Tim Packwood

Case study evaluation.

Case study evaluations, using one or more qualitative methods, have been used to investigate important practical and policy questions in health care. This paper describes the features of a well designed case study and gives examples showing how qualitative methods are used in evaluations of health services and health policy.

Evaluating the Benefits from Health Research and Development Centres A Categorization, a Model and Examples of Application

The most appropriate criteria and the best approach for evaluating centres concerned with research into health and health services, are matters of academic and policy debate. There is interest in assessing the impact made by research on policy and practice as well as using more traditional peer review of the knowledge produced. In this context the article describes the development of a multidimensional categorization of benefits, or payback, from research and development (R&D) and a model for conducting evaluations of impact. This categorization and model were used during an assessment of two R&D centres funded by a regional office of the National Health Service in the UK. The acceptability of such an approach is discussed in the light of relevant proposals from other authors, changes in the nature of knowledge production and the consequent role of multiple stakeholders.

Assessing Benefits from Department of Health and National Health Service Research & Development

Public services in the UK are increasingly expected to account for their outputs and performance. This article describes a retrospective evaluation of the benefits from the R&D funded by a regional office of the NHS Executive. The methods adopted enabled the various elements of the regions R&D portfolio to be examined and provided a basis for the development of a plan for regular monitoring. The proposals for implementation are now also feeding into a debate as to how health services R&D might best be monitored nationally in a way that is compatible with the norms and practices of research in other contexts.

Process and structure: resource management and the development of sub-unit organisational structure.

Resource Management (RM) requires hospital units to manage their work in new ways, and the new management processes affect, and are affected by, organisation structure. This paper is concerned with these effects, reporting on the basis of a three-year evaluation of the national RM experiment that was commissioned by the DH. After briefly indicating some of the major characteristics of the RM process, the two main types of unit structures existing in the pilot sites at the beginning of the experiment, unit disciplinary structure and clinical directorates, are analysed. At the end of the experiment, while clinical directorates had become more popular, another variant, clinical grouping, had replaced the unit disciplinary structure. Both types of structure represent a movement towards sub-unit organisation, bringing the work and interests of the service providers and unit managers closer together. Their properties are likewise analysed and their implications, particularly in terms of training and organisational development (OD), ate then considered. The paper concludes by considering the causes for these structural changes, which, in the immediate time-scale, appear to owe as much to the NHS Review as to RM.

Clinical audit: integrating the management of quality.

The recent implementation of clinical audit by the Department of Health seeks to both integrate existing professional audit activities, and to integrate the resulting multi-professional audit more closely with other quality-assurance activities developed by corporate management and purchasers. This paper, which is based on studies of medical and clinical audit undertaken over the past 3 years, examines the potential for integration in the light of, first, the history and characteristics of the different forms of quality assurance initiative and, second, a comparison of their different properties. In many ways clinical audit appears to stand between domination by both professional and managerial influences, which may enhance its potential for integrating different approaches. If, however, clinical audit is to succeed it is suggested that it requires a strong managerial infrastructure; with clearly delineated responsibilities related to the different modes of quality assurance.

Doctors and resource management: incentives and goodwill

The increasing pressure on resources available for health care in many countries has led to a re-examination of the way in which resources are allocated and committed. One important and innovative option is for managers and doctors to collaborate formally in decision-making. This paper draws on experience of this approach in the UK National Health Service, in the Resource Management Initiative and suggests that its success or failure depends on the nature and strength of the incentives to the two sides to collaborate.

Analysing changes in the nature of health service management in England

Health service management maintains a balance between collective values concerned with service provision and individual values concerned with health practice. It is also balanced between the application of co-ordinative and directive approaches to management. Over the last quarter century economic and ideological factors have caused health service management to experience more directive. Today, the role of health service management becoming more directive. Today, the role of health service management appears further threatened by staffing cuts and changes in traditional patterns of organising work. This, while it may lead to bifurcation between specialist and general management roles, is unlikely to restore the dominance of practitioner values or notably soften the form of management.

Return to the Hierarchy

Concepts of bureaucracy are frequently associated with restriction, rigidity and authoritarianism. Yet, the government of the educational system assumes a bureaucratic organisation with a hierarchy of authority and accountability. This article argues that bureaucratic concepts provide an opportunity to shape school organisation more flexibly than is commonly appreciated. It suggests how bureaucratic concepts can resolve current problems and help adapt the organisation of schools to future demands. The author is in the Department of Governmnent at Brunel University.

Complexity and contradiction in NHS computing

The National Health Service (NHS) has entered a new world of managed competition, where the purchasing and provision of services are formally separated. Accompanying the changes are major investments in computer systems, which will continue for at least the first half of the 1990s. However, the performance of the NHS in implementing computer systems has been variable, so that now is an appropriate time to review the current status of NHS computing, and to consider the key issues for computing in the new environment.

1. The School as a Hierarchy

ial Administration, Brunel University Criticism of the hierarchy has become passe. Authoritarian, anti-individual, anti -professional, inflexible, ineffective and outdated are just some of the epithets that are levelled. Yet work on the Homes, Schools and Social Service; Project undertaken by the Educational Studies Unit of Brunel Universityl demonstrated both the hierarchy’s ubiquity and its complexity as an organisational ton in the schools. This paper, then, attempts to present a fuller picture of the hierarchy in the school situation, describing its components and arguing that tht epithets mentioned above are not necessarily deserved.