NHS Re-Organisation – Hope Over Experience?
June 28, 2010 in Change and Benefits, Leading and Managing Results, Public Services
At its conference in June 2010, the NHS Confederation published a report challenging the wisdom of constant NHS reorganisations. In “The Triumph of Hope Over Experience”, the Confederation examines a history of rapid and turbulent creations, mergers and disestablishments over 20 years.
Presenting a very interesting analysis of structural change in the NHS, the Confederation’s stated aim was -
“to review the history of restructuring, what is known about its results and the reasons for the pattern of increasingly frequent organisational change to draw out some important lessons that are particularly salient at this time.”
In some respects the report’s messages are relevant to other areas of the public sector. Attractor would encourage leaders of QIPP, Total Place and Efficiency and Reform programmes to read the report as they set about tackling the current financial crisis.
The report suggests a tendency to enthusiastically advocate reorganisation as a solution to all problems, regardless of their nature. It indicates reorganisation can provide opportunities for politicians to demonstrate action, for managers to advance careers, remove “problem people” and take generous redundancies – none of which have anything to do with the “reason” for making change. But the forces supporting reorganisation seem stronger than those resisting.
The Confederation recommends far closer scrutiny for such proposals, better review of the results of organisational change and holding proponents to account for results. In conclusion the report recognises the need to embrace change but expresses strong doubts over the kind of top-down redesign that has been all too common.
“Organisational change is necessary to allow organisations to adapt to changes in the
environment. Experiment and evolution may be a more effective approach to this than
insufficiently intelligent design.”
The analysis and conclusions are clear and ring true. While changing the shape of an organisation can support other business change, simply “moving the chairs around”, redrawing boundaries or lines of accountability rarely addresses fundamental or underlying systemic problems with the way “real work” is organised, supported and delivered.
Weakness in resource allocation and deployment, business processes and systems, communication and information-flows, skills and competences are best addressed by action “close to the coalface” with the teams who are delivering services – not by fiddling with the tiers of management way over their heads. This might suggest programmes like “Total Place” – close to customers and service delivery – are more likely to succeed than other approaches. Read the rest of this entry →
