Theorising path dependence: how does history come to matter in organisations, and what can we do about it?

This paper examines the concept of path dependence in organisational theory, attempting to utilise insights from a number of academic disciplines to improve our understanding of it. It examines the claims of the resource-based view of business, perhaps the organisational approach most commonly linked with path dependence, and reassesses them in the light of the framework presented here. It concludes by considering the role of history in organisations, the mechanisms through which it manifests itself in the present, and what we can do to break free from path dependence.

Bad science concerning NHS competition is being used to support the controversial Health and Social Care Bill

A recent report by LSE academics extolling the benefits of competition between NHS hospitals claims causality where there is none. Allyson Pollock, Alison Macfarlane and Ian Greener argue that the authors engage in data dredging and faulty empirical analysis. In so doing, they sweep aside decades of evidence showing why markets do not work in health services and lend support to an HSC Bill that is inherently dangerous

Comparing country risk and response to COVID-19 in the first 6 months across 25 Organisation for Economic Co-operation and Development countries using qualitative comparative analysis

Peer reviewedPublisher PD

Molecular mapping of the rabbit atrioventricular node

The atrioventricular node (AVN) of the heart is responsible for the important conduction delay between atrial systole and ventricular systole. The anatomical architecture and functional properties of the AVN are complex. Ionic currents have been characterised in the AVN at both the whole tissue level and single cell level. However, little is known about the molecular basis of these ionic currents. There were two aims of this research: 1) to generate an accurate three-dimensional reconstruction of the rabbit AVN conduction axis and 2) to use real time PCR and in situ hybridisation to measure levels of mRNA for specific ion channels and membrane proteins in the rabbit AVN and surrounding atrial and ventricular tissue. Neurofilament-M (NF-M) immunolabelling revealed a tract of cells extending from the posterior nodal extension through the compact node to the common bundle. The PNE appeared to correspond to the slow pathway. Loosely packed atrial muscle comprised the anterior region of the AVN conduction axis closest to the enclosed part of the AVN and most likely represents the fast pathway. Lower nodal cells extended from the common bundle to the lower extremities of the compact node and PNE. Significant differences in the mRNA levels between the PNE and atrial muscle for the pacemaker channel HCN4, INa channels Navl. 1 and Na, 1.5, the Ica,L channel Cav 1.3, the I to channel ß-subunit KChIP2 and Cx43 were found HCNI, Nav 1.1, Cav 1.3 and NF-M mRNA were significantly higher in the PNE, compact node and common bundle compared to the atrium and ventricle. Kir 2.1 mRNA was significantly higher in the ventricular muscle compared to the PNE and atrial muscle. Atrial natriuretic peptide (ANP) mRNA, was significantly higher in the atrial muscle compared to other tissues. For mRNAs for the Ito channels, Kv 4.2 and Kv 4.3, the delayed rectifier K+ channels, Kv 1.5, ERG, K, LQTI and minK, the inward rectifier K+ channels, Kir 2.2, Kir6.2 and ß-subunit SUR2A, and the Ca2+ handling proteins, RYR2, RYR3, NCXI and SERCA2a, there were no significant differences between tissues. In situ hybridisation staining revealed further complexity of the AVN conduction axis tissue. A region of loosely packed atrial tissue immediately adjacent to the nodal tissue was KChIP2 negative and Nav1.5 negative, and the lower nodal cells were both Cav 1.2 and Cav 1.3 positive. This study has described a complex architecture of the AVN and added further complexity by providing a detailed account of ion channel expression throughout this tissue

Crisis in the UK National Health Service:What does it mean, and what are the consequences?

There have been more‐or‐less continual suggestions that the UK National Health Service (NHS) has been suffering from one kind of crisis or another since its creation in 1948. If we are to understand the problems the NHS faces, then we need to empirically investigate what kinds of crises it has faced, if such crises have patterns to them, and whether or not they tend to lead to policy change. This article considers NHS crisis in terms of academic accounts of its history, as well in occurrences of the term ‘NHS crisis’ (and its synonyms) in national newspaper headlines from the 1980s up to 2020 through the application of topic modelling. The combination of these two sources of data leads to the construction of a typology of NHS crises. Having constructed this typology, we can then examine the timing and frequency of NHS crises, and consider the relationship between crises and periods of policy change, as well as to the wider economic and social context in which crises occur through the notion of the ‘NHS spatio‐temporal fix’

Healthcare funding and its relationship to equity and outcomes : a QCA analysis of commonwealth fund and OECD data

This article examines Organisation for Economic Co-operation and Development (OECD) and Commonwealth Funding data to explore the relationship between the level and means of funding of 11 different healthcare systems, on the one hand, and overall equity and health outcome measures, on the other. It utilises qualitative comparative analysis (QCA) and the idea of ‘fitness landscapes’ for the clusters of funding combinations and outcomes they present. It finds that health systems with relatively high levels of voluntary health insurance tend to be associated with poor outcomes almost across the board, but healthcare systems with higher overall expenditures combined with low voluntary insurance levels offer combinatory possibilities for achieving both high equity and high outcomes. The article also explores how ‘contradictory cases’ can be used to explore how systems falling short of the outcomes of others with the same funding patterns, might find improvements

An argument lost by both sides? The Parliamentary debate over the 2010 NHS White Paper

This paper examines the rhetoric of government and opposition in the Parliamentary debate over the 2010 NHS White Paper 'Equity and Excellence'. It treats the debate as a process of deliberative argument in which Secretary of State Andrew Lansley justifies his reorganization, and explores the extent to which his policy argument was scrutinised by both the opposition and by members of his own coalition government. The paper suggests that Lansley offered an unjustified reorganization based on market-based governance (although presented as 'social enterprise), and decentralised accountability, which would at the same time generate substantial savings in a time of financial austerity. This is contrasted with the often-fragmented arguments offered by voices in the opposition. The paper and asks questions about the extent to which Parliamentary debate is able to adequately scrutinise governmental proposals of the complexity of healthcare reorganization

Comparing country risk and response to COVID-19 in the first 6 months across 25 Organisation for Economic Co-operation and Development countries using qualitative comparative analysis

This paper explores the contextual and government response factors to the first-wave of the COVID-19 pandemic for 25 the Organisation for Economic Co-operation and Development nations using fuzzy-set qualitative comparative analysis. It considers configurations of: obesity rates; proportions of elderly people; inequality rates; country travel openness and COVID-19 testing regimes, against outcomes of COVID-19 mortality and case rates. It finds COVID-19 testing per case to be at the root of sufficient solutions for successful country responses, combined, in the most robust solutions, with either high proportions of elderly people or low international travel levels at the start of pandemic. The paper then locates its sample countries in relation to existing welfare typologies across two dimensions based on total social expenditure and proportional differences between the GINI coefficient before and after taxes and transfers. It finds that countries generally categorised as liberal in most existing typologies did the most poorly in their first-wave COVID-19 response

The dilemmas of leading health organizations in complex settings comment on "dual agency in hospitals : what strategies do managers and physicians apply to reconcile dilemmas between clinical and economic considerations?"

Waitzberg and colleagues' research explores hospital managers, chief physicians and other physicians in German and Israeli hospitals, making use of thematic analysis to explore what they call 'dilemmas' between the commitments to clinical needs, and their hospitals' financial sustainability. This commentary will provide a summary of the paper, into which I will embed some items I will follow-up on in my second half. The second half will then explore these items in greater depth, considering the strengths and weaknesses of the article. I then make some suggestions for future work based around the findings the authors present in terms of managerial and clinical identity, how compromises are reached in hospital settings, and how we compare different health systems

Learning from new Labour's approach to the NHS

This article treats Labour’s approach to the NHS between 1997 and 2010 as representing a series of ‘programme theories’ to consider what we can learn from them about healthcare and public reorganization more generally. It suggests Labour’s programme theory of ‘delivery’ does have, through the Quality and Outcomes Framework, potential for learning how better to handle performance management, but that ‘choice and competition’ has not achieved the goals asked of it. Labour’s use of increased funding for the NHS appeared to be linked to an improvement in patient satisfaction and health outcomes, both of which now risk being undermined. Finally, the Private Finance Initiative presents a significant legacy and challenge to policymakers and NHS organizations today because of the financial commitments it requires of organizations that put in place poorly-negotiated deals, and are now in a difficult funding situation