Introducing Total Quality Management into an Alien Organisational Culture*
| Author | Dave Morris,Bob Haigh |
| DOI | 10.1177/014473949201200208 |
| Published date | 01 September 1992 |
| Date | 01 September 1992 |
Teaching
Public
Administration:
Autumn
1992
vol.XII
no.2
pp.63-76
Introducing
Total
Quality Management
into an
Alien
Organisational Culture *
BOB
HAIGH and DAVE MORRIS
Sheffield
Business School,
Sheffield
City
Polytechnic
All
developed
countries
have in
place
some
more
or
less
comprehensive
system
for
ensuring
that
their
citizens
have
access
to
health
care.
The
UK has a
health
care
system
under
which
the
funding
of
the
provision
of
health
care
and
the
management
of
that
provision
comes
from
the
state.
The
finances
of
the
British
National
Health
Service
(NHS)
rely
more
on
general
taxation
than
do
those
systems
operating
elsewhere
in
the
European
Community
where
social
insurance
contributions
and
direct
charges
to
customers
are
more
widespread.
The
NHS in
order
to
discharge
its
responsibility
for
hospitals,
primary
health
care
and
some
community
care
employs 1.25 million
personnel
and spends
approximately
£25 billion
per
annum. Its
expenditure,
therefore,
constitutes
about
1/8
of
all public spending in
the
UK.
The
administration
of
this
vast
organisation
is a
decentralised
one
wherein
the
Department
of
Health
does
not
administer
the
NHS
but
allocates
money
to
health
authorities
which
have
the
prime
operational
responsibility
for
the
Service.
The
funds
allocated
come
from
the
annual public
expenditure
round in which
the
spending
departments
of
the
state
agree
with
the
Treasury
how
much
is
to
be
assigned
to
particular
public
programmes.
The
essence
of
this
is,
therefore,
a global
budget
from
which a
range
of
services
has
to
be
provided via a
decentralised
system.
Since
its
foundation
in 1948,
one
of
the
central
features
of
the
operation
of
the
NHS has
been
the
relationship
between
the
perceived
need
to
contain
the
cost
of
the
Service
within
what
has
been
thought
by
the
government
of
the
day
to
be
'reasonable
bounds' and
the
goals
of
efficiency
and
equity
that
form
the
crucial
part
of
the
manifest
rationale
for
the
Service's
creation.
Efficiency
was
taken
to
imply
'rational
planning'
of
health
care
provision and
the
'effective
management'
of
health
care
resources.
Equity
implied
equal
access
to
the
Service
according
to
need and
irrespective
of
the
ability
to
pay.
Since
1948
successive
governments,
irrespective
of
political
persuasion,
have
had
to
struggle
with
the
problem
of
how
to
balance
the
twin
goals
of
efficiency
and
equity
within
a
context
where
the
assumption
of
the
Service's
creators
-
that
better
health
care
would
make
for
a
healthier
nation
and
so
reduce
the
cost
of
service
provision -has
proved
the
precise
opposite
of
reality.
As
early
as 1953 a
committee
of
enquiry
was
established
to
consider
the
ever-growing
*This
article
is
based
on a
presentation
by
the
authors
to
the
3rd
Annual
National
Quality
Management
Conference
held in
Atlanta,
Georgia,
February
14-15, 1991.
63
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