5 results on '"Checkland, Kath"'
Search Results
2. Being Autonomous and Having Space in which to Act: Commissioning in the ‘New NHS’ in England.
- Author
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CHECKLAND, KATH, DAM, RINITA, HAMMOND, JON, COLEMAN, ANNA, SEGAR, JULIA, MAYS, NICHOLAS, and ALLEN, PAULINE
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POLICY sciences , *MEDICAL care , *MEDICAL personnel , *ATTITUDE (Psychology) , *AUTONOMY (Psychology) , *INTERVIEWING , *HEALTH policy , *ORGANIZATIONAL goals , *PSYCHOLOGY - Abstract
The optimal balance between central governmental authority and the degree of autonomy of local public bodies is an enduring issue in public policy. The UK National Health Service is no exception, with NHS history, in part at least, a history of repeated cycles of centralisation and decentralisation of decision-making power. Most recently, a significant reorganisation of the NHS in 2012–13 was built around the creation of new and supposedly more autonomous commissioning organisations (Clinical Commissioning Groups – CCGs). Using Bossert's (1998) concept of ‘decision space’, we explored the experiences of local commissioners as they took on their new responsibilities. We interviewed commissioning staff from all of the CCGs in two regional health care ‘economies’, exploring their perceptions of autonomy and their experiences over time. We found significant early enthusiasm for, and perceptions of, increased autonomy tempered in the vertical dimension by increasingly onerous and prescriptive monitoring regimes, and in the horizontal dimension by the proliferation of overlapping networks, inter-organisational groups and relationships. We propose that, whatever the balance between central and local control that is adopted, complex public services require some sort of meso-level oversight from organisations able to ‘hold the ring’ between competing interests and to take a regional view of the needs of the local health system. This suggests that local organisational autonomy in such services will always be constrained. [ABSTRACT FROM PUBLISHER]
- Published
- 2018
- Full Text
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3. The policy work of piloting: Mobilising and managing conflict and ambiguity in the English NHS.
- Author
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Bailey, Simon, Checkland, Kath, Hodgson, Damian, McBride, Anne, Elvey, Rebecca, Parkin, Stephen, Rothwell, Katy, and Pierides, Dean
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POLICY sciences , *EXECUTIVES , *GOAL (Psychology) , *HEALTH services accessibility , *HEALTH policy , *EVALUATION of human services programs , *PSYCHOLOGY - Abstract
In spite of their widespread use in policy making in the UK and elsewhere, there is a relatively sparse literature specifically devoted to policy pilots. Recent research on policy piloting has focused on the role of pilots in making policy work in accordance with national agendas. Taking this as a point of departure, the present paper develops the notion of pilots doing policy work. It does this by situating piloting within established theories of policy formulation and implementation, and illustrating using an empirical case. Our case is drawn from a qualitative policy ethnography of a local government pilot programme aiming to extend access to healthcare services. Our case explores the collective entrepreneurship of regional policy makers together with local pilot volunteers. We argue that pilots work to mobilise and manage the ambiguity and conflict associated with particular policy goals, and in their structure and design, shape action towards particular outcomes. We conclude with a discussion of the generative but managed role which piloting affords to local implementers. [ABSTRACT FROM AUTHOR]
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- 2017
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- View/download PDF
4. Commissioning in the English National Health Service: What's the Problem?
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CHECKLAND, KATH, HARRISON, STEPHEN, SNOW, STEPHANIE, MCDERMOTT, IMELDA, and COLEMAN, ANNA
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HEALTH policy , *PUBLIC health administration , *POLITICAL science , *DECISION making , *HEALTH care industry , *ETHICS , *MANAGEMENT - Abstract
The English NHS is currently organised around a split between the ‘commissioning’ and the ‘providing’ of health care. There has been considerable critical comment about commissioning, focusing upon perceived inadequacies of the regulatory structure and a perceived lack of competence of the managers concerned. In this paper, we use empirical data from two detailed studies of commissioning to propose a third explanation of the difficulties that have been observed in making commissioning work. We apply Scott's institutional analysis to the issue, arguing that far from reflecting managerial incompetence, some of the difficulties experienced are inherent in the normative and cultural/cognitive pillars of the NHS institution, so that there is a lack of ‘fit’ between commissioning and the institutional characteristics of the NHS. We conclude by exploring the potential impact of the latest round of NHS changes on this institution. [ABSTRACT FROM PUBLISHER]
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- 2012
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5. What happens when GPs engage in commissioning? Two decades of experience in the English NHS.
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Miller, Rosalind, Peckham, Stephen, Coleman, Anna, McDermott, Imelda, Harrison, Stephen, and Checkland, Kath
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GENERAL practitioners , *CLINICAL medicine , *HEALTH care reform , *HEALTH services administration , *HEALTH policy , *PHYSICIANS , *PRIMARY health care , *PURCHASING , *MEMBERSHIP , *OCCUPATIONAL roles , *ORGANIZATIONAL governance , *SOCIETIES - Abstract
Objective To review the evidence on commissioning schemes involving clinicians in the United Kingdom National Health Service, between 1991 and 2010; report on the extent and impact of clinical engagement; and distil lessons for the development of such schemes both in the UK and elsewhere. Methods A review of published evidence. Five hundred and fourteen abstracts were obtained from structured searches and screened. Full-text papers were retrieved for UK empirical studies exploring the relationship between commissioners and providers with clinician involvement. Two hundred and eighteen published materials were reviewed. Results The extent of clinical engagement varied between the various schemes. Schemes allowing clinicians to act autonomously were more likely to generate significant engagement, with ‘virtuous cycles’ (experience of being able to make changes feeding back to encourage greater engagement) and ‘vicious cycles’ (failure to influence services generating disengagement) observed. Engagement of the wider general practitioner (GP) membership was an important determinant of success. Most impact was seen in GP prescribing and the establishment of services in general practices. There was little evidence of GPs engaging more widely with public health issues. Conclusion Evidence for a significant impact of clinical engagement on commissioning outcomes is limited. Initial changes are likely to be small scale and to focus on services in primary care. Engagement of GP members of primary care commissioning organizations is an important determinant of progress, but generates significant transaction costs. [ABSTRACT FROM AUTHOR]
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- 2016
- Full Text
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