BPR: alive and well in the public sector

Service improvement in the English National health service: Complexities and tensions

The English National Health Service (NHS) is a public sector organisation with a longstanding objective to deliver high quality healthcare that is free at the point of use. In order to achieve this, the NHS has endured an evocative and controversial theme of reform across many decades. Despite such high levels of reform, the recent Operating Efficiency Framework declared that the NHS is about to enter its toughest ever financial climate. This paper will illustrate the complexities and tensions of implementing service improvement in the NHS in a climate of persistent policy reform, reduced budgets and tough regulation. The paper reports findings of three case studies of hospital trusts in the UK in relation to the implementation of Lean improvement methodologies, highlighting key complexities of a hospital context and the corresponding tension with service improvement activity.

Service improvement in the English National health service: Complexities and tensions

The English National Health Service (NHS) is a public sector organisation with a longstanding objective to deliver high quality healthcare that is free at the point of use. In order to achieve this, the NHS has endured an evocative and controversial theme of reform across many decades. Despite such high levels of reform, the recent Operating Efficiency Framework declared that the NHS is about to enter its toughest ever financial climate. This paper will illustrate the complexities and tensions of implementing service improvement in the NHS in a climate of persistent policy reform, reduced budgets and tough regulation. The paper reports findings of three case studies of hospital trusts in the UK in relation to the implementation of Lean improvement methodologies, highlighting key complexities of a hospital context and the corresponding tension with service improvement activity.

The Rise of the Phoenix: Methodological Innovation as a Discourse of Renewal

The imperatives on contemporary organizations to adapt to an increasingly uncertain and turbulent environment are intense. The pace of change is at least as great in the public as the private sector, with technology being integral to the UK government's modernization agenda. Resilience refers to the ability of individuals and organizations to cope with change through a continuous process of renewal. Much research on resilience is uncritical, normative and written from a detached perspective that emphasizes the agency of senior management. In contrast, this paper provides an ethnographically based account of resilience at the middle level of a large, public sector bureaucracy. Finding itself under increasing pressure to move away from its traditional, technically oriented role, the IS function sought to reinvent itself as a strategic driver of business transformation. The development of a business process reengineering methodology was seen as the key to operationalizing this new role. Although innovation in IS methodology can be problematic, here it was brought off successfully. This was attributed to several factors, including the adoption of a participative action research approach and the commitment of IS management. Above all, the sense of crisis prevailing at the outset of the initiative was decisive. Crises present a major challenge to organizational sense-making; here, a resilient ‘discourse of renewal’ was kindled with the impending threat interpreted positively as a proactive opportunity to develop the new strategic identity. The paper concludes with some critical reflections on the limits of managerial agency and the notion of resilience as a designable capacity.

Choosing the Best Business Improvement Strategy: The Effects of Organisational Size and Sector on Management Decision-Making

Managers in all sorts of organisations face difficult choices in choosing what, why and when different business improvement methodologies should be applied. Many approaches are available, which exhibit various degrees of overlap, reinvention and claims of universal application. Given the resources involved, especially in regard to time and costs, there is a need to provide some form of guidance in choosing a business improvement methodology or combination of approaches. The aim of this paper is to review the effects of organisational size and sector on management choice of business improvement methodology.

A multi-method approach is used in this research. Firstly, an empirical research methodology is used to survey 800 UK organisations, encompassing different sizes and sectors, in relation to their choice of business improvement methodology. The findings indicate that business improvement methodologies are not universal. Multiple case study analysis (still ongoing) was conducted within five large organisations. Reference is made to preliminary analysis carried out within one of the organisations under study. This case illustrates that executives will introduce business improvement methodologies based on the needs of the organisation, as well as facilitate the transfer of learning and knowledge from experts who are familiar with the application of these tools.