Nick Goodwin

Asking the right questions: Scoping studies in the commissioning of research on the organisation and delivery of health services

Scoping studies have been used across a range of disciplines for a wide variety of purposes. However, their value is increasingly limited by a lack of definition and clarity of purpose. The UKs Service Delivery and Organisation Research Programme (SDO) has extensive experience of commissioning and using such studies; twenty four have now been completed.This review article has four objectives; to describe the nature of the scoping studies that have been commissioned by the SDO Programme; to consider the impact of and uses made of such studies; to provide definitions for the different elements that may constitute a scoping study; and to describe the lessons learnt by the SDO Programme in commissioning scoping studies.Scoping studies are imprecisely defined but usually consist of one or more discrete components; most commonly they are non-systematic reviews of the literature, but other important elements are literature mapping, conceptual mapping and policy mapping. Some scoping studies also involve consultations with stakeholders including the end users of research.Scoping studies have been used for a wide variety of purposes, although a common feature is to identify questions and topics for future research. The reports of scoping studies often have an impact that extends beyond informing research commissioners about future research areas; some have been published in peer reviewed journals, and others have been published in research summaries aimed at a broader audience of health service managers and policymakers.Key lessons from the SDO experience are the need to relate scoping studies to a particular health service context; the need for scoping teams to be multi-disciplinary and to be given enough time to integrate diverse findings; and the need for the research commissioners to be explicit not only about the aims of scoping studies but also about their intended uses. This necessitates regular contact between researchers and commissioners.Scoping studies are an essential element in the portfolio of approaches to research, particularly as a mechanism for helping research commissioners and policy makers to ask the right questions. Their utility will be further enhanced by greater recognition of the individual components, definitions for which are provided.

Assessing the impact of the NHS Service Delivery and Organisation Research and Development Programme

The MDS/RAI (Minimum Data Set Resident Assessment Instrument)is a standardised assessment system developed by interRAI used internationally to raise standards of care in long-term care homes. Implementation in the UK has been sparse and currently there are no well-established demonstration sites for use in long-term care (although Cheshire has adopted and successfully implemented the (MDS-HC (Minimum Data Set Home Care) for community care). Successful implementation of the MDS/RAI requires a methodical approach and commitment: it is a way of developing best practice that goes far beyond just gathering information about care needs. This project aimed to develop an implementation process model for MDS/RAI use in three UK care homes through an iterative and collaborative process.

A managerial and organizational perspective

In the English National Health Service (NHS), the policy of ‘patient choice’ has been developed as a mechanism for creating capacity, improving access and making services more responsive to patient demands. The policy has been manifest in two ways. First, patients waiting more than six months for an operation are entitled to choose an alternative place of treatment. At least one alternative provider should be offered, including a booked time with a shorter wait, in an accessible location. Second, the policy of ‘Choose and Book’ has offered patients needing a hospital referral for elective treatment a choice of four or five providers. The choice of provider can range from an NHS hospital, an NHS treatment centre, a general practitioner with a special interest, a private hospital or an independent sector treatment centre. The choice must be informed, for example, by information on waiting times, geographical location and measures of quality of care. In this issue of the Journal there are two essays on patient choice. Dixon and Le Grand (pp 162–66) explore the possible consequences of greater patient choice for equity, and Thomson and Dixon (pp 167–71) review experiences of choice in other European countries. We invited three people to reflect on the concept of patient choice from different disciplinary perspectives – management, economics and sociology.

An Integrated Theory of Networks

In this chapter, we begin to build the theory which will be developed further in later chapters and then explored empirically in Part III. This theory is fundamentally institutionalist, in that it argues that the fundamental causal forces shaping networks are institutional in character. Like institutional theories in general, it suggests that these institutional factors provide marked constraints upon the scope for optimisation in the choice of network form. They impose limitations on the scope for human agency and also exert pressures for the primacy of certain biases in the ways of framing that choice. These limitations and pressures constrain the options available to agents in particular contexts and these can be explained by the institutional factors that the theory emphasises. However, it allows for a wider range of causal dynamics than do many ‘new’ institutionalist theories.

Trust between Organisations

Trust and trustworthiness have long been regarded as essential characteristics of inter-organisational networks. Indeed, it is commonplace within the social sciences for trust between organisations to be regarded as a positive attribute in alliances, partnerships, networks, and joint ventures. Trust, it is argued, helps to manage uncertainty (Gluckler and Armbrster, 2003); make co-operation easier (Doucette and Wiederholt, 1997); enable organisational learning (Ingham and Mothe, 1998); sustain accountability (Tomkins, 2001); encourage effective joint project management (Holt et al., 2000); secure commitment between parties (Geyskens et al., 1996) including those who have very different degrees of power (e.g. Kim, 2000); and support industrial districts (Sabel, 1992; Boschma and Lambooy, 2001) and economic development in developing countries (Murphy, 2003). Unsurprisingly, the crucial importance of trust has seeped into the literature aimed at managers involved in partnership (e.g. Greig and Poxton, 2001). Perhaps more surprisingly, most of these propositions about the general benefits of trust were already well known to social scientists more than 30 years ago (see Akerlof, 1970; Arrow, 1974; Fox, 1976; Barber, 1983; and Zucker, 1986).

Networks in Defence Procurement and Supply

This chapter examines networks in two distinct but closely related areas: arms procurement and arms supply. Markowski and Hall (1998) identify six dimensions of arms procurement: user requirements (what to buy?); division of labour (make or buy?); contracting (what type of contract?); source selection and competition (how much competition?); organisational (who should have the authority and responsibility for making procurement decisions?); and international collaboration (what should be the drivers of international procurement?). This final dimension – the extent of international collaboration between sovereign governments that underpins the other five dimensions – is the focus of discussion of procurement in this chapter. As the specifiers and paymasters for most new weapons systems, thus acting in effect as monopsony purchasers in contractual arrangements that can take up to twenty years to complete and with keen economic interests in the protection of domestic suppliers, the behaviour of governments is central to shaping the supply side of the defence industry.

Combating Crime, Disorder and Drugs

This chapter considers the development of networks designed to combat crime, disorder and drug misuse within the United Kingdom since the 1980s. These networks are largely designated partnerships within the literature. The period covered by this review reveals three distinct approaches to partnership development in this sector which are themselves informed by broader public policy trends in governance: early network initiatives typified by non-financial voluntary partnerships between enclaves; the overlay of formalised, contractbased relationships between purchasers and providers within internal markets; and, finally, the development of hierarchical hybrids in the form of statutory partnerships in which networks between agencies were mandated rather than encouraged and a suite of joint partnership structures (network forms) for monitoring, predicting, analysing and preventing crime and disorder were developed. The balance of material considered in this review concerns the formation of hierarchical hybrids, whose reported strengths and weaknesses are considered in the light of the neo-Durkheimian framework.

Learning and Leading Across Networks: Styles and Sensibilities

This chapter addresses two sets of issues that are concerned with the processes and capabilities within organisations by which they can support the strategies of, first, management in, and second, external management of, networks that were discussed in Chapter 6. To operate effectively in networks, organisations must be able to recognise and to make intelligent use of information from other organisations, whether that information is taskspecific, structured and concerned with specific operational matters or is more general intelligence about the conditions in their field. That is to say, organisational learning is key to achieving effective influence in networks. This chapter draws on studies of capacities for learning in organisations to enrich the theory already developed. Here, we are concerned principally with management in and of networks rather than their external governance.

Types of Networks

One of the central arguments of this book is that the development of a taxonomy of network forms is more useful than any simple definition of networks. Such a taxonomy offers the chance to distinguish between network forms in respect of the opportunities around, constraints on and resources for management within, management affecting and governance of networks. Moreover, each network form has a different context for sensemaking around these management activities since all networks exhibit divergent patterns of relationships between the member organisations or individuals (despite the claims of some writers and theorists).

Governing and Managing Across Networks: Tools and Strategies

Management within networks is a term used to mean a range of decision-making activities such as resource acquisition and allocation, production, distribution and exchange, co-ordination, positioning, planning and strategy development, collective sense-making, and so on. These activities impact, either intentionally or unintentionally, upon the size, structure and location of power within networks, whether they are collaborations between individual or organisational peers or connections of upstream suppliers and downstream customers.