Published: 06/01/2005, Volume III, No. 5937 Page 32

Organisational development is currently in fashion in healthcare. This is demonstrated by the recent growth in the number of NHS staff with the term in their job title. So what is OD, and what can it achieve for the NHS?

Many threads of theory have contributed to its evolution, including accounts of group process, action research and strategic planning. OD is also synonymous for many managers and clinicians with organisational restructuring.

One of the most cited definitions of OD asserts that it is 'a system-wide application of behavioural science knowledge to the planned development and reinforcement of organisational strategies, structures and processes for improving an organisation's effectiveness'.

This initially seems plausible, and it is certainly ambitious. However, many OD initiatives in healthcare are not systemwide, draw on a range of scientific frameworks, frequently stress the importance of exploring rather than planning and are sensitive to the different perspectives on effectiveness that might exist. As a consequence, in my recent book on OD I opt for something more modest.

This definition suggests that OD's specific contribution enables agencies to learn to become more reflective about their values, processes, procedures and structures.

In other words, effective OD supports organisations in increasing the ways in which they make sense of policy, evidence and practice and thus extend their range of options for action.

So what can OD do? Much talk of OD in healthcare has higher aspirations - for instance to achieve transformational change which is rapid and revolutionary.

Many gurus promote these aspirations, judging, probably correctly, that bold claims are more likely to catch the imagination (and money) of policymakers and managers.

The impact of most OD is transitional.

That is, change typically goes with the grain of managers' and clinicians' concerns and takes shape over prolonged periods of time. Most OD projects focus on the unspectacular but important work of enabling people to reflect on and develop their range of collective sensemaking. They support the capabilities of leaders and the willingness of stakeholders in the negotiation of ways of working between the disparate interests within and around organisations.

Much of the literature is dominated by OD practitioners' accounts of their own interventions, which may overstate their impact in order to prove efficacy and encourage repeat business. To its credit, the Modernisation Agency has invested in several evaluations of their interventions.

For instance, the extensive programme of collaboratives has been assessed by some of my colleagues at Birmingham University's Health Services Management Centre. They found that, typically, only a minority of participating organisations achieved the desired outcomes by the end of the programme. This is not to say the collaboratives were not useful, rather that they could not carry the weight of expectations that were loaded upon them in the time they were given to deliver.

It is important that NHS organisations possess not only a commitment to reflect on the varied ways in which their staff and stakeholders make sense of the issues under examination but also realistic expectations about the time it may take to achieve sustainable impact.

They may also want to select OD practitioners who bring an understanding of the range of established 'schools' - as well as insights into new approaches based on creativity and social movements - rather than a passionate adherent of any one. As has been noted, if all you have is a hammer, every problem becomes a nail.

Professor Edward Peck is director of Birmingham University's Health Services Management Centre and editor of Oganisational Development in Healthcare: approaches, innovations and achievements (Oxford, Radcliffe Publishing,£35). HSJ subscribers can claim a 10 per cent discount by e-mailing hsjworkinglives@emap. com