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06-Social Enterprise in Health Org and MGT
06-Social Enterprise in Health Org and MGT
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Abstract
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Purpose – The purpose of this paper is to reflect on social enterprise as an organisational form in
health organisation and management.
Design/methodology/approach – The paper presents a critique of the underlying assumptions
associated with social enterprise in the context of English health and social care.
Findings – The rise of social enterprise models of service provision reflects increasingly hybrid
organisational forms and functions entering the health and social care market. Whilst at one level this
hybridity increases the diversity of service providers promoting innovative and responsive services,
the paper argues that further inspection of the assumptions associated with social enterprise reveal an
organisational form that is symbolic of isomorphic processes pushing healthcare organisations toward
greater levels of homogeneity, based on market-based standardisation and practices. Social enterprise
forms part of isomorphic processes moving healthcare organisation and management towards market
“norms”.
Originality/value – In line with the aim of the “New Perspectives section”, the paper aims to present
a provocative perspective about developments in health and social care, as a spur to further debate and
research in this area.
Keywords England, Health organization and management, Health care, Social enterprise, Hybridity,
Health and social care, National Health Service, Isomorphism
Paper type Viewpoint
Introduction
Over recent decades, policy developments in public sector reform have increasingly
emphasised the decline and fragmentation of established welfare bureaucracies. This
disaggregation and decentralisation of services has led some to suggest that service
provision is becoming increasingly “hybrid” as established sectors and boundaries
come together. Health and social care has been a key area for such changes. The
promotion of competition and choice has led to an increasing emphasis on private and
third sector providers entering the healthcare market. These providers have been
encouraged on the grounds that they are capable of being more innovative and
responsive than their public sector counterparts (Allen, 2009).
The English healthcare system has been particularly active in encouraging a Journal of Health Organization and
diversity of providers. One such organisational model of provision has been social Management
Vol. 26 No. 2, 2012
enterprise, which has been encouraged as a more innovative and responsive alternative pp. 143-148
for service users and healthcare staff. Social enterprises are broadly defined as q Emerald Group Publishing Limited
1477-7266
“business[es] with primarily social objectives whose surpluses are principally DOI 10.1108/14777261211230817
JHOM reinvested for that purpose in the business or in the community, rather than being
26,2 driven by the need to maximise profit for shareholders and owners” (Department of
Trade and Industry, 2002).
In England, social enterprises are currently presented as organisational vehicles
with the potential for dealing with complex social needs that create social as well as
economic capital. This resonates with global trends that have seen governments invest
144 significantly in social enterprise organisations to deliver public services (e.g. Defourny
and Nyssens, 2008). In the following New Perspectives essay I want to argue that this
increasing interest in social enterprise in health organisation and management reflects
wider trends in welfare that draw attention to increasingly hybrid organisational forms
and functions. Following this, I also want to challenge this notion of hybridity, arguing
that whilst social enterprise increases diversity in our understanding of health
organisation and management, its rise and increasing popularity is illustrative of
isomorphic processes towards market “norms”. Social enterprise is symbolic of
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Background
Policy makers are increasingly using social enterprise as a discursive vehicle to
address a wide range of social problems (Teasdale, 2011). Nicholls (2010) explains that
the organisational legitimacy of social enterprise has been as the result of a dynamic
interplay between macro-level institutional structures and micro-level organisations. In
the UK, network organisations like the Social Enterprise Coalition (SEC) represent
“paradigm-building” actors that have been influential in establishing discourses and
narratives to develop ideas about social entrepreneurship (Nicholls, 2010, p. 616). They
draw attention to how social enterprises are an attractive proposition in providing
“value-added” services better able to more effectively mobilise “pro social behaviour”
than for-profit private enterprises (e.g. Allen, 2009).
In the English National Health Service, a variety of policy initiatives have
encouraged social enterprises with the aim to create patient choice and give greater
freedom to staff to be innovative, responsive and improve quality. For example, a
Social Enterprise Investment Fund (SEIF) was established to support the development
of new enterprises and encourage existing social enterprises to extend into delivery of
health care (Millar et al., 2010). In the primary and community health sector, social
enterprises were one of the organisational forms that could be considered under the
Transforming Community Services programme (Department of Health, 2009). As part
of a purchaser-provider split, primary care commissioning organisations (PCTs) were
required to transfer their provider services to other organisations by 2012. This policy
commitment was highly significant in that NHS employees were to be given a “Right to
Request” (RtR) to set up social enterprise organisations to deliver community health
services (Miller et al., 2012). The RtR programme has been followed in England by a
Mutuals Programme to support 20 services to develop into “public sector mutuals”,
and the Right to Provide programme encouraging staff within healthcare trusts to
become social enterprises.
Existing research in this area has reported some notable benefits in becoming a
social enterprise. This included greater innovation in clinical service delivery; the
provision of a wider range of services; and efficiency savings from reduced staff
absence (Miller et al., 2012; Hall et al. 2012; National Audit Office, 2011). These findings Social enterprise
also support wider research about non-profit organisations in healthcare settings in health
suggesting that they achieve better relations with those they serve; enhance quality
and deliver more innovative service provision (e.g. Heins et al., 2010; Department of
Health, 2009). That said, research also identifies challenges associated with social
enterprise entry. Miller and Millar (2011) found only limited interest expressed by NHS
staff to develop social enterprises due to a lack of staff support, leadership, 145
organisational support and commissioning support. Commissioners have been
highlighted as particularly problematic in often equating social enterprise
organisations with being “not business-like enough” (Baines et al., 2010). Workforce
concerns regarding job security, business skills and the potential loss of public sector
branding have also been documented (Department of Health, 2010), as well as the
difficulties in measuring anticipated benefits and securing funding from financial
institutions and commissioners in a competitive market place.
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Concluding remarks
In DiMaggio and Powell’s (1983) classic article, the “norm” was the bureaucratic
organisation of Max Weber. What we are seeing now is the norms changing towards 147
market forms of organisation. In this New Perspectives essay I have argued that the
rise of social enterprise is indicative of increasingly hybrid forms of organisation in
healthcare delivery. What I have also argued is that within these hybrid arrangements
we are seeing increasing diversity in service provision but we are also seeing an
increasing convergence and homogeneity of organisational forms. Social enterprise
organisations are symptomatic of the requirement to converge around a market based
isomorphic process that is requiring the third sector and the public sector to converge
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References
Allen, P. (2009), “Restructuring the NHS again: supply side reform in recent English health
policy”, Financial Accountability & Management, Vol. 25 No. 4, pp. 373-89.
Allen, P., Bartlett, W., Pérotin, V., Matchaya, G., Turner, S. and Zamora, B. (2012), “Healthcare
providers in the English National Health Service: public, private or hybrids?”,
International Journal of Public and Private Healthcare Management and Economics,
Vol. 23 No. 2, pp. 1-18.
Baines, S., Bull, M.F. and Woolrych, R.D. (2010), “A more entrepreneurial mindset? Engaging
third sector suppliers to the NHS”, Social Enterprise Journal, Vol. 6 No. 1, pp. 49-58.
Billis, D. (2010), Hybrid Organizations and the Third Sector, Palgrave Macmillan, Basingstoke.
Brown, K., Waterhouse, J. and Flynn, C. (2003), “Change management practices: is a hybrid
model a better alternative for public sector agencies?”, International Journal of Public
Sector Management, Vol. 16 No. 3, pp. 230-41.
Defourny, J. and Nyssens, M. (2008), “Social enterprise in Europe: recent trends and
developments”, Social Enterprise Journal, Vol. 4 No. 3, pp. 202-28.
Department of Health (2009), Transforming Community Services: Enabling New Patterns of
Provision, The Stationery Office, London.
Department of Health (2010), Leading the Way Through Social Enterprise: The Social Enterprise
Pathfinder Evaluation, The Stationery Office, London.
Department of Trade and Industry (2002), Strategy for Social Enterprise, HM Treasury, London.
DiMaggio, P.J. and Powell, W.W. (1983), “The iron cage revisited: institutional isomorphism and
collective rationality in organizational fields”, American Sociological Review, Vol. 48 No. 2,
pp. 147-60.
Evers, A. and Laville, J.-L. (Eds) (2004), The Third Sector in Europe, Edward Elgar, Cheltenham.
Frumkin, P. and Galaskiewicz, J. (2004), “Institutional isomorphism and public sector
organizations”, Journal of Public Administration Research and Theory, Vol. 14 No. 3,
pp. 283-307.
Hall, K., Miller, R. and Millar, R. (2012), “Jumped or pushed: what motivates NHS staff to set up a
social enterprise?”, Social Enterprise Journal, Vol. 8 No. 1.
JHOM Haugh, H. and Kitson, M. (2007), “The Third Way and the third sector: New Labour’s economic
policy and the social economy”, Cambridge Journal of Economics, Vol. 31 No. 6, pp. 973-94.
26,2 Heins, E., Price, D., Pollock, A.M., Miller, E., Mohan, J. and Shaoul, J. (2010), “A review of the
evidence of third sector performance and its relevance for a universal comprehensive
health system”, Social Policy & Society, Vol. 9 No. 4, pp. 515-26.
Kelly, J. (2007), “Reforming public services in the UK: bringing in the third sector”, Public
148 Administration, Vol. 85 No. 4, pp. 1003-22.
Maor, M. (1999), “The paradox of managerialism”, Public Administration Review, Vol. 59 No. 1,
pp. 5-18.
Millar, R., Lyon, F. and Gabriel, M. (2010), “Understanding the programme theory of the Social
Enterprise Investment Fund”, available at: www.tsrc.ac.uk/Research/SEIFEvaluation/
tabid/757/Default.aspx (accessed 16 February 2012).
Miller, R. and Millar, R. (2011), “Social enterprise spin-outs from the English Health Service:
a right to request but was anyone listening?”, Working Paper 52, Third Sector Research
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Further reading
Peredo, A.M. and McLean, M. (2006), “Social entrepreneurship: a critical review of the concept”,
Journal of World Business, Vol. 41 No. 1, pp. 56-65.
Corresponding author
Ross Millar can be contacted at: r.millar@bham.ac.uk
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