Implementing Marketization in Public Healthcare Systems: Performing Reform in the English National Health Service

Research output: Contribution to journalArticlepeer-review

Abstract

To implement marketization in public healthcare systems, policymakers need to situate abstract
models of prescriptive practice in complex user settings. Using a performativity lens, we show
how policy processes attempt to bring about the changes they presume. Investigating the
implementation of the Health and Social Care Act 2012, and the development of a policy
instruments and Clinical Commissioning Groups, we explicate the performance of a
marketization programme. Our longitudinal study of the interactions amongst the multiple
constituencies the Act attempted to enrol and the existing socio-technical arrangements the Act
aimed to change, generates three contributions: (1) we characterise the performativity of policy
instruments as a process of bricolage that incorporates the principled attitude of making do on
both sides, those who design the policy and those who are charged to implement it; (2) we
identify the mechanisms through which the performativity of an envisioned model of
marketization operates at multiple scales within a complex and highly distributed system of
provision; and (3) we document and explicate why specific performances result in misfires and
unintended outcomes. In short, we conceptualise policy performativity as a non-linear,
dynamic process where theories and their effects are constantly being assessed, reconfigured
and fed back into policy making and implementation.

Bibliographical metadata

Original languageEnglish
Number of pages34
JournalBritish Journal of Management
DOIs
Publication statusAccepted/In press - 9 Jun 2020