Coping but not coping in health and social care: Masking the reality of running organisations beyond safe design capacity

Abstract

This paper develops a hypothesis that the "normal" mode of operation for many organisations today is beyond their safe design capacity. Evidence for this has emerged from a number of studies carried out to promote systemic practice in local health communities in the U.K. This work has identified mismatches between how managers claim their organisations work and the observed behaviour, which can only be explained by surfacing informal coping policies, many with unintended consequences for patient care and costs. There are important messages in the paper for Health and Social Care management, the meaning of data and for modelling, and the paper contains reflections from senior management involved in the studies. The key message of the paper is that affordable and sustainable downstream capacity additions in patient pathways can be identified, which both alleviate upstream problems and eliminate the need for excessive coping policies. Copyright © 2007 John Wiley & Sons, Ltd.