Making Wicked Problems Governable? (eBook, PDF)

The Case of Managed Networks in Health Care

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Over the last thirty years, scholars of health care organizations have been searching for concepts and images to illuminate their underlying, and shifting, modes of organizing. Nowhere has this controversy been more intense than in the United Kingdom, given the long succession of top down reorganizations within the National Health Service (NHS) over the last thirty years. This book characterises the nature of key reforms - namely managed networks - introduced in the UK National Health Service during the New Labour period (1997-2010), combining rich empirical case material of such managed networks drawn from different health policy arenas (clinical genetics, cancer networks, sexual health networks, and long term care) with a theoretically informed analysis. The book makes three key contributions. Firstly, it argues that New Labour's reforms included an important network element consistent with underlying network governance ideas, specifying conditions of 'success' for these managed networks and exploring how much progress was empirically evident. Secondly, in order to conceptualise many of the complex health policy arenas studied, the book uses the concept of 'wicked problems': problematic situations with no obvious solutions, whose scope goes beyond any one agency, often with conflicting stakeholder interests, where there are major social and behavioural dimensions to be considered alongside clinical considerations. Thirdly, it makes a contribution to the expanding Foucauldian and governmentality-based literature on health care organizations, by retheorising organizational processes and policy developments which do not fit either professional dominance or NPM models from a governmentality perspective. From the empirical evidence gathered, the book argues that managed networks (as opposed to alternative governance modes of hierarchy or markets) may well be the most suitable governance mode in those many and expanding policy arenas characterised by 'wicked problems', and should be given more time to develop and reach their potential.

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Ewan Ferlie AcSS FRSA is currently Professor of Public Services Management at Kings College London and previously Head of Department. He has written and published widely on organizational change and restructuring in public services organizations, including health care and also higher education. He is co editor of the Oxford Handbook of Public Management published by Oxford University Press. He has been a non executive member of Warwickshire Health Authority and is currently Hon chair of the Society of the Study of Organising in Health Care. Louise Fitzgerald is Visiting Professor (Organizational Change) at the Saïd Business School. Her previous career spans HR management posts in the private sector and academic posts at Salford and Warwick, where she worked in an innovative role as a consultant to the Health Service and a Senior Lecturer. She then moved to take up a Chair at City University, where she was Director of Research in St. Bartholomew's School of Nursing and Midwifery. Most recently, she has held a Chair in Organization Development at De Montfort University and been a Visiting Professor at Manchester Business School. Until recently she was Academic Lead in the Greater Manchester Collaboration for Leadership in Applied Health Research and Care (CLAHRC). Gerry McGivern is an Associate Professor of Organizational Behaviour in the International Centre for Governance and Public Management at Warwick Business School. His research focuses on professionals: understanding the nature of their knowledge and practice, identities, and how they are affected by systems of regulation and organization within public services. Gerry has previously worked for Price Waterhouse, Ovum PLC, in HR consultancy, and at Royal Holloway, University of London, and King's College London. He holds a PhD in organizational behaviour from Imperial College Business School. Sue Dopson is Rhodes Trust Professor of Organisational Behaviour and Faculty Dean at Saïd Business School. She is also Fellow of Green Templeton College, Oxford, and Visiting Professor at the University of Alberta, Canada. She is a noted specialist on the personal and organisational dimensions of leadership and transformational change, especially in the public and healthcare sectors. Sue formerly worked as personnel manager in the NHS before pursuing a research and academic career, co-writing and editing many major works on the topic of transformational change in the public and healthcare sectors. Sue's research involvements lie principally in the area of innovation, change and healthcare studies and she has led a number of research projects in the health service sector. Chris Bennett is an independent research psychologist.