I have recently read a phd that carried out research in general practice groups and understanding bureaucratic initiatives in these organisations. The main contribution to knowledge for that phd has been that research in this field has very rarely focused on assessing general practice groups as ‘organisations’. They have been classed as self-employed, individual bodies. As such very little of the research has tried to apply organisational theory on these groups. The premise of the research was that if you begin to do this then you begin to make sense of some of the complexities prevalent and thus help with understanding bureaucratic initiatives…….
This got me thinking as regards to my research. Having looked at the literature, in relation to NHS Direct, there is a diversity of opinion as to whether NHS Direct is a success or failure.
From the OR point of view it is deemed a success as they have achieved their objectives. See Royston OR paper. From the Medical professions point of view it is not deemed as a success as it is perceived to be ‘unreliable’, ‘using inappropriate algorithms’ and it does also encroach on their territory as the gatekeepers of the NHS. NHS Direct has ‘polarised opinion’.
I could then take the premise that the research has not really been looking success/failure as highlighted by Fortune and Peters (2000, and 2005) as being a perspective and nor has the research taken into account the observations made by Ackoff and Churchman in the 60s.
If research into systems and services within the NHS start giving the concept of ‘perspectives’ an equal footings as statistics and other evidence based data then there will develop a richer understanding of complex systems/services are deemed to be a success of a failure.
The contribution to knowledge would be this – research into the success/failure a of systems/services within the NHS has got to take into account perception if it is to try to understand the complexity of impact of these types of systems.
PS. Looking at Greenhalgh’s paper on Adoption of Innovations in the NHS, she identifies a number of barriers, drivers with regards to uptake and successful innovations. The paper however fails to take into account that in organisations, deemed as’ human activity systems’, there is a plurality of perspectives, and this concept of success being in the ‘eye of the beholder’ is not addressed.