Assessing English hospitals: contradiction and conflict

Purpose - This paper aims to examine the micro effects of performance measures introduced in England to control hospitals, following the changing context in the policy directing the delivery of healthcare introduced by the Labour Government. The legislative framework established in 1999 reflected a discontinuity in the way that hospitals are controlled in this country. Design/methodology/approach - This exploratory case study is a result of a deep empirical investigation. It draws on some aspects of Laughlin's and Broadbent and Laughlin's analysis of organisational change. Findings - This study indicates that, in seeking to change to meet the demands of a particular control device, this organisation pursued both proactive and reactive strategies. However, it was deflected from its intended pathway of change and, as a result, it failed to meet the intended outcomes. The pressure exerted by such a demand impacted on the hospital's activities in a conflicting way. Research limitations/implications - The paper examines the issues in view of the organisational members' perspective, and, therefore, from the perception of those affected by control devices introduced by the Government. Originality/value - There is insufficient understanding of how the government's policies to control have affected hospitals' daily activities. Equally, there is scarce understanding of how managers and medical personnel deal with the pressure to change to meet government's expectation. This paper demonstrates empirically the complexities involved in using key targets to control hospitals activities. It contributes to the wide literature in performance management and organisational change.