By Ewan Ferlie
During the last thirty years, students of health and wellbeing care corporations were looking for thoughts and pictures to light up their underlying, and moving, modes of organizing. Nowhere has this controversy been extra excessive than within the uk, given the lengthy succession of most sensible down reorganizations in the nationwide well-being provider (NHS) during the last thirty years. This e-book characterises the character of key reforms - specifically controlled networks - brought within the united kingdom nationwide healthiness carrier throughout the New Labour interval (1997-2010), combining wealthy empirical case fabric of such controlled networks drawn from diversified wellbeing and fitness coverage arenas (clinical genetics, melanoma networks, sexual healthiness networks, and long-term care) with a theoretically expert analysis.
The publication makes 3 key contributions. to begin with, it argues that New Labour's reforms integrated a tremendous community aspect in step with underlying community governance rules, specifying stipulations of 'success' for those controlled networks and exploring how a lot growth was once empirically obvious. Secondly, with the intention to conceptualise the various complicated well-being coverage arenas studied, the booklet makes use of the idea that of 'wicked problems': tricky occasions without noticeable ideas, whose scope is going past anyone employer, usually with conflicting stakeholder pursuits, the place there are significant social and behavioural dimensions to be thought of along scientific issues. Thirdly, it makes a contribution to the increasing Foucauldian and governmentality-based literature on wellbeing and fitness care enterprises, by way of retheorising organizational techniques and coverage advancements which don't healthy both expert dominance or NPM types from a governmentality viewpoint.
From the empirical proof collected, the ebook argues that controlled networks (as against replacement governance modes of hierarchy or markets) may be the main compatible governance mode in these many and increasing coverage arenas characterized via 'wicked problems', and will receive extra time to increase and succeed in their power.
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Extra info for Making Wicked Problems Governable?: The Case of Managed Networks in Health Care
By the mid-2000s, pro-choice policies were re-emerging across the English NHS (see the review of policy developments below), rebuilding quasi markets but possibly also eroding the collaborative networks set up ﬁve or so years earlier. We can explore any such tensions between markets and networks as governance modes in our cases empirically. Major developments in UK health policy and management, 1997–2010 We now move from reviewing academic literatures to consider different— and perhaps even competing—developments in UK health policy in the 1997–2010 period.
Such service improvement and process redesign exercises would be championed at national level by the newly created NHS Modernization Agency as a specialist source of knowledge and support. Thirdly, a new national Performance Assessment Framework would be developed across the NHS, in conjunction with advisory agencies such as NICE. New efﬁciency targets would be based on the achievements of the highest performing NHS Trusts. Depending on their performance assessment, NHS organizations would be rated as ‘green’, ‘yellow’, or ‘red’.
Trajectory of the self and high commitment leadership A third major Foucauldian concept is the ‘trajectory of the self’ and changed identity (Starkey and McKinlay, 1998; Townley, 2008) produced through 35 Making Wicked Problems Governable? governmentality: so the discipline of the penitentiary (Foucault, 1977) brings the offender to repentance, a reformed life, and a new identity. Foucauldian analysis explores the identities of those that govern and are governed (Dean, 1999, p. 32). His libertarian later work suggests subjects recreate themselves actively though ‘practices of freedom’ (Starkey and McKinlay, 1998): the self is developed and transformed by the self, with disciplinary practices playing an enabling rather than a punitive role.