The Governance of Management Consultancy Use:A Review of Practices, Problems and Possibilities

The provision of expert advice in government and its potential threat to democracy is not a new phenomenon (Grundmann, 2018), whether as technocracy or through experts acting as mere ‘servants of power’ (Brint, 1990). In recent decades, policy advice has been increasingly externalised and commercialised to diverse professional service firms (PSF), notably, and our focus here, management consultancy firms and divisions of other PSFs such as the ‘Big Four’ (Craft and Howlett, 2013). This process has been attractive to some policy actors for the relative speed of delivery (‘fast policy’), the offer of an ‘outsider’ or ‘modernising’ (e.g. management-based) view and the greater opportunity, as clients, to shape the content of policy directly. However, critiques emerged in the 1990s/2000s, especially around what was termed consultocracy - how public scrutiny and/or democratic processes were being by-passed in favour of consultants and their market-based approach (Martin, 1998). These and other concerns continue today. This chapter seeks to examine how they have been addressed by outlining the governance of consultancy use and its limitations and begins to explore some of the possibilities for improvement

Power and the diffusion of management ideas:The Case of McKinsey & Co.

In studies of the diffusion or translation of management ideas, power is frequently implied but is rarely theorised explicitly. Moreover, when it is recognised, the focus is often on only one form of power. This can obscure how different forms of power relate to each other, shape idea diffusion and connect to different forms of resistance. Using Lukes’ classic framing of power, we explore the activities of a key agent in the diffusion of ideas – management consultancy – and one of the leading players in that field – McKinsey & Co. We draw on diverse, publicly available forms of data on three different management ideas to identify how different forms of power and resistance enable and constrain the diffusion of management ideas. Our study emphasises both the dynamic relations between different forms of power over time and the importance of acknowledging the unintended consequences of power. At the same time, by focusing on power dynamics mostly operating outside of consulting projects, we add to our understanding of the role of consultancy in the diffusion of management ideas more generally

Deaths certified as asthma and use of medical services: A national case-control study

This is an open access publication. The official published version can be accessed from the link below.Background: Studies have linked asthma death to either increased or decreased use of medical services. Methods: A population based case-control study of asthma deaths in 1994–8 was performed in 22 English, six Scottish, and five Welsh health authorities/boards. All 681 subjects who died were under the age of 65 years with asthma in Part I on the death certificates. After exclusions, 532 hospital controls were matched to 532 cases for age, district, and date of asthma admission/death. Data were extracted blind from primary care records. Results: The median age of the subjects who died was 53 years; 60% of cases and 64% of controls were female. There was little difference in outpatient attendance (55% and 55%), hospital admission for asthma (51% and 54%), and median inpatient days (20 days and 15 days) in the previous 5 years. After mutual adjustment and adjustment for sex, using conditional logistic regression, three variables were independently associated with asthma death: fewer general practice contacts (odds ratio 0.82 (95% confidence interval (CI) 0.74 to 0.91) per 5 contacts) in the previous year, more home visits (1.14 (95% CI 1.08 to 1.21) per visit) in the previous year, and fewer peak expiratory flow recordings (0.83 (95% CI 0.74 to 0.92) per occasion) in the previous 3 months. These associations were similar after adjustment for markers of severity, psychosocial factors, systemic steroids, short acting bronchodilators and antibiotics, although the association with peak flow was weakened and just lost significance. Conclusion: Asthma death is associated with less use of primary care services. Both practice and patient factors may be involved and a better understanding of these may offer possibilities for reducing asthma death.This study was funded jointly between the National Research and Development Asthma Management Programme (contract number AM1/ 05/002) and the National Asthma Campaign through a grant from Glaxo Wellcome (now GlaxoSmithKline)

Acquiring knowledge through management consultancy:A national culture perspective

This paper examines how national culture informs the sourcing of management knowledge through external consultancy. First, it hypothesises and compares the relationship between quantitative measures of Hofstede's cultural indices with adjusted expenditure on consulting in nine countries. Two cultural indices are found to correlate with consulting use – power distance (negatively) and individualism (positively). However, the disparity between our findings and prior research suggests limitations of generalisation in studies solely employing quantitative cultural indices to understand the purchasing of business knowledge. We therefore propose the use of supplementary, qualitative data with sensitivity to local contexts and briefly apply this by using secondary sources to provide historical narratives for two countries – the UK and Japan. Overall, we find and tentatively explain significant statistical relationships between Hofstede's cultural indices and adjusted expenditure on consultancy. We then draw attention to wider implications for consulting research and for practitioners involved in this context

Paying primary health care centers for performance in Rwanda

Paying for performance (P4P) provides financial incentives for providers to increase the use and quality of care. P4P can affect health care by providing incentives for providers to put more effort into specific activities, and by increasing the amount of resources available to finance the delivery of services. This paper evaluates the impact of P4P on the use and quality of prenatal, institutional delivery, and child preventive care using data produced from a prospective quasi-experimental evaluation nested into the national rollout of P4P in Rwanda. Treatment facilities were enrolled in the P4P scheme in 2006 and comparison facilities were enrolled two years later. The incentive effect is isolated from the resource effect by increasing comparison facilities'input-based budgets by the average P4P payments to the treatment facilities. The data were collected from 166 facilities and a random sample of 2158 households. P4P had a large and significant positive impact on institutional deliveries and preventive care visits by young children, and improved quality of prenatal care. The authors find no effect on the number of prenatal care visits or on immunization rates. P4P had the greatest effect on those services that had the highest payment rates and needed the lowest provider effort. P4P financial performance incentives can improve both the use of and the quality of health services. Because the analysis isolates the incentive effect from the resource effect in P4P, the results indicate that an equal amount of financial resources without the incentives would not have achieved the same gain in outcomes.Health Monitoring&Evaluation,Population Policies,Health Systems Development&Reform,Disease Control&Prevention,Adolescent Health

“This is proof”? Forensic evidence and ambiguous material culture at Treblinka extermination camp

In recent years, a forensic archaeological project at Treblinka extermination camp has uncovered significance evidence relating to the mass murder that took place there. A number of questions emerged regarding the provenance and origins of objects discovered as part of this work, and why they had remained undiscovered for over seventy years. These discoveries led to an opportunity to confirm and challenge the history of the extermination camp, and demands (from the public) to view the objects. This paper will outline how archaeologists and artists came together to reflect on these issues, whilst simultaneously providing access to the new findings

Popular critiques of consultancy and a politics of management learning?

In this short article, I argue that popular business discourse on the role of management consultancy in the promotion and translation of management ideas is often critical, informed by more or less implicit ethical and political concerns with employee security, equity, openness and the transparency and legitimacy of responsibility. These concerns are, in part, ‘sayable’ because their object is seen as a scapegoat for management. Nevertheless, combined with the popular form of their expression, they can support and legitimize critical studies of management learning, a discipline which otherwise has become overly concerned with processual and situational phenomena at the expense of broader political dynamics and of the content and consequences of management and management knowledg

Beyond hollowing out: Public sector managers and the use of external management consultants

Expenditure on management consultants in public sector organizations is generally seen as contributing to a “hollowing out” of the state through the substitution of internal management capability. However, there is little systematic evidence for this view which also ignores how public sector managers may, themselves, drive consulting use. Looking at 125 English public hospitals over 6 years, we explore the relationship between the development and composition of management functions and spending on consultants. Our findings show the absence of a substitution effect and, therefore, challenge the “hollowing out” thesis. Instead, they point to a more active, occupationally varied and political use of consultancy. We find that larger management functions overall are associated with greater reliance on consultants— a complementary relationship. However, where a higher proportion of managers are engaged in internal consulting functions, this results in the lower use of external management consultants, with implications for theory, research and policy

The impact of management consultants on public service efficiency

Public sector organisations often make use of management consultants in policy implementation, but we know little about the outcomes. The paper reports one of the first quantitative evaluations of the impact of consulting advice on efficiency of public sector organisations. We employ an extensive dataset covering English NHS acute care hospital trusts over a four-year period. Based on PCSEs estimations, the findings show a significantly positive relationship between consulting expenditure and organisational inefficiency. These results lend support to critical accounts of management consulting, highlighting the need for organisations to be circumspect in deciding whether and how to use these services