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The NHS is undergoing possibly the most significant and far-reaching of its many reforms since its inception in 1948. Many of the reforms relate to experimentation with new forms of ‘governance’. This can be interpreted in a wide sense to include aspects of markets, hierarchies and networks. Recent examples include the revised SHAs, PCTs, Foundation Trusts, ISTCs, and the proposal for a new NHS Board. In the narrow sense the reform of governance concerns recent changes, for example, to the board representation in the various health Trusts.
The purpose of the research is to explore the nature and extent of the linkages between, governance, incentives, behaviour and performance outcomes within the NHS. The first term we define as including ‘organisational arrangements’, organisational structuring, organisational routines, procedures and other administrative and management methods and processes. The managed market commissioning, challenge and choice models within the current policy reforms would be examples as would the scope for collaboration and network arrangements.
Quantitative and qualitative methods are being used. The research team is tracking the multiple measures and performance indicators used by a variety of players in the system at all levels. Qualitative data is being collected concerning actors priorities and interpretations at every level - from Department of Health and at all points through the system including front line health care workers.
Other methods include a postal survey of NHS executives and non-executive members of Trust Boards; a tracking of multiple performance indicators over time; and most centrally, a number of detailed case studies.
Usually, organisational governance and other aspects of organising are designed with an intent to shape behaviour in some way. There is an expectation that certain ways of organising will generate incentives to prompt desired behaviour. A great deal of time is spent trying to design and redesign and to organise and re-organise health services. Recent examples include the revised SHAs, PCTs, Foundation Trusts, ISTCs, networks etc. Much is at stake for patients, staff and society. In this context our work FOCUSES ON:
(1) what national-level system designers intend and expect when they make policy choices affecting organisational forms (and the theories, frameworks and assumptions that underlie these);
(2) how directors, managers, leaders and senior clinicians interpret and respond to the policy message they receive concerning governance and organisation (issues around culture and orientation, commitment, compliance, discretion and autonomy, and strength and weakness of connections and ties);
(3) the organisation and governance design principles used at organisation level by directors and managers (the implicit and explicit rules that frame and drive their decision-making and action);
(4) how healthcare staff perceive and respond to the governance and incentive messages they receive. What are the impacts on health outcomes?
