Let's be PALS: User‐Driven Organizational Change in Healthcare*
| Author | David Buchanan,Julienne Meyer,Jane Bentley,Stephen Abbott,Anne Lanceley |
| DOI | http://doi.org/10.1111/j.1467-8551.2005.00462.x |
| Date | 01 December 2005 |
| Published date | 01 December 2005 |
Let’s be PALS: User-Driven
Organizational Change in Healthcare
*
David Buchanan, Stephen Abbott,
w
Jane Bentley,
w
Anne Lanceley
w
and
Julienne Meyer
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Leicester Business School, De Montfort University, The Gateway Leicester, LE1 9BH, and
w
St Bartholomew
School of Nursing and Midwifery, City University London, Philpot Street, London, E1 2EA, UK
Corresponding author emails: d.buchanan@dmu.ac.uk; BuchDave@aol.com
This paper explores user-driven organizational change in the National Health Service
(NHS). The NHS Plan (Department of Health, 2000) created Patient Advice and
Liaison Services (PALS) to provide information, solve problems and drive user-led
change. Evidence is drawn from a study of PALS in London acute, primary care,
mental health and specialist trusts, drawing on discussion forums, interviews with PALS
officers and documentation. From context and role profiles, two conclusions are evident.
First, organizational instability, boundary disputes, variable management support,
resource limitations, financial insecurity and multi-site working characterize the context
in which PALS operate, and the officer role is characterized by problem diversity,
overlap with complaints systems, monitoring problems, relationship building and ‘serial
users’. Second, these context and role attributes restrict PALS to ‘repair and
maintenance’, ensuring that established systems work correctly. While PALS sit on the
bottom rung of a ‘participation ladder’, their contribution is more than tokenistic.
However, a processual perspective demonstrates how a fluid, networked, and diversified
context isolates PALS structures from management decision-making, constraining
their power base, and inhibiting the promotion of substantive change agendas.
A patient-centred service with PALS
How can customers, or users, contribute to
organizational change? This article explores the
potential for Patient Advice and Liaison Services
(PALS) to facilitate service improvement and
culture change in the National Health Service
(NHS), following their introduction in 2001 with
The NHS Plan (Department of Health, 2000).
The Plan argued that the service was being run in
the interests of staff. PALS were a component in
operationalizing the policy of turning the NHS
into a patient-centred organization. The Plan’s
ten-year ‘modernization’ agenda may constitute
one of the most ambitious organization develop-
ment interventions ever undertaken, in any
sector, and PALS is thus a unique experiment
in user-driven change. PALS do not just collate,
analyse and report on user data. Faced with a
patient with a problem, their role is to solve that
problem on the spot, or find a senior manager to
negotiate resources and remove barriers. PALS
were thus designed to be a mechanism through
*
The research on which this paper is based was initially
commissioned through the Health Services Research
Call Down Unit (HSRU) of Queen Mary University of
London and City University, and undertaken in
collaboration with the London Quality Task Force
(QTF). The authors wish to express their gratitude for
this support, and also to acknowledge the contributions
of healthcare staff and patients to this project. Following
the Department of Health Research Governance guide-
lines introduced in April 2001 (Department of Health,
2001a, 2001b), Multi-Site Research Ethics Committee
approval was obtained for this project. The authors wish
to thank George Boyne and two anonymous reviewers
for their clear and constructive criticisms and sugges-
tions on previous drafts of this paper, while accepting
full responsibility for the gaps and flaws that remain.
British Journal of Management, Vol. 16, 315–328 (2005)
DOI: 10.1111/j.1467-8551.2005.00462.x
r2005 British Academy of Management
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