Reforming a Health Care System in a Big Way? The Case of Change in the British NHS

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Reforming a Health Care System in a Big Way? The Case of Change in the British NHS. / Powell, Martin.

In: Social Policy and Administration, Vol. 50, No. 2, 03.2016, p. 183-200.

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@article{a35cdf7a769142daac96e303c80a5408,
title = "Reforming a Health Care System in a Big Way? The Case of Change in the British NHS",
abstract = "There is a significant literature on change in health care systems, but much of this has little explicit discussion of conceptual approaches, measures or explanations of change. This article examines studies of the British National Health Service (NHS) focusing on the what, how much and why of change. It sets out the main approaches to studying continuity and change: institutional continuity and path dependency (PD); incremental change; punctuated equilibrium; gradual institutional change; ideational analysis; paradigm change; and institutional logics. It briefly critically discusses each of these approaches, and then examines the main studies in chronological order. With reference to the three main questions of this article, the {\textquoteleft}what{\textquoteright} of change suggests that, in terms of the number of studies, PD and ideational approaches appear to be dominant. The {\textquoteleft}how much{\textquoteright} of change question remains problematic due to unclear dependent variables and conflicting conclusions. Lastly, the {\textquoteleft}why{\textquoteright} of change remains unresolved. In short, studies of change in the British NHS tend to be overly descriptive and under-theorized, and do not fully address issues of theories and concepts, measures and explanations; or the what, how much and why of change.",
keywords = "Change, Health system, UK, National Health Service",
author = "Martin Powell",
year = "2016",
month = mar,
doi = "10.1111/spol.12210",
language = "English",
volume = "50",
pages = "183--200",
journal = "Social Policy and Administration",
issn = "0144-5596",
publisher = "Wiley",
number = "2",

}

RIS

TY - JOUR

T1 - Reforming a Health Care System in a Big Way? The Case of Change in the British NHS

AU - Powell, Martin

PY - 2016/3

Y1 - 2016/3

N2 - There is a significant literature on change in health care systems, but much of this has little explicit discussion of conceptual approaches, measures or explanations of change. This article examines studies of the British National Health Service (NHS) focusing on the what, how much and why of change. It sets out the main approaches to studying continuity and change: institutional continuity and path dependency (PD); incremental change; punctuated equilibrium; gradual institutional change; ideational analysis; paradigm change; and institutional logics. It briefly critically discusses each of these approaches, and then examines the main studies in chronological order. With reference to the three main questions of this article, the ‘what’ of change suggests that, in terms of the number of studies, PD and ideational approaches appear to be dominant. The ‘how much’ of change question remains problematic due to unclear dependent variables and conflicting conclusions. Lastly, the ‘why’ of change remains unresolved. In short, studies of change in the British NHS tend to be overly descriptive and under-theorized, and do not fully address issues of theories and concepts, measures and explanations; or the what, how much and why of change.

AB - There is a significant literature on change in health care systems, but much of this has little explicit discussion of conceptual approaches, measures or explanations of change. This article examines studies of the British National Health Service (NHS) focusing on the what, how much and why of change. It sets out the main approaches to studying continuity and change: institutional continuity and path dependency (PD); incremental change; punctuated equilibrium; gradual institutional change; ideational analysis; paradigm change; and institutional logics. It briefly critically discusses each of these approaches, and then examines the main studies in chronological order. With reference to the three main questions of this article, the ‘what’ of change suggests that, in terms of the number of studies, PD and ideational approaches appear to be dominant. The ‘how much’ of change question remains problematic due to unclear dependent variables and conflicting conclusions. Lastly, the ‘why’ of change remains unresolved. In short, studies of change in the British NHS tend to be overly descriptive and under-theorized, and do not fully address issues of theories and concepts, measures and explanations; or the what, how much and why of change.

KW - Change

KW - Health system

KW - UK

KW - National Health Service

U2 - 10.1111/spol.12210

DO - 10.1111/spol.12210

M3 - Article

VL - 50

SP - 183

EP - 200

JO - Social Policy and Administration

JF - Social Policy and Administration

SN - 0144-5596

IS - 2

ER -