EVALUATING PUBLIC ORGANISATION

Evaluating Strategy for the Success or Failure of Public Organization (NHS as an Example)

Evaluating Strategy for the Success or Failure of Public Organization (NHS as an Example)

Introduction

The aim of this very paper is to perform detailed service quality audit of a public organisation of UK, NHS and to investigate whether service quality could be maintained within budgetary restrictions and how to succeed by offering supreme quality services to British citizens. The multifaceted definition of quality will be considered first of all, considering that basic concepts of superiority and quality, which are derived from industry, cannot be simply applied to the sector of healthcare. In considering the relationship of cost to quality a number of examples are used, mostly related to cardiac care and acute services. Primarily our discussion draws auditory results on medical management where the economics of health are more clearly established. This is followed by a discussion of quality management where issues pertinent to nursing are discussed, considering whether Crosby's (2000) slogan `quality is free' is applicable to healthcare. In the second half of the paper thrombolytic therapy sector is used as an exemplar for detailed audit and quality improvement: the role which nurses could play in this area is an example of how medical and nursing practice could overlap. This section discusses a variety of quality tools in identifying the opportunities for quality improvement within cost constraints.

Donabedian (2001: p456) viewed quality as a precious commodity, his basic premise being that more quality costs more, whether in terms of resources, time, attention, knowledge or skill. In contrast Carpenter (2006) refutes the belief that quality and cost are a trade-off, claiming there may not even be a relationship between quality and cost containment: at least any relationship is difficult to establish through lack of consensus about the meaning of either term. Ovretveit (2002) develops this view by stating that cost savings are only possible within a quality system, that the costs of the system are offset by the savings produced. In view of these different propositions the meanings of quality and cost must be discussed before the issue of maintaining and improving quality within budgetary restrictions could be considered.

Defining quality

Defining quality is more than a semantic issue, since beliefs about quality management are dependent on its definition. A first step towards defining quality is considering differences between industrial and service sector quality, discussing those definitions which do or do not include cost. Drawing on product quality management Morris and Bell (2006) identify five different perspectives on quality: these transcendent, product-based, user-based, manufacturer-based and value-based views will now be considered.

The transcendent view, that quality means innate excellence, stems from the creative arts: although successful in promoting individual excellence, this view has generally been supplanted in healthcare because it requires long periods of expensive training and does not focus on teamwork and collaboration (Kitson 2002: p84). Its elitist perspective (that quality may only be recognised by an individual experienced in the particular field, but not necessarily defined for others to ...