Changing government, changing cultures? Moving the quality agenda towards effective processes to counterbalance...

This paper begins by identifying current government initiatives to tabulate performance in the National Health Service by the identification and codification of selected clinical indicators, and notes the ambivalence as to whether effectiveness is to be seen on financial or qualitative terms. It continues by reviewing official and academic definitions of effectiveness, and discovers a similar lack of consensus. It then moves on to consider the concept of effectiveness in another public utility -- education. A distinction is drawn between effectiveness as a measure of institutional outcome and as a key factor influencing institutional process. The factors that promote effectiveness in education are identified and exemplified. The paper concludes by reflecting on the steps necessary if such processes are to be adopted in the management of the National Health Service, and notes that the new 'National Plan' offers, at least in theory, an ideal context for a collective effort to enhance effectiveness processes in the health service, in which managers can play a decisive role.