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.