A comparison of the equity-supportiveness of organizational cultures of (public) NHS organizations and (private) Social Enterprise (SE) providers

Title: A Comparison of the Equity-supportiveness of Organizational Cultures of (Public) NHS Organizations and (Private) Social Enterprise (SE) Providers

Theory: New Public Management (NPM) has been the most influential paradigm in public administration in the last three decades. NPM-driven ideas such as provider competition, privatisation and patient choice have resulted in increased interest from recent UK governments in Social Enterprises (SEs) for delivering public health services. NPM-based changes have been criticized for creating inequitable provision of healthcare and increasing unjust health inequalities. It is worth asking whether equity for patients is promoted equally effectively by public (NHS) organizations and SE providers.

Research Aims and Methodology: A mixed methods approach was employed. The quantitative strand used a survey to compare the equity-supportiveness of NHS and SE organizational cultures [124 respondents (68 NHS and 56 SE staff) from 21 organizations (12 NHS and 9 SEs)]. The qualitative strand used semi-structured interviews with 27 SE staff members to examine organizational changes in SEs and the impact of these changes on equity in service provision.

Findings: By achieving better alignment with organizational values, reducing bureaucracy, speeding up decision-making, giving staff more autonomy and responsibility, encouraging initiative, risk-taking and innovation, involving staff more actively in strategic decision-making, and making better use of technology, Social Enterprises are promoting equity to an equal or greater degree than public (NHS) organizations.

Implications: However, the SE model (currently limited to community healthcare services) remains unclear and problematic, suggesting caution in its use by larger NHS acute Trusts. More research is needed before a policy to support the adoption of the SE model in public service delivery is mainstreamed.