Changing management roles in the Scottish NHS: implications for management learning and development

Do accountabilities change when public organisations transform to service systems: A new conceptual approach

“…We argue that interactive action learning during co‐production of services is an agentic shift (Milgram, ) typified by the changed roles, responsibilities and relationships of middle‐managers (Memon and Kinder, ), specifically those relating to embedded users: both of whom demonstrate Fry's () felt responsibility in learning and innovating based on service delivery and quite distinct from what Power () terms ritualistic auditing .…”

“…This is a goods‐dominant logic (GDL) approach according to Vargo et al (), that is akin to manufacturing product rather than delivering services. According to Memon and Kinder ( and ) fitting people into a pre‐determined set of competences is one of the main criticisms of NPM as an approach de‐professionalising health and social care. New ways‐of‐working, new enactments require new ways of analysing organisations and organising.…”

“…Since service systems include users and their co‐production and co‐design, the middle manager's remits, roles, responsibilities and relationships centre around the effectiveness of the services from the user viewpoint, acknowledging at times the need to ration access and always the need (especially in austerity) to also work efficiently. As Memon and Kinder () point out, existing management training and development processes and structure are ill‐fitted to preparing middle managers for the remits, roles, responsibilities and relationships required in integrated service systems a key issue in the accountability of the senior management to middle managers.…”

“…Koppell's () warning of multiple accountability disorder is partly addressed by adopting a service systems approach, since potentially conflicting/competing performance indicators will be part of the dialogue between users and providers. As Memon and Kinder () note, for middle managers, service systems introduce new roles and relationships, part of which is reconciling vertical and horizontal accountabilities.…”

“…Using our new framework, we are also able to comment on some general issues in the literature, such as Held's () argument on the extent to which accountability is situated in systems that are nationally and professionally regulated and Koppell's () warning on multiple accountability disorder – do service systems ameliorate or exacerbate the disorder? If in service systems, managers take on new remits, roles, responsibilities and relationships as Memon and Kinder () argue, do these changes make accountability easier or more difficult? Leutz () argues that integration costs before it pays : does the integrated service systems perspective help focus attention on the return on a system investment in the form of action learning and innovation?…”