Loose coupling in asset management systems in the NHS

This paper aims to identify whether the components of a loose-coupled system were present in the asset management systems of the National Health Service (NHS) in Wales and, if so, whether this had a negative impact. By utilising a qualitative analysis of semi-structured interviews with senior officials at two NHS Hospital Trusts together with the findings of a survey of all of the Hospital Trusts in Wales, we conclude that the asset management system of the NHS in Wales exhibits the features of a loosely coupled system with detrimental consequences. Where information on capital assets has been required below board level, lower management relies on local systems, while the information for senior managers and political leaders relies on the management accounting system and ad hoc enquiries. The result has been an impairment of the ability of lower management to reconfigure capital assets which leads to the nation's health service underperforming.

► We analyzed semi-structured interviews with senior NHS managers and a survey of Welsh Hospital Trusts.
► We find that the asset management system of the NHS in Wales is loosely coupled.
► As a result of loose coupling the reconfiguration of capital assets has been impeded.
► Subordinate managers were not affected by the accounting change.
► It impacted negatively on their participation in actively managing the asset base because there was no financial incentive.