The Impact of Organisational change on Health Care Delivery to the Adult Mentally Ill

Abstract

This thesis is about assessing the impact of organisational change on health care delivery to the adult mentally ill patients by North West London Mental Health (NHS) Trust which became a Third Wave NHS Trust health care provider unit on 1 April 1993, following a successful application to the Secretary of State for Health, Mrs Virginia Bottomley. The research study examines the processes, contents and contexts of organisational change of the Trust; the extent to which the Trust has successfully managed the processes of strategic change and achieved improvements in the quality standards of service delivery since it became a self governing NHS health care provider. Cost improvements, improved performance and service quality were identified as the key objectives and priorities of the corporate strategy of North West London Mental Health (NHS) Trust. These objectives are reflective of the main aims of the NHS reforms - Working for Patients (1990). The framework of organisational change of North West London Mental Health (NHS) Trust involved changes in its management structures, systems, strategic direction and organisational values. The new governance of the Management Teams and the introduction of information systems and technology, development of community based mental health service and other elements of strategic change. It was noted that the changes had been evolutional, the efficiency savings (Cost Improvement Programmes) targets that the Trust achieved over the period were mostly through the measures of redundancies and deletion of vacancies. Financial control to reduce cost and expenditure was noted to have predominantly featured as the main priority of the strategic programmes of the Trust during the period. NWL Trust, however, did not achieve its main aim and priority to improve the quality of service delivery to the adult mentally ill, particularly inpatients, during the period. It is worth to note the limitations of a single empirical case study, the size of the respondents interviewed and time and material resources constraints. Therefore, the findings of the research study cannot be generalised and do not represent the general experiences of NHS mental health service provider units in London or entire England. Nevertheless, the experiences of organisational change of North West London Mental Health NHS Trust and the service users are, perhaps, not unique in the National Health Service. Top and senior managers of other NHS health care provider units who read this report might learn from the experiences of NWL Trust, reflect upon their own experiences and take the most appropriate action to improve the performance and quality of health care delivery by their organisations.