Guest editorial

Citation

Dickinson, H., Millar, R. and West, M. (2011), "Guest editorial", Journal of Health Organization and Management, Vol. 25 No. 3. https://doi.org/10.1108/jhom.2011.02525caa.001

Guest editorial

Article Type: Guest editorial From: Journal of Health Organization and Management, Volume 25, Issue 3

About the Guest Editors Dr Helen Dickinson is a Lecturer at the Health Services Management Centre, University of Birmingham. At HSMC Helen leads the health and social care partnerships programme and has research interests in inter-agency collaboration, leadership and the role of the third sector in health and social care. Helen headed the organising committee for OBHC 2010 and has recently been appointed as Co-editor of Journal of Health Organization and Management.

Despite the best intentions of policy makers and practitioners alike, plans do not always turn out as expected. The “implementation gap” is a phrase that is often used to refer to the difference between what a particular policy promises and what is delivered in practice. This gap (or deficit as it is sometimes called) is both puzzling and challenging to practitioners and researchers. It has provoked pronounced debates of late, partly as a consequence of the rise of movements in evidence-based policy, practice and medicine. The Society for the Study of Organizing in Health Care (SHOC) has had a particular focus on the ways in which this gap manifests in health care and addressed this issue at its biennial international conference in Organisational Behaviour in Health Care (OBHC) in 2010.

This Special Issue of the journal draws on selected papers presented at the 7th OBHC Conference, which was held at the University of Birmingham from the 11-14 April 2010. The theme of the conference, which attracted over 150 academics and practitioners from across the globe, was “Mind the Gap: Policy and Practice in the Reform of Healthcare”. Visiting academics were invited to share their expertise, and present and discuss papers that explored how healthcare shapes, adapts and resists developments in healthcare policy and practice. As an innovation for this conference, an additional practitioner-focused day complemented the two days of academic debate and was attended by senior managers and clinicians from the English NHS. They took the opportunity to discuss the conference theme with academics. Over the course of the conference, delegates welcomed three distinguished keynote speakers:

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  Professor Michael West from Aston Business School;

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  Dr Peter Hupe from Erasmus University, Rotterdam; and

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  Ben Page from Ipsos MORI.

Papers presented at the conference dealt with a range of topics relating to the policy/practice “gap”, and this diversity is reflected in the papers selected to form this special issue of the journal. We developed several criteria for selecting the work that provides the basis of this special issue. We wanted to capture the diversity of contributions across this field and from a variety of different perspectives. We wanted to capture both empirical and theoretical perspectives on the conference theme and sought to illustrate the depth of contributions that the OBHC community can provide to this complex area of study.

Turning to the papers, one of the strands of writing around the implementation gap relates to the issue of performance. In our first paper, Angus Corbett, Jo Travaglia and Jeffrey Braithwaite investigate how “sociological citizenship” might help provide a pathway for health care organisations to navigate the gap between the policy and practice of improving quality and safety. Through a literature review into the concept of sociological citizenship, Corbett et al. argue that successful initiatives to improve patient safety need to induce change at the individual level. In other words, changes at a system level should be accompanied by those that draw connections between individuals and their actions in bringing about the capacity of health care systems to improve patient safety.

The findings of the first paper are echoed by Sandra Leggat, Timothy Bartram and Pauline Stanton, who investigate the gap between policy and practice in high-performance work systems (HPWS). In their study of Australian hospitals, the research team investigate the link between HPWS, human resource management and organisational performance. Although much of the literature supports a strong relationship between HPWS and organisational performance, the team found little evidence of implementation and maintenance of the main components. The research team conclude that leaders of health systems should pay attention to the human resource management systems, structures and processes that support HPWS as an essential and necessary component of health system reform. Attention to HRM and cultures, values and practices has for some time been seen by academics as important in high quality health care, but is often neglected by policy and in practice.

Emmanouil Gkeredakis and colleagues study the gap between policy and practice in terms of how knowledge is produced within particular policy or research discourses and therefore becomes relevant for those who do the work in health care delivery. These authors argue that the issue of how knowledge is utilised in practice is rather under-developed in the literature. Through in-depth studies of the practices of commissioning managers in the NHS, the research team sheds light on the “real work” of managers and into the use of policy instruments and research evidence in practice. In drawing out the practical implications of this research, Gkeredakis and colleagues stress the importance of the active involvement, skill and creativity of practitioners for utilising either policy directives or research evidence. This observation leads us on to the paper by Paul Smith and colleagues, which focuses on a management development programme for a UK primary care organisation. They describe how they created a successful programme of leadership development with a particular focus on introducing innovation and improvement into the practice of a range of individuals within a primary care organisation. Again these researchers argue for the importance of staff development in embedding new policy developments in practice in order to improve organisational performance.

The last two papers deal with the issue of employment, although from rather different perspectives. Simon Bishop and Justin Waring explore the issue of public-private partnerships in English healthcare and the potential for gaps or inconsistencies in employment in these new provider organisations. Bishop and Waring argue that, in order for these providers to deliver on their promises of innovation, greater harmonisation and alignment with employment practices is required. Importantly, these authors note that without the willing cooperation of professional groups, changes led by private managers are unlikely to be adopted. Again this work reiterates the importance of paying attention to micro-level HRM practices.

The final paper in this special issue, by Henna Hasson, Ulrika Bejerholm and Mats Andersson, investigates the implementation of an evidence-based method of support for people with severe mental illness in finding regular employment in Sweden. This research found quite different barriers to the adoption of these types of initiatives to those that the literature might suggest. Cooperation between mental health practitioners was positive and information dissemination seemed to be particularly effective in this case. What this meant is that some of the types of individual-level barriers that are often present in cases of policy implementation might be overcome with information and experience. One of the greatest challenges posed by these researchers is the amount that programmes can be altered and shaped without losing their fidelity.

Although drawn from a range of different national and international settings, what is common across these papers is conceptualising the implementation gap between policy and practice in a more complex and dynamic way than simplistic notions sometimes encountered in the literature. These papers all argue for more attention to be paid to the linkages between the macro and micro levels in the design, adaptation and delivery of policy. We look forward to many of these themes being revisited at the 8th Biennial Conference in Organisational Behaviour in Health Care, which will take place in April 2012 in Dublin, hosted by Dublin City University and Trinity College Dublin. The conference will explore how health care organisations and professionals can work towards achieving patient-centred health care teams. We anticipate that Dublin will provide a warm welcome and a fine host for OBHC 2012 and be as intellectually stimulating and as enjoyable as was OBHC 2010.

Helen Dickinson, Ross Millar, Michael West