Reeingineering Health Care The Complexities

Through the use of a real case study within a major NHS hospital, this book attempts to address the idea of Process Transformation in the field of health care. The authors explore three interlined themes: the models and nature or organizational change; the implementation of Business Process Reengineering or BPR and the management of contemporary public sector organizations. Process Transformation: A Case of Reengineering in Health Care, reveals the major challenges of reorganization and provides knowledge and feedback on the impact of corporate change, impediments and enablers of lateral organizing structures and contradictions between functional and process principles for organizing.

Ewan Ferlie is Professor of Management and Head of Department at the School of Management, Royal Holloway, University of London. Terry McNulty is Senior Lecturer in Organization Behaviour at Leeds University Business School.

List of Tables

xi

List of Figures

xi

List of Appendices

xi

Abbreviations

xiii

Introduction and Key Themes

1

(16)

Organizational transformation, its limits, and process-based organization

3

(4)

BPR as an exemplar of process organization

7

(1)

Changing contexts of health care

8

(4)

A process study: overall principles of design

12

(3)

Concluding remarks

15

(2)

Understanding Business Process Reengineering as Planned Organizational Transformation

17

(28)

Introduction

17

(3)

A process perspective on organizing

20

(2)

Business process reengineering

22

(10)

Assessing BPR as transformation

32

(3)

Explaining BPR as transformation: dynamics of action and context

35

(10)

Process Redesign and Changing Contexts of Health Care

45

(32)

Intersectoral analysis and process-based organizations

47

(4)

The macro-context: the rise of the new public management

51

(10)

The meso-context: hospitals as organizations

61

(10)

Implications for the micro-context

71

(3)

Concluding discussion

74

(3)

Organizational Process Research: Research Style and Methods

77

(37)

Qualitative forms of analysis

77

(4)

Issues within management research

81

(1)

Our choice of qualitative methods

82

(3)

Process research within organizational studies

85

(7)

Evaluating reengineering as a social intervention: issues and challenges

92

(6)

Operational design, data collection, and analysis

98

(10)

Remaining methodological issues

108

(6)

Appendix 4.1 Interview sample by roles

112

(1)

Appendix 4.2 Interview sample statistics

113

(1)

Reengineering as Strategic Choice and Change

114

(33)

Introduction

114

(2)

Introducing reengineering into the Leicester Royal Infirmary NHS Trust

116

(7)

Reengineering LRI: a chronological overview

123

(7)

Reengineering LRI: a thematic overview

130

(17)

Patient Process Reengineering: Six Case Studies

147

(94)

Introduction to case studies

147

(2)

Reengineering the care process for patients attending the A&E department with minor injuries

149

(7)

Chronology of reengineering the care process within A&E

156

(1)

The impact of reengineering queue management in A&E

157

(11)

Reengineering the process of care for patients admitted to LRI with a fractured neck of femur

168

(18)

Reengineering elective surgery in the specialty of gynaecology

186

(13)

Reengineering outpatient services in the specialty of gynaecology

199

(10)

Reengineering elective surgery in the specialty of ENT

209

(19)

Reengineering out-and in-patient services in the specialty of gastroenterology

228

(10)

Concluding remarks

238

(3)

Reengineering Organizational Form and Process: The Old Shapes the New

241

(31)

Introduction

241

(1)

Organizational form and process within LRI

242

(9)

Reengineering within the medical directorate

251

(7)

Review of the impact of reengineering across clinical settings within the medical directorate

258

(3)

Reengineering the medical directorate: a thematic overview

261

(11)

Limits to Organizational Transformation: Explaining Local Variation within a Change Programme

272

(42)

Strengths and weaknesses of the reengineering programme

274

(8)

Patient process redesign: organizational, behavioural, and political dynamics

282

(32)

Dynamics of Programmed Transformation and Reproduction

314

(27)

Introduction

314

(3)

Related studies on change programmes within health care organizations

317

(5)

Reengineering and a theory of radical change

322

(8)

Limits of authoritative change models in professional settings

330

(3)

Stable sedimentation

333

(3)

Sectoral diffusion

336

(2)

Concluding remarks

338

(3)

Process-Based Organizations in the UK Public Services? Prospects for the Future

341

(23)

Introduction

341

(1)

The evolution of the UK NPM movement in the late 1990s

342

(5)

Key changes since the mid-1990s: some evidence and speculation

347

(8)

Major statements of proclaimed policy in relation to the organization and management of the public services

355

(3)

Empirical observations from the case-study site

358

(2)

Process-based models of organizing and the new public management: contradictory rather than complementary?

360

(2)

Final remarks and challenges for the future

362

(2)

References

364

(13)

Index

377

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Reeingineering Health Care The Complexities of Organizational Transformation

Summary

Author Biography

Table of Contents

Supplemental Materials