World Health Organization (Ovreveit, 2003, 2005, 2013), the OECD (Arah et al., 2003) and the European Union (Vollaard et al., 2013), as well as the policy responses of individual countries (Arah et al., 2003) and devolved regions (such as the Scottish example considered in this chapter1). The Institute of Medicine’s seminal report (IOM, 2001; Kohn et al., 2001) led to increasing recognition of the need for a systems focus in managing healthcare quality. However, a European Union (EU)-oriented analysis (Vollaard et al., 2013: 229) notes, ‘There is much variation [in national quality and safety strategies] between and within Member States and that therefore there is a large potential to learn from each other.’ In this chapter, we follow Ovreveit and Staines (2007) in purposively analysing an established system-wide approach to quality improvement. We consider the evolution of the policy process in Scotland — rather than evaluating its impact — and ensuing lessons for other contexts.