A multi-disciplinary identification of issues associated with ‘contracting’ in market-oriented health service reforms

Multi-disciplinary perspectives from operational research, management information systems, purposeful activity systems, accounting and finance, transaction-cost economics and organization learning are discussed in relation to ‘contracting’ in the NHS following the recent reforms, applied within the general framework of soft-systems methodology. These are then used to frame questions for collecting information about contracting practices and issues. The data so collected suggest that the issues and activities associated with contracting can be grouped into five interacting categories of: strategy formation, making enabling arrangements, operational management of contracted activities, identifying and relating to stakeholders, and carrying forward organizational learning from experience. Each of the disciplinary perspectives attributes significance to specific forms in these five activities. The possibility of some multi-disciplinary linking of theoretical perspectives is demonstrated. Information and purposeful systems are central to this, being on the one hand created by social processes which define relevant information and corporate alignments of purpose, and on the other hand patterns of activity that can be evaluated in terms of contribution to these purposes, with properties of greater or lesser inhibition of innovation to improve purpose achievement. As a case study of an attempt at interdisciplinary research, it demonstrates that interdisciplinary linkage can be made, though certain epistemological issues are skated over in the process. On the basis of the case study, some of the richness and insight of the different perspectives is lost in the process. The critical debate about the neutrality of soft-systems methodology is commented on in the light of the study.