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A Review of Reengineering Health Care: the Complexities of Organizational Transformation written by Terry McNulty and Ewan Ferlie reviewed by Christian L. van Tonder published by Oxford University Press ISBN 0199269076 (2004)
Reengineering health care is essentially a documented account of the authors' 'empirical case-study work' which attempted to bring about organizational transformation in a large National Health Service teaching hospital (the Leicester Royal Infirmary) in the UK between 1992 and 1998, using Business Process Engineering (or BPR as it is commonly known) as the change vehicle3. The authors further qualify the book's objective as one of producing an analysis of the experience of BPR implementation that is both empirically-based and theoretically informed.
The book is logically and clearly structured, commencing with an orientating chapter (chapter 1), which is followed with coverage of business process reengineering (BPR) as a model for planned organizational transformation (chapter 2), the changing context of health care in the United Kingdom (and research setting) in chapter 3, the research design and methodology pursued (chapter 4) and the various empirical results chapters (5 and 6) and discussion and contextualization chapters (chapters 7 to 10).
Except for the occasional carefully-worded statement of outcomes, it is clear that the authors are (impressively) direct and frank about the realities of a process that started out as a 'radical solution' and transformational ideal, but ultimately emerged as an incremental and evolutionary change endeavour. The latter, they concluded, was largely a consequence of the pronounced influence of the very organizational setting that it sought to change and as a result the change impact was 'uneven'.
The reader may not always subscribe to some of the positioning statements and supporting arguments the authors' offer but this is of course reader-specific and will naturally vary from reader to reader. As a case in point note for example that the authors' are particularly critical of the place and utility value of more quantitative / positivist methodologies in the field of change management and argue that quantitative approaches need to be succeeded by qualitative methodologies. This, it is submitted, depends entirely on 'where' (in a manner of speaking) the research question is located and 'how' it is detected, recognized and defined ...-an issue that cannot be disentangled from the...