Managing change :using organisational change theory to understand organisational responses to health policy : a case study in commissioning

Abstract

Background : The NHS in England has been subject to numerous reforms and changes in health policy since its inception in 1948. Such changes often mean that organisational strategies are halted, diverted or otherwise prevented from being completed. To date research in health care settings has considered change in a broad context but there has been limited research which focuses on how organisations respond and adapt to changes in health policy specifically. The objective of this research is to explore how existent change management literature and models can be used to understand how organisations respond to changes in health policy. Methods : In 2010 the White Paper ‘Equity and Excellence Liberating the NHS’ was released. The paper, which proposed ambitious and widespread reform to the NHS, was met with significant resistance and experienced a protracted passage through Parliament. This research utilised the changing policy landscape to conduct a natural experiment, using a commissioning organisation as a case study, to understand responses to these policy changes. The eight factors of receptivity model was used as a medium to explore organisational receptivity to NHS policy changes. Results : A synthesis of the results is presented in the form of a new model to guide organisations in developing receptivity to change. The model identifies four key factors influencing the organisation’s ability to respond to policy change policy system management, organisational context and change agenda and locale. Conclusions : Receptivity to policy change in the NHS is influenced by different factors than traditional management induced change or organic organisational change. Implications : for policy makers have been drawn from this research which includes the need to develop coherent policy with clearly articulated vision, the requirement to manage national political culture, the importance of tackling system issues, and the need for careful management during transitions to avoid loss of valuable skills and expertise.