THE POLITICAL ECONOMY OF MANAGEMENT KNOWLEDGE: MANAGEMENT TEXTS IN ENGLISH HEALTHCARE ORGANIZATIONS
| Author | CHRIS BENNETT,MICHAEL D. FISCHER,SUE DOPSON,LOUISE FITZGERALD,GERRY MCGIVERN,JEAN LEDGER,EWAN FERLIE |
| DOI | http://doi.org/10.1111/padm.12221 |
| Published date | 01 March 2016 |
| Date | 01 March 2016 |
doi: 10.1111/padm.12221
THE POLITICAL ECONOMY OF MANAGEMENT
KNOWLEDGE: MANAGEMENT TEXTS IN ENGLISH
HEALTHCARE ORGANIZATIONS
EWAN FERLIE, JEAN LEDGER, SUE DOPSON, MICHAEL D. FISCHER,
LOUISE FITZGERALD, GERRY MCGIVERN AND CHRIS BENNETT
Have generic management texts and associated knowledges now extensively diffused into public
services organizations? If so, why? Our empirical study of English healthcare organizations detects
an extensive presence of such texts. We argue that their ready diffusion relates to two macro-level
forces: (i) the inuence of the underlying political economy of public services reform and (ii) a
strongly developed business school/management consulting knowledge nexus. This macro per-
spective theoretically complements existing explanations from the meso or middle level of analysis
which examine diffusion processes within the public services eld, and also more micro literature
which focuses on agency from individual knowledge leaders.
INTRODUCTION
Have generic management texts and associated knowledges now extensively diffused into
public services organizations? If so, why? We argue that texts from management consul-
tants and mainly American business school academics have diffused extensively into the
important setting of English healthcare organizations. We add to the well-established lit-
erature on public management reforms by considering public managers’ knowledge base
and how and why it shifts. We here put together two traditionally separate academic lit-
erature streams: those on public management and management knowledge.
The English healthcare sector displays sustained policy activity promoting Evidence-
Based Medicine (EBM), so we had initially wondered whether this context might be recep-
tive to the diffusion of Evidence-Based Management (EBMgt) texts. We know little about
how health services managers engage with health management research (if they do), pro-
viding a major gap we wanted to explore.
After reviewing relevant literatures and describing our methods, we introduce our
empirical study of management texts found in English healthcare organizations (Dop-
son et al. 2013). We detected few EBMgt texts, but the extensive diffusion of texts from
management consultants or mainly American business school academics.
We theorize these empirical ndings by considering two macro-level effects: rst, how
the political economy of public services reform inuences preferences for management
knowledge; and second, inuence from a strong ‘business school/management con-
sultancy knowledge nexus’. Our macro-level analysis adds to conventional meso-level
explanations of the diffusion of management knowledge in the healthcare/public ser-
vices eld and also more micro-level explanations focusing on agency from ‘knowledge
leaders’.
Ewan Ferlie and Jean Ledger are at the Department of Management, King’s College London, UK. Sue Dopson is at the
Said Business School, University of Oxford, UK. Michael D. Fischer is at the Centrefor Workplace Leadership, University
of Melbourne, Australia. Louise FitzGerald is at the Said Business School, University of Oxford, UK. Gerry McGivern is
at the Warwick Business School, University of Warwick, UK. Chris Bennett is at the Department of Geography, King’s
College London, UK.
Public Administration Vol.94, No. 1, 2016 (185–203)
© 2015 John Wiley & Sons Ltd.
186 EWAN FERLIE ET AL.
LITERATURE REVIEW
Healthcare management knowledge: evidence-based medicine and now
evidence-based management?
The English healthcare sector displays sustained policy activity promoting EBM models
(Sackett 2000; Evans 2003), designed to ensure that clinical practice is evidence based. The
National Institute of Health and Care Excellence (NICE) produces many evidence-based
guidelines to inform ‘evidence-based’ clinical practice and service delivery.
Healthcare managers’ role in such arenas is, however, opaque. Previous studies have
suggested that they lack the knowledge or skills to access research ndings and play a
marginal role in research-informeddecision making arenas (Dopson and FitzGerald 2005).
Health managers may seek to meet top-down targets rather than read or ‘own’ research
(McGivern et al. 2009), preferring to access experiential knowledge from a community of
like-minded colleagues (Macfarlane et al. 2011).
However, an expanding academic management literature advocates an EBMgt
approach, taking EBM as a role model (Walshe and Rundall 2001; Traneld et al. 2003;
Rousseau 2006, 2007). A new non-prot organization (the Centre for Evidence-Based
Management, CEBMA) acts as an international clearing house for EBMgt, providing open
access to downloadable materials, including systematic reviews (see Hollingsworth 2008
on healthcare organizations) and critical appraisals. CEBMA’s approach (Barends et al.
2014) is pluralist, acknowledging various forms of management evidence (http://www.
cebma.org/). A summary systematic review (equivalent to NICE’S evidence-based guide-
lines) or critical appraisal document are possible EBMgt texts which might in principle
diffuse into the healthcare management eld. However,we so far lack descriptive/analytic
studies of such diffusion in practice.
An alternative literature stream: business schools, management consulting
and management knowledge
Healthcare managers relate not only to the EBM/EBMgt movements, but also to a grow-
ing body of private sector orientated general management knowledge (Thrift 2005). Scott
et al. (2001, pp. 20–21) make an (undeveloped) observation that knowledge shifts express
wider institutional changes: ‘an institutional change is signalled in the health care eld,
for example, when hospital managers once trained in schools of hospital administration
are replaced by health care executives trained in business schools’.
This ‘business school/consulting knowledge nexus’ has porous boundaries between
its different knowledge producers. Engwall (2010) explores the symbiosis of business
school academic writing and consulting. Thrift (2005) suggests that this knowledge nexus
displays powerful interlocking institutions, self-referential insulation and an ability to
acquire ever more resources.This ‘cultural circuit of capitalism’ (Thrift 2005; Engwall 2010;
Jung and Keiser 2010) produces a linked constellation of Masters of Business Administra-
tion, major business school faculty, management gurus,consulting rms, business media,
journals and presses, inspirational conferences and ‘blockbusting’ management texts
(e.g. Osborne and Gaebler 1992). Inuential knowledge producers are often located in
elite American business schools and management consultancies, with their management
knowledge ‘products’ diffusing from the private to the public sector and from America to
the United Kingdom/Europe.
So how can these management texts be characterized? This distinct genre has strong
authorial and editorial conventions (e.g. Harvard Business School books) (Clark et al.
2010). They are closely linked to a proposed solution, are normative in tone and less
Public Administration Vol.94, No. 1, 2016 (185–203)
© 2015 John Wiley& Sons Ltd.
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