Vijayan, S; (2013) Performance Anxiety: The Nature of Performance Management in the NHS under New Labour. Doctoral thesis , UCL (University College London).

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Abstract

This thesis explores both the proliferation and prominence of ‘performance’ in the NHS, focusing on the New Labour years from 1997-2010. The research’s main objective was to understand how performance policy impacts the work-place experience: to understand the nature of work undertaken by performance managers, the tools used and the effect of these techniques. The secondary objective was to understand the goals of performance management. The introduction and rise of performance saw a change in expert authority. A new set of professionals had arrived in the NHS: regulators, auditors and performance managers. This thesis looks at the performance managers’ body of expertise, drawing upon several forms of qualitative research. The primary research tool used was institutional ethnography, which included focused interviews, a case study and experiences and notes gathered during a period based as a participant in NHS organisations. Documentary analysis carried out in the first phase of this thesis revealed that the principal rhetoric employed by politicians concerned the function of performance management in reducing risk and harm to patients. However, further research based on interviews and ethnography suggests that performance was experienced as a process of rationalisation and stigma, with risk rarely mentioned in the same way as in policy documents. In particular, various aspects of rationalisation, including measuring, quantifying and tabularisation, were deployed, these processes being a means for state surveillance. Performance, it will be argued, was part of the bureaucratic machine by which efficiency and effectiveness were judged in areas where the state previously had little knowledge or information. The research draws heavily on approaches in Science and Technology Studies to consider ‘performance’ and audit as a form of socio-technological intervention as well the Sociology of Health to inform issues of organisational and work-based stigma.

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