Huw Davies, PhD

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Huw Davies, PhD

• Professor of Health Care
• Policy Management
• Co-Director Centre for Public Policy
  Management (CPPM)
• University of St Andrews
• Associate Director Social Dimensions of Health
  Institute (SDHI)

St A Picture/crest
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On the Importance of Social Capital in Health
Care Organisation(s)
- a socialised versus a mechanistic view of
organisation(s)

• Organisations as rational, instrumental,
  mechanistic agencies heartless arrangements
  for getting things done.
• Organisations as values-infused mini-societies
  driven by social dynamics and concerned with
  meaning, power and emotion.

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those social aspects of organisations and
organising that enable efficient coordination and
production -
The Nature of Social Capital
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Structured Social Networks

• Who you know-
• Bonding links intra-organisational
• Bridging links inter-organisational
• Density and interconnectedness
• Status of, and expectations about, these
  connections ? relational issues

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Relational aspects

• Trust Reciprocity preconditions for
  co-operative behaviour
• Sometimes trust is calculative but also often
  with a moral component
• Built through repeated interactions.

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• Contractual relationship

Extrinsic motivation

• Trusting relationship

Intrinsic motivation
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The benefits of trust

• Lower overheads, lower transaction costs
  and reduced verification costs.
• Improved communication, better
  teamwork increased worker
  participation, better job satisfaction
  and commitment to the organization.
• Employee empowerment, and increased innovation
  and creative problem solving.
• Facilitation of organisational learning.

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The strange properties of trust

• Trust as a lubricant
• reducing transaction costs and making possible
  otherwise uneconomic exchanges
• Trust as a glue
• binding parties into longer-term mutually
  rewarding relationships
• Trust as a stimulant
• fostering organisational learning and promoting
  improvements in performance.

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The risks of trust

• Fragility deterioration to mistrust
• Lock-in to certain modes of operation
  stagnation, complacency.
• Neglect of appropriate verification.
• Risk of opportunism or even betrayal.

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Cognitive aspects role of culture

• That which is shared across groups
• shared mental maps or models
• beliefs, values, attitudes, norms of behaviour
• routines, traditions, ceremonies, rewards
• meanings, narratives and sense-making
• Help define legitimacy and acceptability form a
  kind of social and normative glue - the
  way things are done around here.

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Social capital always been there in healthcare,
but now more invoked and pressed into service

• emphasis on clinical networks and partnership
  working
• renewed interest in Human Resources strategies
• pleas for trust and demands for cultural
  transformations

We are looking at a major cultural change for
everyone a fundamental shift in culture
clinical governance needs to be underpinned by a
culture that values lifelong learning - A
First Class Service, 1998
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Social Capital and Impacts on Organisational
Performance?
Social Capital
Performance(s)
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A Darker Side to Social Capital

• Strong networks and associated cultures can
  become exclusionary, cliquish, closed off, and
  vulnerable to group think contributing to
  inefficiency and raising equity concerns.
• They may neglect (or even resist) other
  sometimes more appropriate - forms of
  coordination, regulation or accountability.

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Policy Research Implications

• Social Capital Matters! and deserves
  investigation for its contribution to health
  care production.
• Social Capital may be (should be?) the target of
  purposive policy interventions.
• More often, such impacts will be incidental,
  unintended and perhaps unfortunate.
• Assessment of such impacts should be integral to
  all policy evaluations.