Cornell University International Conference on Healthcare Delivery System Reform

1. Cornell University International Conference on Healthcare Delivery System Reform Creating the conditions for entrepreneurial behaviour and sustainable change in healthcare Rosemary Exton UK Work Organisation Network & National Health Service

2. NHS Modernisation Agenda To move the NHS from a centrally regulated bureaucracy delivering mass-produced services to an innovative sector responsive to individual patient needs

3. Line management as a barrier reef or a resource for change?

4. Background To promote NHS changes government ministers and civil servants championed: “entrepreneurial leaders” bringing “vision, leadership and passion” to the NHS, and who “generate new and alternative solutions that extend the boundaries of healthcare…challenge factors that are growth-limiting and refuse to accept the status quo” (Sir Nigel Crisp NHS 2005).

5. Defining public sector drivers for change Champions Change Agents Entrepreneurs

6. Defining the public sector entrepreneur Inconsistency and ambiguity of objectives and goals create the need for flexibility, seeking opportunities which may otherwise not have emerged. Entrepreneurs forge creative and unpredictable solutions, often in the spaces between formal organisational structures and protocols, in terms of their particular circumstances and experiences.

7. Dual role of structure in organisational entrepreneurship Organisational structures shape individual behaviour, but individuals can influence organisational structures through entrepreneurial behaviour

8. Implementation of IWLAcross an English County - Circa 20,000 staff Eleven NHS organisations

9. The Improving Working Lives programme A national programme to improve HR performance Applied to all 400 NHS organisations Externally accredited Eleven NHS organisations in Derbyshire studied over 2 years including primary care, acute hospitals and mental health Considerable variations in outcome

10. Ideal type outcomes from the interaction between behaviour and organisational structure Entrepreneurial Conforming Organisational Entrepreneurial Individual Conforming

11. Ideal type outcomes from the interaction between behaviour and organisational structure Entrepreneurial Conforming Organisational Organisational entrepreneurship Entrepreneurial Sonya Individual Conforming

12. Organisational Entrepreneurship Sanctioned and supported at Board level Actors have autonomy and opportunities for creativity in working between organisation structures and across organisational boundaries and networks Wider staff engagement

13. Ideal type outcomes from the interaction between behaviour and organisational structure Entrepreneurial Conforming Organisational Organisational entrepreneurship Resisted or dissonant entrepreneurship Entrepreneurial Jess Sonya Individual Conforming

14. Resisted or dissonant entrepreneurship The actor possesses a real understanding of the need to embed change within the deep structures of an organisation but is constrained by those same structural forces. Entrepreneurial behaviour may be interpreted as subversive as although focused on shared goals it involves bypassing established practices

15. Ideal type outcomes from the interaction between behaviour and organisational structure Entrepreneurial Conforming Organisational Organisational entrepreneurship Resisted or dissonant entrepreneurship Entrepreneurial Sonya Jess Individual Conformity Conforming Sally

16. Conformity Characterised by compliance in which hierarchical management deep structures produce dependence on performance targets Conformity to working within given roles

17. Ideal type outcomes from the interaction between behaviour and organisational structure Entrepreneurial Conforming Organisational Organisational entrepreneurship Resisted or dissonant entrepreneurship Entrepreneurial Sonya Jess Individual Symbolic entrepreneurship Conformity Conforming Sally ?

18. Symbolic entrepreneurship Exists where the language of entrepreneurship is adopted at corporate level but without evidence of entrepreneurial behaviour in practice

19. Ideal typical responses from the interaction between individual behaviour and organisation structure

20. Structureand agency Structural influences interact with individual behaviour to generate strategies differentiated by entrepreneurship or conformity

21. Characteristics of the entrepreneurial organisation Horizontal divisions of labour give way to networking as an organising concept. Partnership drives the devolution of power and responsibility to line managers. Empowered frontline teams and distributed leadership with an emphasis on high involvement innovation and problem solving.

22. Regulation alone does not bring about sustainable change but may only secure compliance with audit requirements. However given the right circumstances regulation can create the conditions for sustainable and meaningful change.

23. www.ukwon.netwww.workplaceinnovation.eu