Waiting time targets and informal professional networks in English NHS

Purpose - This paper examines the relationship between key actors in an organisation and informal professional networks. It uses pragmatic constructivism (PC) as a research paradigm together with concepts borrowed from the theory of social networks to investigate how these actors responded to a particular set of non-financial performance targets. Design/methodology/approach - The implementation process of waiting time targets in the Accident and Emergency Department was observed as part of an in-depth study at a large English National Health Service hospital. The main sources of data were face-to-face interviews with key actors, documentary archival evidence and observation diaries. Findings - The results indicated that with the effect of information sharing through these networks, implementation methodology switched from systems approach to actors approach. Professional connections between key actors had allowed them to generate their own understanding in responding to new performance measures. As a consequence, the perceptions of other actors in relevant networks, as well as the implementation practices were influenced. Research limitations/implications - This is a single-site, in-depth case study; hence, the findings are not generalizable. Practical implications - This study demonstrated just how influential some key actors can be in shaping the implementation of performance measures. Originality/value - The paper contributes to PC by providing evidence on the influence of informal professional networks and structural holes in shaping organisational topos.