Organisational and managerial public sector reforms and their impact on performance: the case of the English NHS

In this presentation, I will explore the nature and impact of management reforms in the public sector and their implications for organisational performance. To do so, I will draw from the latest research evidence focusing on one area of the English public sector: the National Health Service (NHS). Specifically, I will focus on two main aspects of these reforms: changes to organisational structures and involvement of professionals in leadership roles. First, I will concentrate on the introduction of business-like organisational arrangements which have driven the process of ‘corporatisation’ of public sector organisations. Corporatisation has led to the emergence of more autonomous organisational forms, with assumed positive implications for overall performance. Second, I will investigate the increase in demands for professionals to take on leadership roles in the running of public sector organisations across countries, in particular in healthcare. The underlying assumption is that healthcare professionals have greater expertise of the relevant sector, as well as credibility and legitimacy, and can, therefore, more effectively influence the performance of their organisations. But how true are these assumptions and are there any conditions that support the impact of corporatisation and professional leadership on organisational performance? In the presentation, I will seek to address these two question by focusing on the case of acute care hospital trusts in the English NHS. I will present the findings from two different studies both relying on a composite database of nine years (2008/09-2016/17), mostly based on publicly available information, and employing time series cross section analysis as methodological approach. I will show that corporatisation has a positive impact on organisational performance and this effect is to an extent mediated by the configuration of the workforce (i.e., the level of administrative intensity). Subsequently, I will describe the existence of two boundary conditions (derived from board human and social capital theory) for the positive impact of professional leadership on a specific type of organisational outcome: overall staff satisfaction. I will then conclude by drawing the implications of these findings for theory, research and practice.