Change in healthcare: the impact on NHS managers

Purpose – The purpose of this paper is to examine the impact of new public management (NPM) style practices on public sector managers and in particular on the stress experienced by managers in the UK National Health Service (NHS). Although, ostensibly NPM liberates public sector managers to act more like managers in the private sector, the authors argue that it can also lead to negative work outcomes and high levels of stress. Design/methodology/approach – The authors used a multi-method approach, including 33 focus groups and 15 interviews involving 193 middle- and front-line managers in five NHS organisations; together with a survey of 611 managers in the same organisations. Direct and mediation effects were tested using structural equation modelling; qualitative data are used to illustrate the quantitative results. Findings – An indirect effect, but no direct effect, of NPM use on stress experienced by managers was demonstrated. The relationship between NPM use and stress was fully mediated by a series of work outcomes, suggesting that the introduction of NPM leads to expanding responsibilities, constant pressure to meet deadlines and extended working hours, which in turn leads to high levels of stress. Originality/value – This paper builds on literature that questions the appropriateness of introducing private sector principles into the management of the public sector, by demonstrating a relationship between the introduction of NPM and high stress experienced by managers. The use of a multi-method design allows both the relationship to be demonstrated and its nature to be explored.