A Multi‐disciplinary Identification of Issues Associated with ‘Contracting’ in Market‐oriented Health Service Reforms
| Date | 01 March 1997 |
| Published date | 01 March 1997 |
| DOI | http://doi.org/10.1111/1467-8551.00038 |
Introduction
This paper stems from a multi-disciplinary study
of the introduction of ‘contracting’ as a key mech-
anism in National Health Service (NHS) market
reforms. The aim of the paper is to report an
attempt at this substantive multi-disciplinary
model of the contracting process and to reflect
on the methodological issues arising from this.
(Methodology in its own right has been dealt with
elsewhere, Hindle et al., 1995.) It covers the con-
text of NHS contracting, the multi-disciplinary
perspectives brought to bear on this, an empirical
description of contracting practices and issues,
uni- and multi-disciplinary interpretation.
The context
The UK health service has been reformed period-
ically since its post-war inception. ‘Contracting’,
British Journal of Management, Vol. 8, 39–49 (1997)
A Multi-disciplinary Identification of
Issues Associated with ‘Contracting’ in
Market-oriented Health Service Reforms1
J. G. Burgoyne, D. H. Brown, A. Hindle and M. J. Mumford
The Management School, Lancaster University, Lancaster LA1 4YX, UK
Multi-disciplinary perspectives from operational research, management information
systems, purposeful activity systems, accounting and finance, transaction-cost economics
and organization learning are discussed in relation to ‘contracting’ in the NHS
following the recent reforms, applied within the general framework of soft-systems
methodology. These are then used to frame questions for collecting information about
contracting practices and issues. The data so collected suggest that the issues and activi-
ties associated with contracting can be grouped into five interacting categories of: strat-
egy formation, making enabling arrangements, operational management of contracted
activities, identifying and relating to stakeholders, and carrying forward organizational
learning from experience. Each of the disciplinary perspectives attributes significance
to specific forms in these five activities.
The possibility of some multi-disciplinary linking of theoretical perspectives is demon-
strated. Information and purposeful systems are central to this, being on the one hand
created by social processes which define relevant information and corporate align-
ments of purpose, and on the other hand patterns of activity that can be evaluated in
terms of contribution to these purposes, with properties of greater or lesser inhibition
of innovation to improve purpose achievement. As a case study of an attempt at inter-
disciplinary research, it demonstrates that interdisciplinary linkage can be made,
though certain epistemological issues are skated over in the process. On the basis of the
case study, some of the richness and insight of the different perspectives is lost in the
process. The critical debate about the neutrality of soft-systems methodology is
commented on in the light of the study.
© 1997 British Academy of Management
1This paper reports some of the substantive findings
from phase one of a research project supported by a
grant from the Economic and Social Science Research
Council (award number L11425 1025) which is part of
the Council’s Contracts and Competition Research
Programme. The help of other members of the re-
search team less directly involved in the preparation of
this paper is gratefully acknowledged: David Blackett,
Peter Checkland, Sue Holwell, David Worthington.
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