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New Public Management (NPM) in health services has proved increasingly controversial. It has been criticised as Weberian in terms of authoritarian hierarchy, Fordist in its obsession with gaining economies of scale and Taylorist in its surveillance of performance criteria. It has assumed a production and output logic derived from manufacturing, whereas both private and public services differ from this. Nonetheless there recently has been a resurgence of interest in what can be learned in terms of lean management in manufacturing, both in terms of economies of scope rather than scale and of multi-tasked and multi-skilled hybrid management at operational levels. This chapter seeks to inform this by distinguishing operational and organisational logics within institutions and by evaluating alternative models of governance of health, including the scope for New Public Services rather than NPM to reinforce social rights and the degree to which replacing a command-and-control model of hospital management with health professionals as ‘hybrid’ managers may enable both social efficiency in service delivery and enhance the wellbeing and fulfilment at work of health service employees .
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- From New Public Management to New Public Services: Challenges for Hospital Governance and Lean and Hybrid Management
Teresa Carla Oliveira
Francisco Edinaldo Lira de Carvalho
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