Understanding Change in the NHS

Pettigrew (Pettigrew A., 1988) argues that research in change within the NHS should be looked at from a processual, comparative, pluralist and historical perspective.   He further argues that the NHS has been, since the mid 80s, under a number of pressures which he attributes to the following:

• growth in the public demand for services
• the pace of technological change
• cash limits to welfare provision
• growth of consumerism
• government’s changing priorities.

He highlights the fact that there is a gap between statements of strategic intentions and operational reality – the difference between rhetoric and reality.

My research in plain English

Recently I came across a list on Twitter #phdchat .  I don’t post much on the list so I assume I could be classified as a lurker but I have found the phd community there incredibly helpful and supportive.  One of the excellent suggestions was to try to write about our research in plain English.  I think this is an excellent idea as it will help me in trying to clarify my own thinking without the background noise of putting it into ‘academic speak’.

The National Health Service has been going through  key changes ever since its inception in 1948.  There are various justifications why the changes are needed.  We are seeing numerous ones as the moment!   However, the changes have tended in the past to be based on the experiences and knowledge of the medical staff themselves.   Since the late 80s this has started to change.   There appears to be an emphasis on introducing new ideas that have been drawn up by central government as opposed to independent initiatives.    NHS Direct, the national telephone medical advice service has been one of such innovation that I am referring to.    But how do we know whether these changes are succesful?  There have been a number of investigations looking at whether services/innovations have been successful or not but what interested me was using a different way of judging as to whether a service is a success or a failure.   I am doing this by trying to  understand how people decide and actually negotiate that something as complex as NHS Direct is judged a success or a failure.

I spent the first few years when NHS Direct was introduced talking to a group of doctors and nurses in the North West of England trying to understand their views of NHS Direct and see how they had started to use NHS Direct as part of their service in treating patients.   I then took a break of six years and went back again to the doctors and nurses to see if their views and opinions on NHS Direct had changed.   I am interested in understanding how the NHS staff make sense of all of this and how does that then affect their decisions as to whether NHS Direct is a success or failure.

I am hoping that by using NHS Direct as an example I can shine a ‘different’ light as to how changes could be introduced in large complex organisations such as the NHS in the current climate of everything being imposed on people from the centre.

How to write everyday!!!and not go crazy

I have come across an excellent PhD blog, the Thesis Whisperer.  It has great advise and really helpful ideas especially for PhD students who are working on their research part-time and away from their institution.  The latest article is about how to get organised and write everyday.  It is brilliant.  Thank you to Thesis Whisperer!

NHS Direct intends to become a Foundation Trust!

Recently we saw media coverage stating that NHSD was going to cease to function and that its role was going to be taken over by 111.  Yes, how come then they are still intending to apply for Foundation Trust status. Is this another of the government’s u-turns or once again the media misinterpreting news about NHSD.

The PhD Blog

There are a great many sites out there which can help with the studying for a phd especially if you are doing it part time and away from your institution.  It is important to network and I think that the social networking digital media is probably my best option.  In the space of two days I have read an excellent blog, joined a twitter community of fellow phd researchers and not come across this phd blog which offers lots of useful advice.  Thanks to everyone doing this out there!

PhD blog and chat on Twitter

Great post on the Guardian’s Higher Education Network about blogging whilst writing your PhD.   This is something that i am trying to develop and not having much luck!  Maybe talking to a community within Twitter, see #phdchat might help as well.   Keeping fingers crossed.

Digital Taylorism

I know that this is not directly relevant to my PhD but I thought it was so great that I wanted to keep a record of it somewhere.    The labour-market academic Phil Brown has a come up with this phrase: Digital Taylorism. It’s a play on FW Taylor’s idea of scientific management. Taylor didn’t think much of the American worker (“The man who is . . . physically able to handle pig iron and is sufficiently phlegmatic and stupid to choose this for his occupation is rarely able to comprehend the science of handling pig iron,” he told Congressmen) and saw them as mere cogs, working to a fixed pattern set from above. Where this has already happened to manual work, Brown argues, it’s now happening to skilled and graduate jobs: law, finance, software-engineering.  Everything is being digitised – even teaching!  A school in London is providing one to one Maths tuition with the virtual tutor being located in India.   So what impact will this have on the middle classes on the western world?

Primer on leading improvement in systems

BMJ article by Don Berwick on a systems perspective on health improvement.

Changing role of NHS Direct

Years ago I spoke to GPs asking them why they weren’t using NHS Direct to manage their appointments and take bookings.  The reply was ‘Oh no that is not possible – different systems, different, organisations, different cultures’! Well ten years on and some GPs have decided that maybe there is some value in thinking outside the bos in relation to NHS Direct.  See Guardian story ” Need to book an appointment with your GP, call NHS Direct”!

Most big change management systems fail!!!

Editorial in the BMJ 29th January on the organisational changes taking place in the NHS.  David Nicholson, the NHS chief executive, is quoted within that editorial stating that ‘most big change management systems fail!  Interesting take and something to follow through!  This is linked to top down reorganisations – something that the NHS has been doing the past ten years of which NHS Direct was one of them!