Suchergebnisse

An enduring feature of New Public Management in many countries has been the move to create more autonomous, 'complete' organisations such as universities, hospitals and social service agencies. Often referred to as 'corporatisation', this process is assumed to be leading to the emergence of new organisational forms with dedicated management functions and a greater focus on strategy. However, these assumptions remain largely untested and rely heavily on 'technical' accounts of organisational re-structuring, ignoring the potential influence of institutional pressures and internal political dynamics. In this paper, we address this concern focusing on the case of acute care public hospitals that have undergone corporatisation (to become Foundation Trusts) in the English National Health Service. Using administrative data spanning six years (2007–2012), the analysis shows that corporatisation is having mixed effects. While it is associated with a shift in the focus of managers to strategic concerns, it has not led to an expansion of management functions overall. Both tendencies are found to be mediated by institutional pressures, in the form of media scrutiny, and, indirectly, by the involvement of clinical professions in management. These results advance ongoing debates about the emergence of new organisational forms in the public sector, highlighting the limitations of technical accounts of change and raising the possibility that corporatisation is leading to organisations that are both more managed and under-managered at the same time.

An enduring feature of New Public Management in many countries has been the move to create more autonomous, 'complete' organisations such as universities, hospitals and social service agencies. Often referred to as 'corporatisation', this process is assumed to be leading to the emergence of new organisational forms with dedicated management functions and a greater focus on strategy. However, these assumptions remain largely untested and rely heavily on 'technical' accounts of organisational re-structuring, ignoring the potential influence of institutional pressures and internal political dynamics. In this paper, we address this concern focusing on the case of acute care public hospitals that have undergone corporatisation (to become Foundation Trusts) in the English National Health Service. Using administrative data spanning six years (2007–2012), the analysis shows that corporatisation is having mixed effects. While it is associated with a shift in the focus of managers to strategic concerns, it has not led to an expansion of management functions overall. Both tendencies are found to be mediated by institutional pressures, in the form of media scrutiny, and, indirectly, by the involvement of clinical professions in management. These results advance ongoing debates about the emergence of new organisational forms in the public sector, highlighting the limitations of technical accounts of change and raising the possibility that corporatisation is leading to organisations that are both more managed and under-managered at the same time.

A growing evidence base suggests that increasing the involvement of clinical professionals on governing boards of hospitals has a positive impact on organizational performance. However, less is known about the wider conditions that influence this process and whether recent moves to restructure the governance of public hospitals, extending their formal autonomy, has made any difference to the outcome of clinical involvement on patient experience. Using four years of data and concentrating on the acute hospital sector in the English National Health Service, this study shows that clinical participation on hospital governing boards can significantly improve the patient experience of the care provided. Yet, whereas a more autonomous organizational form (Foundation Trust status) does not seem to produce positive effects on its own, patient experience appears to markedly improve in those organizations that have both higher levels of clinical involvement in their strategic apex and greater flexibility in decision‐making.

AbstractThe process of corporatization in public services has led to the emergence of new, more autonomous organizational forms. However, while these reforms have been centrally about the development of management capabilities in public sector organizations, we know surprisingly little about what this process involves. To address this concern, we draw on the literature on administrative intensity (AI) to frame hypotheses about the likely relationship between corporatization and investments in management and administration, and the consequences of these investments for performance. As an empirical case, we then focus on the effects of Foundation Trust status on AI and efficiency, effectiveness, and responsiveness in the acute care hospital sector in the English NHS. Based on a database of nine years (2008/09–2016/17) and dynamic panel data regressions, the results show that corporatization leads to a leaner administration and improved organizational efficiency, effectiveness, and responsiveness. In addition, the analysis reveals that lower levels of AI positively mediate the relationship between corporatization and performance, although only in relation to the efficiency dimension. These findings highlight the crucial, but previously misunderstood, importance of lean administration as part of the corporatization reform package, with implications for theory, research, and policy.