Leadership, Service Reform, and Public-Service Networks: The Case of Cancer-Genetics Pilots in the English NHS

Abstract

In attempting to reform public services, governments worldwide have sought to effect change through policies aimed at both transforming structures of public service provision and facilitating the agency of public servants working within these. Various obstacles have been found, however, to impede the effectiveness of such efforts. In this paper, the authors examine the role of organizational networks and distributed leadership-two prominent policies aimed at structure and agency respectively-in the establishment and consolidation of service reform in the English National Health Service. Using a comparative case-study approach, they contrast the trajectories of two attempts to introduce and gain acceptance for service reform, noting important differences of context, process and outcome between the sites. The findings indicate the importance of dispersed, as well as distributed, leadership in achieving change in a networked public-service setting. Effective leaders may indeed achieve change through the structures and processes of the network. However, the coexistence alongside the network of other organizational forms constrains the ability of leaders to achieve change without complementary action beyond the boundaries of the network.

The Grit in the Oyster: Professionalism, Managerialism and Leaderism as Discourses of UK Public Services Modernization

“…Across the world there has been an exponential rise in the advocacy of 'public value' or public service leadership as a means for reinvigorating state-run services (Goldfinch and Wallis 2010;Martin, Currie and Finn 2009;O'Reilly and Reed 2010;see OECD 2010 for an example). Prompted by this advocacy of public service leadership as a form of legitimated organizational agency in a variety of international contexts, this article focuses on the UK as an illuminating individual case study.…”

Networked innovation in the health sector: comparative qualitative study of the role of Collaborations for Leadership in Applied Health Research and Care in translating research into practice

“…Here, recent studies, with relatively few exceptions, have focused on networks as formal, quasi-organisational entities, frequently associated with policy interventions. 65 As McAneney et al 36 note, relatively few studies have addressed the implications of network structure for KT. Only in more recent work do we find social network analytical techniques being applied to uncovering the latent structure of ties between groups and individuals.…”

“…The impact of the institutional and policy context on innovations in health care is widely reflected in the existing literature. 40,65,78,79 One conclusion here, then, is that, while much can be learned from models of KT in other nations, we must also be sensitive to the need to adapt and appropriate such models for the UK health-care setting.…”

Responsibilising Managers and Clinicians, Neglecting System Health? What Kind of Healthcare Leadership Development Do We Want? Comment on “Leadership and Leadership Development in Healthcare Settings - A Simplistic Solution to Complex Problems?”

“…As McDonald notes, discourses of leadership have moved away from a sole focus on those at the apex of organisations, towards various forms of distributed leadership. Such shifts might be seen as reflecting the more complex reality of healthcare networks and markets, where the authority of a small group of leaders at the top of a hierarchy is no longer sufficient on its own to determine organisational direction (2,3). With this shift towards distribution of leadership has come a proliferation of forms of leadership behaviour, with concepts such as 'quiet' and 'servant' leadership joining more traditional understandings of transformational and heroic leadership (4).…”