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Repositioning the boundaries between public and private healthcare providers in the English NHS

PURPOSE: Neo-liberal “reform” has in many countries shifted services across the boundary between the public and private sector. This policy re-opens the question of what structural and managerial differences, if any, differences of ownership make to healthcare providers. The purpose of this paper is...

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Autores principales: Sheaff, Rod, Halliday, Joyce, Exworthy, Mark, Gibson, Alex, Allen, Pauline W., Clark, Jonathan, Asthana, Sheena, Mannion, Russell
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Emerald Publishing Limited 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7100872/
http://dx.doi.org/10.1108/JHOM-12-2018-0355
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author Sheaff, Rod
Halliday, Joyce
Exworthy, Mark
Gibson, Alex
Allen, Pauline W.
Clark, Jonathan
Asthana, Sheena
Mannion, Russell
author_facet Sheaff, Rod
Halliday, Joyce
Exworthy, Mark
Gibson, Alex
Allen, Pauline W.
Clark, Jonathan
Asthana, Sheena
Mannion, Russell
author_sort Sheaff, Rod
collection PubMed
description PURPOSE: Neo-liberal “reform” has in many countries shifted services across the boundary between the public and private sector. This policy re-opens the question of what structural and managerial differences, if any, differences of ownership make to healthcare providers. The purpose of this paper is to examine the connections between ownership, organisational structure and managerial regime within an elaboration of Donabedian’s reasoning about organisational structures. Using new data from England, it considers: how do the internal managerial regimes of differently owned healthcare providers differ, or not? In what respects did any such differences arise from differences in ownership or for other reasons? DESIGN/METHODOLOGY/APPROACH: An observational systematic qualitative comparison of differently owned providers was the strongest feasible research design. The authors systematically compared a maximum variety (by ownership) sample of community health services; out-of-hours primary care; and hospital planned orthopaedics and ophthalmology providers (n=12 cases). The framework of comparison was the ownership theory mentioned above. FINDINGS: The connection between ownership (on the one hand) and organisation structures and managerial regimes (on the other) differed at different organisational levels. Top-level governance structures diverged by organisational ownership and objectives among the case-study organisations. All the case-study organisations irrespective of ownership had hierarchical, bureaucratic structures and managerial regimes for coordinating everyday service production, but to differing extents. In doctor-owned organisations, the doctors’, but not other occupations’, work was controlled and coordinated in a more-or-less democratic, self-governing ways. RESEARCH LIMITATIONS/IMPLICATIONS: This study was empirically limited to just one sector in one country, although within that sector the case-study organisations were typical of their kinds. It focussed on formal structures, omitting to varying extents other technologies of power and the differences in care processes and patient experiences within differently owned organisations. PRACTICAL IMPLICATIONS: Type of ownership does appear, overall, to make a difference to at least some important aspects of an organisation’s governance structures and managerial regime. For the broader field of health organisational research, these findings highlight the importance of the owners’ agency in explaining organisational change. The findings also call into question the practice of copying managerial techniques (and “fads”) across the public–private boundary. ORIGINALITY/VALUE: Ownership does make important differences to healthcare providers’ top-level governance structures and accountabilities and to work coordination activity, but with different patterns at different organisational levels. These findings have implications for understanding the legitimacy, governance and accountability of healthcare organisations, the distribution and use power within them, and system-wide policy interventions, for instance to improve care coordination and for the correspondingly required foci of healthcare organisational research.
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spelling pubmed-71008722020-03-31 Repositioning the boundaries between public and private healthcare providers in the English NHS Sheaff, Rod Halliday, Joyce Exworthy, Mark Gibson, Alex Allen, Pauline W. Clark, Jonathan Asthana, Sheena Mannion, Russell J Health Organ Manag Research Paper PURPOSE: Neo-liberal “reform” has in many countries shifted services across the boundary between the public and private sector. This policy re-opens the question of what structural and managerial differences, if any, differences of ownership make to healthcare providers. The purpose of this paper is to examine the connections between ownership, organisational structure and managerial regime within an elaboration of Donabedian’s reasoning about organisational structures. Using new data from England, it considers: how do the internal managerial regimes of differently owned healthcare providers differ, or not? In what respects did any such differences arise from differences in ownership or for other reasons? DESIGN/METHODOLOGY/APPROACH: An observational systematic qualitative comparison of differently owned providers was the strongest feasible research design. The authors systematically compared a maximum variety (by ownership) sample of community health services; out-of-hours primary care; and hospital planned orthopaedics and ophthalmology providers (n=12 cases). The framework of comparison was the ownership theory mentioned above. FINDINGS: The connection between ownership (on the one hand) and organisation structures and managerial regimes (on the other) differed at different organisational levels. Top-level governance structures diverged by organisational ownership and objectives among the case-study organisations. All the case-study organisations irrespective of ownership had hierarchical, bureaucratic structures and managerial regimes for coordinating everyday service production, but to differing extents. In doctor-owned organisations, the doctors’, but not other occupations’, work was controlled and coordinated in a more-or-less democratic, self-governing ways. RESEARCH LIMITATIONS/IMPLICATIONS: This study was empirically limited to just one sector in one country, although within that sector the case-study organisations were typical of their kinds. It focussed on formal structures, omitting to varying extents other technologies of power and the differences in care processes and patient experiences within differently owned organisations. PRACTICAL IMPLICATIONS: Type of ownership does appear, overall, to make a difference to at least some important aspects of an organisation’s governance structures and managerial regime. For the broader field of health organisational research, these findings highlight the importance of the owners’ agency in explaining organisational change. The findings also call into question the practice of copying managerial techniques (and “fads”) across the public–private boundary. ORIGINALITY/VALUE: Ownership does make important differences to healthcare providers’ top-level governance structures and accountabilities and to work coordination activity, but with different patterns at different organisational levels. These findings have implications for understanding the legitimacy, governance and accountability of healthcare organisations, the distribution and use power within them, and system-wide policy interventions, for instance to improve care coordination and for the correspondingly required foci of healthcare organisational research. Emerald Publishing Limited 2019-11-07 2019 /pmc/articles/PMC7100872/ http://dx.doi.org/10.1108/JHOM-12-2018-0355 Text en © Rod Sheaff, Joyce Halliday, Mark Exworthy, Alex Gibson, Pauline W. Allen, Jonathan Clark, Sheena Asthana and Russell Mannion Published by Emerald Publishing Limited. This article is published under the Creative Commons Attribution (NC BY 4.0) licence. Anyone may reproduce, distribute, translate and create derivative works of this article (for non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence may be seen at http://creativecommons.org/licences/by/4.0/legalcode
spellingShingle Research Paper
Sheaff, Rod
Halliday, Joyce
Exworthy, Mark
Gibson, Alex
Allen, Pauline W.
Clark, Jonathan
Asthana, Sheena
Mannion, Russell
Repositioning the boundaries between public and private healthcare providers in the English NHS
title Repositioning the boundaries between public and private healthcare providers in the English NHS
title_full Repositioning the boundaries between public and private healthcare providers in the English NHS
title_fullStr Repositioning the boundaries between public and private healthcare providers in the English NHS
title_full_unstemmed Repositioning the boundaries between public and private healthcare providers in the English NHS
title_short Repositioning the boundaries between public and private healthcare providers in the English NHS
title_sort repositioning the boundaries between public and private healthcare providers in the english nhs
topic Research Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7100872/
http://dx.doi.org/10.1108/JHOM-12-2018-0355
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