Managing change: using organisational change theory to ... change: using organisational change theory to understand organisational responses to Health Policy. A case study of changes

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  • Managing change: using organisational

    change theory to understand

    organisational responses to Health Policy.

    A case study of changes in

    commissioning.

    Sara McCafferty

    A thesis submitted in partial fulfilment of the requirements of

    Newcastle University for the degree of Doctor of Philosophy

    Institute of Health and Society

    September 2013

  • ii

    Declaration

    The work presented in this thesis has been composed by the candidate Sara

    McCafferty. The material has not been previously submitted for a degree of any

    qualification at this or any university.

    The thesis is the candidates own work and all the work has been completed by the

    candidate. At the outset of this thesis the candidate was employed as a researcher on

    a commissioning study funded by the Department of Health, (Bate et al., 2012). This

    thesis shared some of the data sets and fundamental means of data collection as the

    research study; namely the semi-structured interviews included in Part A. Although

    the data was collected for dual purposes, the two studies had different aims and

    objectives and the analysis for each has been undertaken separately.

  • iii

    Abstract

    Background

    The NHS in England has been subject to numerous reforms and changes in health policy since its inception in 1948. Such changes often mean that organisational strategies are halted, diverted or otherwise prevented from being completed. To date research in health care settings has considered change in a broad context but there has been limited research which focuses on how organisations respond and adapt to changes in health policy specifically. The objective of this research is to explore how existent change management literature and models can be used to understand how organisations respond to changes in health policy.

    Methods

    In 2010 the White Paper Equity and Excellence: Liberating the NHS was released. The paper, which proposed ambitious and widespread reform to the NHS, was met with significant resistance and experienced a protracted passage through Parliament. This research utilised the changing policy landscape to conduct a natural experiment, using a commissioning organisation as a case study, to understand responses to these policy changes. The eight factors of receptivity model was used as a medium to explore organisational receptivity to NHS policy changes.

    Results

    A synthesis of the results is presented in the form of a new model to guide organisations in developing rreceptivity to change. The model identifies four key factors influencing the organisations ability to respond to policy change: policy, system management, organisational context and change agenda and locale.

    Conclusions

    Receptivity to policy change in the NHS is influenced by different factors than traditional management induced change or organic organisational change. Implications for policy makers have been drawn from this research which includes the need to develop coherent policy with clearly articulated vision, the requirement to manage national political culture, the importance of tackling system issues, and the need for careful management during transitions to avoid loss of valuable skills and expertise.

  • iv

    Acknowledgments

    I wish to acknowledge the support and encouragement received during the course of

    completing this doctorate. In particular I would like to express my deep gratitude to

    my supervisors, Dr Angela Bate, Dr Tracy Finch and Dr Tom McGovern. Their

    intellectual input, time, questioning, critique and support has been invaluable. I am

    also grateful to Professor Cam Donaldson who acted in a supervisory capacity at the

    outset of this process, and was key in enabling me to embark on this journey. I am

    thankful to Professor Luke Vale, for being more than accommodating whilst I have

    attempted to juggle study with work, and for the whole team of health economists at

    Newcastle University. Conducting this PhD has genuinely been a joyful experience. I

    have been fortunate to have many wonderful colleagues and friends who have

    constantly encouraged me and spurred me along. I gratefully acknowledge the

    funding received from the Health Foundation towards this study.

    Finally this work could not have been completed without the input of all those

    interviewed, I appreciate you giving up your time and speaking honestly and openly at

    a time of challenge. I am also grateful for the support of the case study site, in

    particular for allowing me to continue with this research at a time of political and

    organisational sensitivity.

  • v

    Table of Contents

    Declaration ......................................................................................................................... ii

    Abstract ............................................................................................................................. iii

    Acknowledgments .............................................................................................................. iv

    Table of Contents ................................................................................................................ v

    List of Figures ..................................................................................................................... ix

    List of Tables ....................................................................................................................... x

    List of Acronyms ................................................................................................................. xi

    Chapter 1 Introduction 1

    1.1 Chapter introduction ............................................................................................... 1 1.2 Policy ....................................................................................................................... 1

    1.2.1 Public policy 2 1.2.2 Health policy 3 1.2.3 Policy implementation 4

    1.3 Justification of research .......................................................................................... 5 1.4 Research question and objectives .......................................................................... 7 1.5 Research design....................................................................................................... 8 1.6 Contextual situation of the thesis research ............................................................ 9 1.7 Contributions of the thesis to research and policy ............................................... 12 1.8 Thesis summary ..................................................................................................... 12

    Chapter 2 Background and context 15

    2.1 Chapter introduction ............................................................................................. 15 2.2 National Health Service ......................................................................................... 15 2.3 Commissioning policy ............................................................................................ 24

    2.3.1 World Class Commissioning 27 2.3.2 Critique of commissioning reforms 28 2.3.3 Managing commissioning change 29

    2.4 Chapter summary .................................................................................................. 30

    Chapter 3 Literature review 31

    3.1 Chapter introduction ............................................................................................. 31 3.2 Review of organisational change literature .......................................................... 31 3.3 Health policy .......................................................................................................... 37 3.4 Change management models ............................................................................... 40

    3.4.1 Recurring concepts 46 3.4.2 Application in health care settings 51 3.4.3 International applications 56 3.4.4 UK application 57

    3.5 Critique of Pettigrew model .................................................................................. 58 3.6 Application in this thesis ....................................................................................... 60

  • vi

    3.7 Chapter summary .................................................................................................. 62

    Chapter 4 Methodology and methods 64

    4.1 Chapter introduction ............................................................................................. 64 4.2 Research question and objectives ........................................................................ 65 4.3 Research paradigm ................................................................................................ 65 4.4 Research design..................................................................................................... 67 4.5 Research methods ................................................................................................. 71

    4.5.1 Qualitative interviews 73 4.5.2 Observation (direct and participant) 74 4.5.3 Documents 77 4.5.4 Sampling 78

    4.6 Methods of analysis .............................................................................................. 79 4.6.1 Transcribing of interview data 79 4.6.2 Analysis of transcriptions 80 4.6.3 Deductive coding framework generation and application 88

    4.7 Ethics ..................................................................................................................... 94 4.8 Critique of research design and methods ...............................