Large scale models and large scale thinking : The case of the health services.
The delivery of health services represents one of the most daunting challenges confronting contemporary management.
The complexity of the issues involved suggests that health service policy makers seeking to allocate scarce resources would find the opportunities offered by large scale modelling attractive.
However, the application of soch models to strategic management of the health services has not been a success in the UK.
This paper seeks to explain the failure by describing three important initiatives in the UK National Health Service that have occurred over a period of 20 years.
The first is the deployment of the large scale « balance of care » model, and sought to allocate local government and health service resources between competing claims.
The second is the performance indicator initiative of the 1980s, which concentrated on the measurement of a large number of processes and outcomes in the health sector.
The third is the « internal market » reform of the 1990s.
These developments were informed, respectively, by the disciplines of operational research, accountancy and economics.
Alternatively, they can be thought of as representing the planning, bureaucratic and market views of management.
The paper argues that the traditional OR approach fails not because its model is an inadequate representation of reality, but because it does not acknowledge the priorities of the manager or politician who must take responsibility for implementing the model's findings.
Mots-clés Pascal : Système santé, Service santé, Organisation santé, Gestion organisation, Politique sanitaire, Modèle, Homme
Mots-clés Pascal anglais : Health system, Health service, Public health organization, Organization management, Health policy, Models, Human
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 95-0320252
Code Inist : 002B30A01B. Création : 01/03/1996.