Professor Ewan Ferlie Dept of Management King’s College London January 2013 Presentation at NHS Confederation Event

Introduction Consider the theory and practice of organisational process research and why it may be a useful and distinctive approach to case based work; Large scale designs and connection to theory; Getting beyond the single descriptive case; Give a worked example from NIHR funded research on managed networks in health care;

Organizational Process Research Pettigrew is a key UK author ; A major current within general management research, associated with ‘soft’ strategy; ‘getting beyond the variables paradigm of the 1960s’ (Aston Group) Interest in processes of strategic change and of resistance to such change; Historical, cultural and political perspectives; Fitted well with the UK of the 1980s as a ‘high change’ decade (Pettigrew et al, 1992 on NHS); both private and public sectors; Also a more managerialist interest in ‘performance’;

Some Key Characteristics Treat ‘implementation’ as problematic and as something to be accomplished; Comparative case study designs; n=8! Purposeful selection of cases; Longitudinal and retrospective: where there is a clear organisational outcome to explain; Processual elements – decision streams unfold over time (Mintzbergian notion of strategy); rich seam of organisational politics;

Some Key Characteristics Contextual: - inner context; - outer context; narratives of health policy ‘reforming’; - receptive and non receptive contexts for strategic change (Pettigrew et al, 1992); Multi layered designs; Operates at the meso/strategic level rather than the macro (national health policy) or the micro level (the clinical team);

Research Methods Documents; Observation of meetings; Semi structured interviews; Team management and writing up the cases; What is a good case study? Comparative analysis;

Managed Networks Study Ferlie et al (2010) – nature, impact and performance of a set of 8 managed networks set up in the early 2000s ( ); Complex and large scale sites; 4 different pairs; E.g. Urban and County Cancer Networks; Attempt at a performance assessment and generation of proxy indicators; Emblematic New Labour reform to health policy so policy connected; (luckily for us) end of the New Labour period in May 2010;

Managed Networks Study 8 comparative cases, using standard methods; Approx 220 interviews; Retrospective following through of a major tracer issue E.g. Urology IOG in the cancer networks; Team of five researchers; Many team meetings at the end of the project to make sense of what we have found; Comparative cases written up in a common format;

Managed Networks Study First article addressed health policy implications (Ferlie et a, 2010) and made a measured defence of networks in ‘wicked problem’ arenas as the least bad governance mode; Of direct policy relevance – Future Forum workstream on networks (2011) picked up the Public Administration article ; Later article (Ferlie et al, 2012) developed an overall theoretical interpretation of governance modes found – Foucault and governmentality stream of literature;

Managed Networks Study Helped generate a distinctive overall interpretation of a New Labour period ( ) in English health policy; Networks Vs Targets/terror (Hood and Bevan) Marketisation (Mayes et al)

Concluding Discussion Critics would see it as a relatively conservative variant of case study research; Large scale and comparative designs (so need big research teams and grants); Increases external validity concerns; there is always a concern for informing policy; In principle, can mix well with more quantitative components in a mixed design; Not hostile to a notion of proxy ‘performance’ measures (implicitly rather managerialist, see Pettigrew et al, 1992?); not really ‘critical’ enough?;

Concluding Discussion Important element of longitudinality makes it unsuitable for short studies; Comes with a sophisticated methodological discussion in mainstream org studies literature (Eisenhardt, 1989; Langley, 1999); Need good writing skills of a historian; Open to theory, including basic social science theory, as a way of emplacing the many empirical observations;

References Eisenhardt, K. (1989) ‘Building Theories from Case Study Research’. Academy of Management Review, 14(4), Ferlie, E., Exworthy, M., FitzGerald, L. and Addicott, R. (2010) ‘Networks in Health Care: A Comparative Study of Their Management, Impact and Performance’, Final Report to NIHR, HS and DR project: 08/1518/102 Ferlie, L. FitzGerald, McGivern, G., Dopson, S. and Bennett, C. (2011) ‘Public Policy Networks and ‘Wicked Problems’: A Nascent Solution?’, Public Administration, 89(2):

References E. Ferlie, G. McGivern and L. FitzGerald (2012) ‘New Modes of Organizing in Health Care?: Governmentality and Managed Networks in Cancer Services in England’, Social Science and Medicine, 74(3): Langley, A. (1999) ‘Strategies for Theorizing from Process Data’ Academy of Management Review, 24(4), Pettigrew, A. (1990) ‘Longitudinal Field Research on Change: Theory and Practice’. Organization Science, 1(3): Pettigrew, A., Ferlie, E. and McKee, L. (1992) ‘Shaping Strategic Change’, London: Sage