Understanding organizational culture in reforming the National Health Service (original) (raw)

Looking forward: Clinical governance and the drive for quality improvement in the new NHS in England

BMJ, 1998

sugar and adjust their insulin doses, achieving far better control than when the doctor was making the insulin adjustments. 9 You learned from Dr David Sobel at Kaiser Permanente in America, who trained chronically ill adults to provide care and education to other chronically ill adults, achieving better health status outcomes and lower cost for both teachers and students. 10 You built your programmes on evidence of the benefits of patient self care in studies of asthma treatment, 11 hypertension treatment, and self diagnosis of urinary tract infection. 12 By the early 21st century, the NHS was becoming a truly patient centered clinical care system. The emphasis today is on helping people with acute and chronic illnesses to become experts in their own care whenever they wish, able to participate fully in their own diagnosis, treatment, and monitoring. Shared decision making, incorporating every patient's values and circumstances, is now the norm. 13 NHS patients today write in and read their own medical records, receive much of their care in their own homes, and remain fully connected with their loved ones and communities. At first, your doctors resisted this trend-fearing, perhaps, that it would relegate them to second fiddle, demean their expertise, and perhaps subject patients to undue hazards. Instead, this reformulation of the respective roles of doctor and patient has helped everyone-giving patients and their families the chance to establish control over their own lives and giving doctors, nurses, and other healthcare professionals the chance to focus their time and energies on exactly those technical, pastoral, and humanitarian tasks that they are in the best position to pursue. These principles endure. You are not by any means finished. As in 1998, and as it will be in 2048, you in 2023 seek the continual improvement of an NHS full of knowledge, taking the best as its norm, growing its capacity as a full and integrated system of shared effort, wasting little, and respecting every patient as an individual. You continue to know that you started off right in 1948, and with some important midcourse corrections, you remain well on track. Maybe some day healthcare leaders in the United States will catch up. I am sure you will help them if they ask.

Internal Market Reform of the British National Health Service

Health Affairs, 1991

In 1984, Gordon McLachlan, then director of the Nuffield Provincial Hospitals Trust in London, invited Stanford professor Alain Enthoven to spend a month in the United Kingdom reviewing the British National Health Service (NHS). At the end of his visit, Enthoven was to give a talk to the Nuffield board of trustees, offering his views on which direction the NHS should head us the British government contemplated its reform. Enthoven's findings were published in 1985 as Reflections on the Managment of the National Health Service, a document that eventually reached the hands of then Prime Minister Margaret Thatcher and her advisers. "Enthoven's notion of an 'internal market' in the NHS. .. looks remarkably like the solution adopted by the government four years later," Rudolf Klein and Patricia Day have noted. In this article, Enthoven examines the concept of internal market reform, which is designed to address the perverse economic incentives that have existed for years in the NHS. "The NHS is intensely political," Enthoven said. "All over the world, it carries much ideological freight. What I have done is to look at it us a practical problem in organizational management: how to structure the service so that desirable innovations will happen." Enthoven's association with Britain is a long and fruitful one. The son of a British father, he studied at Oxford as a Rhodes scholar, received a muster of philosophy degree in economics, and her returned as a visiting fellow at St.

REDESIGNING UNITED KINGDOM’S HEALTHCARE SECTOR

The United States’ healthcare system has evolved over the years, with the development of newer techniques for evaluating and improving healthcare quality (Luce, Bindman, & Lee, 1994; Burstin, Leatherman & Goldmann, 2016). However, recent studies reveal inefficiencies in United States’ healthcare system (Garber & Skinner, 2008; Goldman, 2015). Kaplan and Babad (2011) claim that majority of the healthcare organisations in the United States of America are privately owned and profit oriented, with some researchers revealing the growing proportion of Americans that do not benefit from the healthcare system (Ayanian et al., 2000; Goldman 2015). Goldman (2015) attributed these inefficiencies to the differential ideologies upheld by the politicians in America’s two-party system. Goldman (2015) stated that although American politics and existing policies hamper the nation’s ability to fully solve welfare related issues in the healthcare system, these two elements are needed for bringing about reform.

Accounts of the NHS reforms: macro-, meso- and micro- level perspectives

Sociology of Health and Illness, 1996

The purpose of this paper is to review the various strands of academic commentary on the origins of the reforms of the British NHS announced in Working for Patients and implemented from 1991. The intention is to point to the very different ways in which this major event was interpreted and to question some of the interpretations advanced of the reforms. Ranging the various perspectives along a continuum from macro-level accounts (at the level of global or international trends) to micro-level perspectives (which concentrate on developments internal to health care systems), the paper draws attention to the multifaceted character of the various explanations that have been advanced and argues that no one perspective can satisfactorily account for the reforms. A degree of ecleticism may therefore be involved in producing a comprehensive explanation, and the paper draws attention to some parallels between accounts written from rather different ideological perspectives.

Competition, Cooperation, Or Control? Tales From The British National Health Service

Health Affairs, 1999

In the battle between market competition and central control in Britain's health care system, control won. Will Labour's new version of the market prevail? by Julian Le Grand PROLOGUE: In July 1998 the British National Health Service (NHS) marked its fiftieth anniversary. The NHS brought together in one organization, for the first time, hospital, physician, and community health services-and also posed administrative and fiscal challenges that continue to plague it. Britain undertook the latest in a series of reforms after the New Labour party assumed power in 1997. This latest reform, which represents a "third way" between the poles of liberal and conservative, focuses more on collaboration and less on the competitive principles of the previous internal-market reforms of Britain's Conservative government. In this paper Julian Le Grand discusses "the evidence concerning the internal market's effectiveness," building on a paper published in Health Affairs last July (Rudolf Klein, "Why Britain Is Reorganizing Its National Health Service-Yet Again"). Following Le Grand's paper is a series of Perspectives, focusing both on the NHS reforms and on another endeavor under way in Britain: an attempt to address inequalities in health, based on a study of the social determinants of health and poverty. This discussion has implications for other health care systems as they seek to improve their citizens' health in an era of cost constraints. Le Grand is Richard Titmuss Professor of Social Policy at the London School of Economics and holds a doctorate in economics from the University of Pennsylvania. He has served as an adviser to the World Bank and the European Commission, and is prominent in Britain as an advocate of the "third way."

Membership of the 'New Style' Health Authorities: Continuity or Change?

Public Administration, 1993

The 1989 White Paper 'Working for Patients' continued the process begun by Griffiths of managerial reform and the introduction of private sector concepts into the NHS. One of the new proposals was to change the composition and constitution of health authorities, both to avoid the assumed weaknesses of the existing format and to emulate the pattern found in the private sector. The essence of the change was the removal of the representational elements on authorities, both of medical professionals and nominees from the local authority. The health authorities were reduced in size to just eleven members and for the first time executives were included. Previous attempts at reform within the NHS have been judged to have resulted in more continuity than change. This article examines in detail who the new members are and assesses the balance between continuity and change. Despite a high level of continuity of membership, there are signs of more fundamental change. There is a significant increase in the proportion of non-executive members from the private sector and with the inclusion of executives, a stronger managerial role is emerging. The article concludes by assessing what the implications of these changes may be.

The 1974 reorganization of the British National Health Service: An analysis

J Commun Health, 1975

, for the first time since its formation in 1948. The Reorganization attacked one serious problem: the anomalous separation of the general practitioners (and other nonhospital, non-local authority ambulatory services), hospitals, local government authority public health services, and teaching hospitals into different administrative units with different boundaries. These services are now integrated into one structure. However, other important problems will not be affected substantially. The British National Health Service (NHS) was 25 years old on July 5, 1973. On that date, the Royal Assent was given to legislation intended to effect major changes in it. 1 On April l, 1974, the NHS underwent its first major administrative reorganization. The NHS has significant achievements to its credit but also has some serious problems that the Reorganization is intended to address, at least in part. This paper will describe the major achievements and the major problems of the National Health Service, the premises on which Reorganization is based and its major provisions, and the ways in which the Reorganization may (or may not) affect the problems. Reorganization for each of the four parts of Great Britain-England, Wales, Scotland, and Northern Ireland-is, in each case, slightly different. We will concentrate on the English Health Service, since England contains the bulk of the population of Great Britain. We will deal briefly with the Scottish Health Service in a separate section.