Organisational Change in the Public

Services: Does Evidence Inform Policy?

Professor Ewan Ferlie
School of Management
Royal Holloway University of London
October 2003

Introduction
Can one do organisational research that is
both rigourous and relevant?
Can it should it seek to affect public
policy?
What is the best balance between researcher
engagement and distance?

The Substantive Problem

Increased policy pressure on public service
managers to manage large scale change;
Investment in management of change tools
(Modernisation Agency);
NHS Plan (2000) radical redesign of the health
service around the patient; rhetoric of radical
change and organisational transformation;
Earlier local experiments in the mid 1990s (NHS
Trusts);

The Leicester BPR Experiment

National BPR experiment in Leicester
Royal Infirmary 1992-1997;
Based on Hammer and Champy;
Promised big bang change in two years
against certain benchmarks;
Subjected to an external evaluation;
Managers there went on to take on national
leadership roles post 1997;

Issues in Organisational Theory

From incremental to strategic and now
organisational transformation (OT);
Empirical evidence for OT?
Structuration (structure as well as action)
How to assess OT?
If not OT, then what and why?
Impact of programmatic change strategies such as
BPR?
So some theoretical emplacement;

Methods Organisational
Process Research
Large scale evaluation funded by the Dept of
Health 1994-98;
Qualitative and quantitative teams;
2 senior researchers on the qualitative side;
8 Comparative and longitudinal case studies;
The corporate centre;
One Division (Medicine)
Six clinical settings (A and E 2; gynaecology
2; ENT; gastro enterology)

Methods

Archives
Observation at meetings (50) (major method)
Semi structured interviews (144)
canteen chat
Summative rather than formative approach to
evaluation
Difficult to move to deep multi disciplinary
working
Dept of Health R and D held the ring

Methods
Not action research;
Not partnership based research subjects
not co investigators;
DOH brief was explicit about this;
LRI obliged to cooperate as part of the NHS
finance;
They also welcomed independent
evaluation as a learning source;

Findings The Corporate Story

Pre history up to 1992; NHS Trust status; internal
market; big environmental pressures;
Phase 1: The genesis of the reengineering
intervention at LRI, 1992-94

Project Sigma sites (neurology)

Lesson drawing
Contacts with Hammer
Financial support from NHS Executive

Phase 2, Aug 94- Feb 95

Reengineering diagnostic services and outpatient
clinics;
Management consultants and internal change agents;
Big bang change in 2 years (mix of activity; cost;
quality and process indicators and targets)
Central reengineering labs;
Strategic management approach;
Patient visit and patient test processes;
Some early hits;

Phase 3, the clinical heartlands

March Aug 1995
Switch from sequential to concurrent redesign;
Expansion of labs and projects (about 60 at any
one time)
Emergency entry and patient stay processes;
Difficult to hold together;
Increasing evidence of variable impact;
Local managers and professionals;
Time scales lengthen;

Phase 4, Oct 95-May 96

Reengineering Implementation lags the
reengineering vision
Labs are decentralised to the directorates;
100 projects as of Nov 1995;
Some directorates slow and resistant (e.g. A and E)
Proposals to abolish directorates were not realised;
CEO would not confront clinicians;

Phase 6??
Key managers moved to national level circa
1998;
The three Leicester hospitals merged;
Directorate structure retained;
Long term legacy?

Phase 5, June 96-March 98

Move to a continuous reengineering
model;
Committee structure dissolved and
management consultants pull out;
New process management arrangements;
Change of language (the R word!)
Some momentum for process redesign
continued;

Policy Implications
Limits to big bang change; move back to more
TQM style Collaboratives model;
Differences between private and highly complex
public sector organisations;
Limitations of programmatic change strategies;
Engagement of clinical professionals;
Dangers of early hype;
ALSO a brave and visible experiment which
generated national learning;

Implications for Organisation

Theory
Core finding: convergent rather than
transformational change;
Greenwood and Hinings 1996 model of archetype
change: precipitating and enabling dynamics;
some exogenous and some endogenous;
But also forces which act to ensure the
reproduction of existing organisational forms;

Organisational Reproduction
Failure to generate reformative commitment on a
wide enough scale from key power holders;
Local managers, clinicians and nurses were
defensive;
Defence of professional jurisdictions;
Senior management was cautious;
Mediated through existing functional rather than
process based forms (directorates)

Organisational Reproduction
Counter intuitive alliances between local
clinicians and managers to defend their
directorates;
reengineering did not mobilise sufficient
dissatisfaction with existing arrangements and
commitment to a new organising logic to overarch
or replace value commitments manifest in the
coexistence of clinical specialties and directorates
(p330)

Organisational Reproduction
An institutionalised order with:
Many interest groups and dense organisational
politics;
Powerful professionals;
High complexity and uncertainty;
Embedded values and ideologies;
the old shaped the new (structuration)

Sedimented Change Theory

Original professional bureaucratic archetype
New vertical managerial archetype (1990s) also
emerged (including clinical directorates)
Both threatened by the process organisation
Unexpected defensive alliance between the two;
These sedimented arrangements seem more stable
than previous literature has suggested;
A stable negotiated order rather than a temporary
and fragile state?

The Research Policy Interface

Does research influence policy (or even
should it)?
Notion of Evidence based Policy;
Cf Great Society programmes in USA of the
1960s (Weiss);
Indirect impact; enlightenment and
utilisation models; knowledge creep;
Appreciative communities;

The Research Policy Interface

(Weiss, 2000)
Avoid evaluation imperialism;
Study actual uses of evaluation;
Recognise that evaluation cannot be
insulated from politics;
Make evaluations more valid and
interpretable;

What happened here?

Policy shifted in a way which was
consistent with research;
Researchers asked to present at the Dept of
Healths Strategy Unit;
BPR was not diffused nationally;
move on to so called Service Collaboratives
(more incremental; high emphasis on
learning; strong on clinical involvement)

Positive factors?
A political rather than a Political decision;
Strong track record of evaluation in the service
redesign area: research had something to say;
LRI managers now in national positions;
Long period of face to face contact with the
research team;
An appreciative community or community of
practice was emerging?;

Positive Factors
Synthetic reviews (more cited than read)
summarised the lessons;
OUP research monograph as a source of
legitimation;
A useful alibi for the limits to OT in the
NHS Plan?

Academic and Policy COPs

Bartunek et al write about stimulating
communication across different communities of
practice;
COP linkers and hybrids (Strategy Unit; R and D
personnel);
Academic presentations to policy audiences;
Research friendly managers; (DBAs)
Lot of face to face contact;

New Managerial COP?

Around the management of change;

New institutions, roles and budgets;
NHS Modernisation Agency;
Interest in learning and applied research;

Criticisms of the Book

Too academic;
Too long;
Summative rather than formative:
watching people drown
No follow up with a D component;
NOT the methodology itself;

Reflections on Research Style

Reformist and Fabian in tone;

Not Critical but critical!
Balancing rigour and relevance;
Balancing distance and engagement;
Speaking different languages to different
audiences (ASQ and HSJ);
The pleasure of research with an outward facing
component; having fun in the process;

References
Bartunek, J. et al (2003) Sharing and
Expanding Academic and Practitioner
Knowledge in Health Care, 8 (S2), 62-67
In Journal of Health Services Research and
Policy, 8 Supplement 2, special issue on
researcher decision maker partnerships;

References
McNulty, T. and Ferlie, E. (2002)
Reengineering Health Care: The
Complexities of Organisational
Transformation
Oxford: Oxford University Press
Paperback in Jan 2004!
Also Organisational Studies article appearing
in 2004;

References
Weiss, C.H (2000) The Experimenting
Society in a Political World, in (Ed)
Bickman, L. Validity and Social
Experimentation London: Sage