Assessing strategic behaviour within the acute sector of the National Health Service

The creation of the internal market has merely been the latest progression in the change processes confronting the NHS over recent years as the UK Government searches for new ways of expanding patient output while concurrently restricting provision of additional financial resources. To assist in the implementation of change, acute sector providers have introduced managerial concepts from the private sector such as strategic planning. It is not clear, however, whether these techniques are appropriate or effective in the management of health-care services. A survey was undertaken to gain the perspectives of middle managers in acute units on the degree to which senior management involves them in determining performance goals and strategic plans. Results indicate that in most units, the orientation of senior management is to retain control over key issues associated with strategic planning and to minimize the degree to which the workforce is involved in any decision-making processes. Reviewing these results relative to the service-sector management theories concerning the options of industrializing or employee empowerment strategies indicates that senior management in the acute sector is operating a production-line service output philosophy. Although this orientation may meet the immediate needs of the UK Government, a review of how this strategic philosophy has severely weakened Western firms' position in world markets provides a basis for examining whether greater economic advantages might accrue to Britain by redirecting the management of change in the NHS towards a strategic philosophy based on employee empowerment.