title: Innovation and the English National Health Service: a qualitative study of the independent sector treatment centre programme.
abstract: Over the past two decades, an international trend of exposing public health services to different forms of economic organisation has emerged. In the English National Health Service (NHS), care is currently provided through a quasi-market including 'diverse' providers from the private and third sector. The predominant scheme through which private sector companies have been awarded NHS contracts is the Independent Sector Treatment Centre (ISTC) programme. ISTCs were designed to produce innovative models of service delivery for elective care and stimulate innovation among incumbent NHS providers. This paper investigates these claims using qualitative data on the impact of an ISTC upon a local health economy (LHE) composed of NHS organisations in England. Using the case of elective orthopaedic surgery, we conducted semi-structured interviews with senior managers from incumbent NHS providers and an ISTC in 2009. We show that ISTCs exhibit a different relationship with frontline clinicians because they counteract the power of professional communities associated with the NHS. This has positive and negative consequences for innovation. ISTCs have introduced new routines unencumbered by the extant norms of professional communities, but they appear to represent weaker learning environments and do not reproduce cooperation across organisational boundaries to the same extent as incumbent NHS providers.
authors.affiliation: NIHR King's Patient Safety and Service Quality Research Centre, King's College London, Strand Bridge House, 138-142 Strand, London WC2R 1HH, United Kingdom. Electronic address: simon.j.turner@kcl.ac.uk.
authors.forename: Simon
authors.initials: S
authors.lastname: Turner
authors.affiliation: London School of Hygiene and Tropical Medicine, United Kingdom.
authors.forename: Pauline
authors.initials: P
authors.lastname: Allen
authors.affiliation: London School of Economics and Political Science, United Kingdom.
authors.forename: Will
authors.initials: W
authors.lastname: Bartlett
authors.affiliation: Leeds University Business School, United Kingdom.
authors.forename: Virginie
authors.initials: V
authors.lastname: Pérotin
mesh_terms: D004739:England; D006801:Humans; D009936:Organizational Innovation; D017149:Private Sector / Q000191:economics / Q000458:organization & administration*; D015397:Program Evaluation; D036301:Qualitative Research; D013222:State Medicine / Q000458:organization & administration*