title: Implementing market-based reforms in the English NHS: bureaucratic coping strategies and social embeddedness.
abstract: This paper reports findings from an ethnographic study that explored how market-based policies were implemented in one local health economy in England. We identified a number of coping strategies employed by local agents in response to multiple, rapidly changing and often contradictory central policies. These included prioritising the most pressing concern, relabelling existing initiatives as new policy and using new policies as a lever to realise local objectives. These coping strategies diluted the impact of market-based reforms. The impact of market-based policies was also tempered by the persistence of local social relationships in the form of 'sticky' referral patterns and agreements between organisations not to compete. Where national market-based policies disrupted local relationships they produced unintended consequences by creating an adversarial environment that prevented collaboration.
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK. Lorelei.jones@lshtm.ac.uk
authors.forename: Lorelei
authors.initials: L
authors.lastname: Jones
authors.forename: Mark
authors.initials: M
authors.lastname: Exworthy
authors.forename: Francesca
authors.initials: F
authors.lastname: Frosini
mesh_terms: D018166:Health Care Reform / Q000458:organization & administration*; D006291:Health Policy; D006801:Humans; D009936:Organizational Innovation; D013222:State Medicine / Q000458:organization & administration*; D006113:United Kingdom