Reengineering Health Care. The Complexities of Organizational Transformation

Citation

Hurst, K. (2003), "Reengineering Health Care. The Complexities of Organizational Transformation", Journal of Health Organization and Management, Vol. 17 No. 4, pp. 329-330. https://doi.org/10.1108/14777260310494816

In the early 1990s there was a time when health care professionals were divided into those who had an understanding of patient‐focused care (PFC) and those who did not. The former, a much smaller group, however, were surprised that PFC was famous for less than 15 minutes, despite investment by the Department of Health into seven hospital pilot sites. Unsurprisingly, therefore, healthcare professionals were wising up to hospital process reengineering (HPR, the health equivalent to business process reengineering (BPR), the so‐called successor to PFC (Greene, 1994), and were prepared for a similar outcome. However, those who thought they were ready were about to be surprised again because BPR was being written‐off, even before HPR took off in UK healthcare (Mumford and Hendricks, 1996).

McNulty and Ferlie more or less confirm the early predictions. However, unlike the earlier commentators, the authors do this from a detailed, largely qualitative, empirical base because they were commissioned to evaluate HPR in one of the UK's main protagonist sites. The book, a detailed description of this evaluation, is well organised into ten chapters. After an overview, the book's sections cover: BPR; HPR; change theories; a detailed evaluation research design segment; case‐study based warts and all findings; conclusions and prospects for the future.

I found all the chapters informative and generating new insights. Chapter 4, the research design chapter, a full panoply of triangulative methods, will be especially useful to healthcare researchers. The book's text is dense and, therefore, not for novices, but the case studies (ranging from emergency to elective care settings), notably the quotations used to support the main themes, bring HPR to life (typical of good qualitative texts). Also, the authors' thorough examination of change management theory, will be useful to students exploring change management more broadly. Readers expecting more tangible materials on HPR cost‐benefits and outcomes, for example, will be disappointed not to find directorate structure, processes and outputs/outcomes evaluated quantitatively. To be fair, on the other hand, these were handled separately by another academic team. As in the case of PFC, elements such as multiskilling the workforce survived, a likely equivalent outcome with HPR too, so readers should not be overly concerned about the book's lack of specific application. Readers instead, I'm sure, will take the book's theoretical and change management evaluation research design issues for broader application. In short, there are no surprises about specific HPR outcomes, but I won't spoil the reader's enjoyment by an early revelation of the bottom lines.