Rating system in healthcare: contradictions and conflicts in an English hospital

Abstract

The changing context in the New Labour Government policy and legislation to deliver healthcare introduced in England in 1999 reflected a discontinuity in the way that the healthcare organisations are controlled and this represented a new experience for the National Health Services (NHS). This paper examines empirically the effects of the introduction of a compulsory set of performance measures on the management processes of a particular English hospital. It demonstrates the complexities involved in using performance indicators to control activities in health care organisations. It explicates the course of change experienced by a particular organisation by highlighting both the intended and unintended outcomes associated with the pressure to change to meet the demands of a specific set of key targets. This case-study based research indicates that there is the need to pay a close attention to the way that the local-level healthcare organisations are interacting. The theoretically language adopted is informed by Broadbent and Laughlin (2005)’s analysis of organisational change, which draws on Laughlin (1991) and some aspects of Habermas’ (1987) critical theory.

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