Standardisation and its Consequences in Health Care: A Case Study of PRINCE2 Project Management Training
Shaw S., Hughes G., Greenhalgh T.
“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 and the kind of work that gets done. In this chapter we adopt an interpretive approach to critically examine the significance of project management for public sector health care, drawing on a case study of PRojects IN Controlled Environments (PRINCE2TM) training to examine how the idea of “project management” is constructed, the discourses and categories in play, and the implications for public sector health care. Our findings focus on three areas. Firstly, the principles underpinning PRINCE2TM draw on standardised and linear views of the world with processes leading directly to outputs. This way of conceptualising change presents the work of project management as neat and tidy and distances those involved from the human elements of managing. Secondly, the models, procedures, and techniques underpinning PRINCE2TM are concerned with efficient and cost-effective delivery of projects. This focus on technical responsibility encourages users to focus on the means rather than the end, to substitute moral and ethical concerns with technical procedures and decontextualises projects from the very communities they are (in theory) intended to serve. Finally, language plays a key role in promoting and sustaining ideas of a “market society”. Repeated use of terms such as “business”, “interests”, and “assurance mechanisms” hold potential 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 public duty often associated with public welfare. We conclude by reflecting on the consequences of this project management work for health care and other public sector work, paying particular attention to the potential for “moral blindness”.