Hybrids and professional communities: comparing UK reforms to healthcare, broadcasting and postal services

Many countries use state-owned, for-profit, and third-sector organizations to provide public services, generating ‘hybrid’ organizational forms. This article examines how the hybridisation of organizations in the public sector is influenced by interaction between regulatory change an professional communities. It presents qualitative data on three areas of the UK public sector that have undergone marketization: healthcare, broadcasting, and postal services. Implementation of market-based reform in public sector organizations is shaped by sector-specific differences in professional communities, as these groups interact with reform processes. Sectoral differences in communities include their power to influence reform, their persistence despite reform, and their alignment with the direction of change or innovation. Equally, the dynamics of professional communities can be affected by reform. Policymakers need to take account of the ways that implementation of hybrid forms interacts with professional communities, including risk of disrupting existing relationships based on communities that contribute to learning

Major system change: a management and organisational research perspective. In Raine R, Fitzpatrick R, Barratt H, Bevan G, Black N, Boaden R, et al. Challenges, solutions and future directions in the evaluation of service innovations in health care and public health.

The scale and complexity of major system change in health care (typically involving multiple change processes, organisations and stakeholders) presents particular conceptual and methodological challenges for evaluation by researchers. This essay summarises some current approaches to evaluating major system change from the field of management and organisational research, and discusses conceptual and methodological questions for further developing the field. It argues that multilevel conceptual frameworks and mixed-methods approaches are required to capture the complexity and the heterogeneity of the mechanisms, processes and outcomes of major system change. Future evaluation designs should aim to represent key components of major system change – the context, processes and practices, and outcomes – by looking for ways that quantitative and qualitative methods can enrich one another. Related challenges in ensuring that findings from evaluating major system change are used by decision-makers to inform policy and practice are also discussed

Evaluating an innovative approach to the diagnostic processes for chronic eye disease: a feasibility study

The aim of this study was to develop a framework that would support the evaluation of new ways of diagnosing and monitoring chronic eye disease being planned and implemented by a large NHS hospital. The study involved interviews with a range of health care professionals within the Trust, observation of glaucoma outpatient clinics and related meetings, analysis of routinely collected data, and planning an economic analysis to evaluate the cost and cost-effectiveness of the new service. The information used to inform this study was collected between February 2013 and June 2014. The framework highlights three areas that should be taken into account when evaluating innovation: (1) organisational context, (2) operational impact, and (3) cost and cost effectiveness relative to existing services. In relation to organisational context, those evaluating innovation should seek to understand how different professional groups are involved in, and affected by, the implementation of change and aim to identify the underlying social and organisational factors that may inhibit or support the implementation of innovation. Evaluation should also aim to capture patients’ perceptions of existing services and proposed changes to services and how changes to the delivery of services may affect interactions between patients and clinical staff. From an operational perspective, quantitative analysis should aim to provide estimates of the level of improvement required to meet the challenges presented by anticipated increases in the burden of disease and the likely impact of the suggested changes on patient access metrics. To undertake an economic analysis of the new service, researchers should consider the main cost components of the new and existing services, how to collect resource use and unit cost data for each of these cost components, and a range of potential outcome measures

Learning in doing: the social anthropology of innovation in a large UK organisation

In the face of increasingly dynamic market environments, firms are being urged to develop learning and innovation capabilities if they wish to secure competitive advantage and long-term growth. A bank of work written from numerous theoretical perspectives has converged on the view that knowledge underpins the formation of such capabilities. While much of this literature emphasises the importance of cognitive knowledge, a new approach grounded in techniques from social anthropology suggests that learning is a non-cognitive practice, drawing on embodied exploration, everyday sociality, and a communitarian infrastructure of human and non-human actants. This thesis aims to consolidate the current literature on ‘possessed’ knowledge by clarifying the relationship between cognition and learning, and to advance understanding of innovation practices within firms by examining the role of non-cognitive mechanisms in the development of organisational capabilities. Drawing on a nine-month period of ethnographic research, this thesis describes the on-the-ground processes of learning and innovation within the marketing department of a large UK organisation. This evidence is used to investigate critically the theoretical claims regarding the role of both cognitive and non-cognitive forms of knowledge. Based on the empirical findings, three interrelated arguments are proposed: the design and governance of strategic learning devices involve non-cognitive practices; informal mechanisms of learning underpin the formation of new capabilities; and communitarian theories of learning overemphasise the social construction of knowledge, while neglecting the agency of the materiality of context

Ethnic differences in the indirect effects of the COVID-19 pandemic on clinical monitoring and hospitalisations for non-COVID conditions in England: a population-based, observational cohort study using the OpenSAFELY platform

BACKGROUND: The COVID-19 pandemic disrupted healthcare and may have impacted ethnic inequalities in healthcare. We aimed to describe the impact of pandemic-related disruption on ethnic differences in clinical monitoring and hospital admissions for non-COVID conditions in England. METHODS: In this population-based, observational cohort study we used primary care electronic health record data with linkage to hospital episode statistics data and mortality data within OpenSAFELY, a data analytics platform created, with approval of NHS England, to address urgent COVID-19 research questions. We included adults aged 18 years and over registered with a TPP practice between March 1, 2018, and April 30, 2022. We excluded those with missing age, sex, geographic region, or Index of Multiple Deprivation. We grouped ethnicity (exposure), into five categories: White, Asian, Black, Other, and Mixed. We used interrupted time-series regression to estimate ethnic differences in clinical monitoring frequency (blood pressure and Hba1c measurements, chronic obstructive pulmonary disease and asthma annual reviews) before and after March 23, 2020. We used multivariable Cox regression to quantify ethnic differences in hospitalisations related to diabetes, cardiovascular disease, respiratory disease, and mental health before and after March 23, 2020. FINDINGS: Of 33,510,937 registered with a GP as of 1st January 2020, 19,064,019 were adults, alive and registered for at least 3 months, 3,010,751 met the exclusion criteria and 1,122,912 were missing ethnicity. This resulted in 14,930,356 adults with known ethnicity (92% of sample): 86.6% were White, 7.3% Asian, 2.6% Black, 1.4% Mixed ethnicity, and 2.2% Other ethnicities. Clinical monitoring did not return to pre-pandemic levels for any ethnic group. Ethnic differences were apparent pre-pandemic, except for diabetes monitoring, and remained unchanged, except for blood pressure monitoring in those with mental health conditions where differences narrowed during the pandemic. For those of Black ethnicity, there were seven additional admissions for diabetic ketoacidosis per month during the pandemic, and relative ethnic differences narrowed during the pandemic compared to the White ethnic group (Pre-pandemic hazard ratio (HR): 0.50, 95% confidence interval (CI) 0.41, 0.60, Pandemic HR: 0.75, 95% CI: 0.65, 0.87). There was increased admissions for heart failure during the pandemic for all ethnic groups, though highest in those of White ethnicity (heart failure risk difference: 5.4). Relatively, ethnic differences narrowed for heart failure admission in those of Asian (Pre-pandemic HR 1.56, 95% CI 1.49, 1.64, Pandemic HR 1.24, 95% CI 1.19, 1.29) and Black ethnicity (Pre-pandemic HR 1.41, 95% CI: 1.30, 1.53, Pandemic HR: 1.16, 95% CI 1.09, 1.25) compared with White ethnicity. For other outcomes the pandemic had minimal impact on ethnic differences. INTERPRETATION: Our study suggests that ethnic differences in clinical monitoring and hospitalisations remained largely unchanged during the pandemic for most conditions. Key exceptions were hospitalisations for diabetic ketoacidosis and heart failure, which warrant further investigation to understand the causes. FUNDING: LSHTM COVID-19 Response Grant (DONAT15912)