Strategic management and National Health Service hospital trusts: empirical evidence from the West of Scotland

Forbes, Thomas McCrone (1999) Strategic management and National Health Service hospital trusts: empirical evidence from the West of Scotland. PhD thesis, University of Glasgow.

Abstract

This research examines the development of strategic management within five National Health Service Hospital Trusts (NHST's) used as case studies in the West of Scotland between 1994 and 1997. The rationale for the study was the 1990 NHS Reforms, which created an internal market in health care by separating the purchasing of health care from its provision via the purchaser/provider split. In Scotland, Area Health Boards (AHB's) and General Practitioner FundHolders (GPFH's) became purchasers of health care and hospitals became providers of health care as NHST's. Purchasers and provider relationships were mediated through the use of contractual agreement over services. The NHST's, now freed from AHB management and control, began to develop their organisations both internally and externally to complete with other providers within what they considered would be a competitive market. This involved the development of a strategic management role for NHS managers within their hospitals where previously none had existed, and the setting up of groups of clinical specialisms into devolved management structure known as clinical directorates. These clinical directorates had their own management teams consisting of a senior clinician as clinical director supported by a business manager [and] or service manager. Strategy was examined at a macro level (NHST senior managers) and at a micro level (clinical directorate) as was the relationship between the NHST senior managers and their clinical directorates. The thesis examined three broad areas in relation to strategic management within the five NHST case studies. These were as follows: The Development of the Internal/Quasi Market within the NHS in the West of Scotland; The Development of Strategic Management at Senior Management or (macro) Level Within the Five NHST Case Studies; and The Development of Strategic Management at Clinical Directorate (micro) Level Within the Five NHST Case Study Hospitals.

In summary this thesis illustrates how NHS managers within NHST's for the first time were in a position to develop strategy for their organisations. The key to understanding strategy development within the NHST case studies was the relational market in the West of Scotland, and the strategic processes that unfolded over time as the NHST's moved away from generic strategy approaches to approaches based upon collaboration and co-operation. This was seen at both senior NHST manager level (macro) and at clinical directorate level (micro). There were a number of similarities that all the NHST case study managers were considering in their individual strategies, but also a number of differences. It is also to be remembered that the NHS is a political organisation. There was therefore a limit to the extent to which NHS managers were 'free' to develop a full strategic management agenda given that resources in the NHS were limited and because of the political implications that could arise if certain strategic decisions were made. Strategic management concepts and models have a place in the NHS, although they may have to be adapted and modified, particularly with regard to the processes involved in reaching strategic decisions.

• Item Type: Thesis (PhD)
• Qualification Level: Doctoral
• Subjects: H Social Sciences > HD Industries. Land use. Labor > HD28 Management. Industrial Management
• Colleges/Schools: College of Social Sciences > Adam Smith Business School > Management
• Supervisor's Name: Hunter, Prof. Sir Laurie and Francis, Prof. Arthur
• Date of Award: 1999
• Depositing User: Ms Anikó Szilágyi
• Unique ID: glathesis:1999-5900
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 12 Jan 2015 09:49
• Last Modified: 12 Jan 2015 09:51
• URI: https://theses.gla.ac.uk/id/eprint/5900