As any organisation with relatively long history and thousands of employees, the NHS has certain norms and rules that traditionally determine the nature of managerial practices. However, these rules and norms do not seem to be effective these days when the problem of management in NHS has turned into one of the major issues associated with this organisation. The case study and other scholarly studies provide sufficient information to identify the factors that may contribute to such situation.
There are several types of standards applied within the organisational practices to evaluate effectiveness of management. However, the NHS is a specific organisation with outputs which are exceptionally difficult to measure objectively: for example, a middle level manager in a construction company has absolutely clear performance goals which must be achieved by certain deadline with the available resources. Failure to achieve the goals despite favourable situation and no force majeure circumstances demonstrates that the manager might lack skills and/or qualification to effectively perform his basic functions. These functions have been formulated over the second half of the 20th century and include planning, organising, leading, controlling and assessing (often these functions are abbreviated to POLCA) (Morgan, 1986).
Evidently, this set of basic functions is valid for the NHS, but it is also clear that the specifics of healthcare does not allow for the possibility to evaluate the manager's failure or success in the same way as it is done in other industries such as construction, automotive, financial, etc. The explanation is simple: there are too many factors affecting health outside the health care industry to evaluate performance of the industry in easily measurable terms such as deaths per 100 beds and other statistical data. The impressive amount of intangibles involved in the process of healthcare management requires specific approach in evaluation of associated factors, including effectiveness of management.
Therefore, one of the major problems related to management in the NHS might be absence of the correct evaluation criteria. As Willcocks (1997) puts it, "...the research literature fails to provide empirically-based standards against which to judge and compare managerial behaviour. A central problem is that the researchers have neglected the manager's role demands or expectations and concentrated on role performance or behaviour" (Willcocks, 1997: 181). Development of the adequate criteria that can be applied to assessment of managerial performance in the environment characterised by lack of statistically measurable parameters and oriented rather toward improvement of the process than achievement of any final goals may be a helpful solution in this regard. Absence of such criteria can probably be referred to as the most essential primary problem which acts as the major reason for other problems associated with management in the NHS environment.
Managing educated professionals such as doctors, architects, lawyers