Designing Health Service Organization in the UK, 1968 to 1998: from Blueprint to Bright Idea and ‘Manipulated Emergence’

Abstract

Four sets of reforms of the National Health Service are employed to illustrate the changing character of policy making in this sector over a thirty year period, from the production of a carefully developed technocratic blueprint for its organization to the promulgation of a series of bright ideas accompanied by incentives for local actors to develop them into concrete organizational arrangements consonant with these ideas. We term this latter approach ‘manipulated emergence’ and relate it to the literatures of organizational culture and of post‐Fordism. The approach adopted by the 1997 Labour government is largely, though not wholly consistent with this, and it remains to be seen whether the high‐water mark of manipulated emergence has passed.

Leadership competencies for implementing planned organizational change

“…NHS managers play a key role in the implementation of changes because NHS policies provide, rather than a narrowly defined blueprint, a broad outline that accommodates local innovation (Harrison & Wood, 1999;Peckham & Exworthy, 2003). Thus, although the government mandates initiatives for change, managers at the regional and organizational levels are responsible for implementing changes appropriate to local needs and circumstances.…”

The influence of institutions and culture on health policies: different approaches to integrated care in England and The Netherlands

“…The strategies of 'New Public Management' should bring the rigours of the private sector into the NHS and Local Authorities (for a discussion of neoliberalist policies in the health sector see Allsop 1995;Harrison and Wood 1999;Light 2000). A purchaser/provider split was created, expecting that competition would increase health care efficiency and user-orientation.…”

Organization, Society and Politics

“…Attempts at marketization produce conflicts and tension cross-nationally and in different parts of the sector, for instance 'choice', voucher schemes, capitation (payment per client treated or served), internal markets, the 'purchaser/ provider split', privatization, the commodification of 'science' (Cooper and Taylor, 2005;Gibbons et al, 2004;Harrison and Wood, 1999;Hyde and Davies, 2004;Kazancigil, 1998;Morrell, 2006b;Mrotek, 2001). More broadly, the transnational phenomenon of new public management, and managerialism, can be understood as an explicit attempt to replace hierarchic modes with market-based initiatives, and to replace administration with management (Ballas and Tsoukas, 2004;Shergold, 1997).…”