‘New models of care’, ‘care home vanguards’ and ‘innovation test beds’. These are just a few of the initiatives being pursued in England’s National Health Service (NHS). They reflect wider changes in the organisation of the public sector that encourage short-term, focused projects that frequently de-couple the change process from the wider context. The dominant research interest in such projects has been on questions of implementation and outcome (e.g. how are project aims achieved). Far less attention has been given to questions of process, for instance, how do projects progress, how are they managed, and how does this shape the kind of work that does – and doesn’t – get done?
This paper asks precisely these questions in the context of health care in England. It has emerged from repeated observations that those working in the health service are often guided by the means of delivering projects rather than the hoped for ends. As one clinician told us in a study of health-related IT, “The problem is the mindless effect this management style has on everybody, they can’t think straight when told to do things in this way”. In other words, far from being a neutral, technocratic process, we suspect that the approach to managing healthcare projects plays a significant role in shaping health care.
Project management approaches are ubiquitous in the NHS. We have elected to focus on PRINCE2 (‘PRojects IN Controlled Environments’), which is a structured project management methodology developed by the UK government and widely used in NHS projects. The PRINCE2 method purports to offer ‘best practice guidance’ on project management, and is marketed as relevant for any project in any area and of any scope or scale. Drawing on interpretive policy analysis and linguistic ethnography (Shaw and Russell 2015), we present findings from a netnography of PRINCE2, adapting traditional participant observation methods to study the meanings and experiences manifest in an online PRINCE2 course. Our findings focus on three areas. Firstly, language plays a key role in PRINCE2 in promoting and sustaining ideas of a ‘market society’ (Mautner 2013). Repeated use of terms such as ‘suppliers’, ‘business’, ‘interests’ and ‘assurance mechanisms’ work to translate concerns over sickness or care into market-oriented language that is focused on business cycles and oriented to creating 'value'. This jars with values of citizenship or duty often associated with public welfare. Secondly, the principles underpinning PRINCE2 draw on standardised, technocratic and linear views of the world, with processes leading directly to outputs. This way of conceptualising change distances those involved in project management from the human elements of managing. Finally, the tools and templates inherent in PRINCE2 decontextualize projects from the very communities they are (in theory) intended to serve. We conclude by reflecting on the consequences of this project management work for health care and other public sector work.
References
Mautner G (2013) Language and Market Society. London, Routledge.
Shaw SE and Russell J (2015) Narrating healthcare planning. In Snell, Shaw & Copland, Linguistic Ethnography: An Interdisciplinary Reader. Palgrave.
H8 - The Projectification of the Public Sector: the possibilities, limitations and politic
