How does patient choice impact on secondary care: an in depth investigation in a large teaching hospital

Bhogal, Balbir Kaur (2016). How does patient choice impact on secondary care: an in depth investigation in a large teaching hospital. University of Birmingham. Ph.D.

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Over recent decades health care policy in the English NHS has focused on the role of patient choice of provider as a lever for health care improvement (Mays 2010; Fotaki 2013). The thesis explores the degree to which patient choice policy has been successful in its aim. Specifically, it explores the influence that patient choice policy has on changing and shaping organisation culture in an acute hospital trust.

A qualitative case study was undertaken in a teaching hospital Trust involving interviews with 30 interviewees drawn from different levels of the hierarchy in the hospital. The study also reviewed documents to understand where PCP was positioned in the hospitals ambition. The study found that patient choice had not changed organisational behaviour in the hospital and did not have the desired impact as expected by policy makers.

The study identified that the PCP programme theory had failed to recognise the impact that the culture of an organisation has on change. The culture of the hospital was still one of ‘knowing what was best for its patients’ and rejecting the notion that patients wanted choice. Also, the incentives of patient choice policy were considered weak in the context of hospitals overrun with demand and competing priorities.

Type of Work: Thesis (Doctorates > Ph.D.)
Award Type: Doctorates > Ph.D.
College/Faculty: Colleges (2008 onwards) > College of Social Sciences
School or Department: Health Services Management Centre
Funders: None/not applicable
Subjects: H Social Sciences > HD Industries. Land use. Labor > HD28 Management. Industrial Management
H Social Sciences > HV Social pathology. Social and public welfare
R Medicine > RA Public aspects of medicine


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