The Quasi‐market, the Entrepreneur and the Effectiveness of the NHS Business Manager

Abstract

The recent changes in the UK National Health Service were heralded by the publication of the Griffiths report in 1983 which highlighted the need for a business‐like’approach to management. The policy makers’generic strategy of the late 1980s and early 1990s centred around the concept of‘quasi‐markets’. These were artificial internal markets encompassing the purchasers and providers of public services. Little research has been undertaken into this new phenomenon of the‘quasi‐market’but entrepreneurship economic theory would suggest that for markets to be efficient would require a supply of alert and aware entrepreneurs. Within the restructured NHS, the mantle for entrepreneurial management seems to have been placed firmly on the shoulders of the newly created‘business managers’. A 1993 survey amongst NHS business managers in first and second wave trust hospitals in the Trent Regional Health Authority indicated that whilst business managers were knowledgable of what entrepreneurial activity is, they currently feel constrained in their new roles for a variety of reasons. The authors suggest that rational economic analysis is insufficient to explain this lack of innovatory endeavour. Instead policy makers’attention should be devoted to liberating health managers from their current constraints to encourage their entrepreneurial development.

Management retention in the NHS

“…Following the 1990 reforms, managers who had chosen to work in the service for idealistic reasons as well as security of employment (Palmer, 1996), found they were criticised and often the victims of reorganisations. The NHS was an unpleasant employer (Flanagan, 1997) for managers, because unlike clinicians (Boyett and Finlay, 1995), managers were not seen as organisational assets. Blame for failure tended to be apportioned to individuals rather than systems (Iles, 1997).…”

The organizational implications of the role NHS Service Managers played in the quality process in the mid-1990s

“…There was also little evidence in this study of proactive strategies on the part of the Trusts as advocated by Joss and Kogan (1995). There were double standards prevailing in the NHS at this time, clinical failures were allowed (Boyett & Finlay 1995), in contrast with the emphasis placed on finance and increased throughput (Howarth 1997). Service managers played a more active role in finance than they did in the maintenance of standards.…”

Entrepreneurship research dynamics (1992–2013): Aim at entrepreneurial, innovative firms and business operations

“…Entrepreneurship economic theory would suggest that for markets to be efficient, it would require a supply of alert and aware entrepreneurs [60].…”