Organisational Designs for a Modern NHS

Helping senior managers design effective organisations ought to be a central feature of what OD people do. However I’m often quite surprised about how little senior management attention is given to exploration of organisational design choices in the NHS. Why is this? It will certainly need to be a more prominent activity in future.

Traditionally acute/general hospitals, consciously or otherwise, seem to have adopted a hybrid approach to meta design, combining two of Mintzberg’s four organisational types – the professional bureaucracy for the clinical domain - where professional people perform complex tasks in a stable environment and a divisionalised version of a machine bureaucracy for the administrative domain - where tasks are relatively simple and the environment is still stable.

Although tricky to manage both at the same time, these two forms of design are generally thought to be suitable when organisations are concerned primarily with production and operational efficiency. But it also makes them slow to adapt to changing circumstances and market movements. So:

1. As routine surgery and diagnostics is ‘unbundled’ from general hospitals might we see changes to organisational design to reflect the more unpredictable and more complex work that remains?

2. As policy initiatives like Patient Choice, Provider Plurality and PBR create more dynamic and unpredictable local environments might we see an acceleration of the trend, already underway, to introduce more temporary project teams, networks and matrix features alongside or instead of the two dominant organisational forms mentioned above?

3. As Foundation Trusts become more confident and expansive might we see more systematic introduction of small, entrepreneurial units that operate ‘at arms length’ from or compete with established departments or even the organisation as a whole?

It will be interesting to see how designs change, whether they are the result of managerial choices or emergent adaptation, what role OD professionals play in this work and most importantly, whether we can make them work well!

Steve

www.stevepashley.co.uk