Let's be PALS: User-Driven Organizational Change in Healthcare*

This paper explores user-driven organizational change in the National Health Service (NHS). The NHS Plan (Department of Health, 2000) created Patient Advice and Liaison Services (PALS) to provide information, solve problems and drive user-led change. Evidence is drawn from a study of PALS in London acute, primary care, mental health and specialist trusts, drawing on discussion forums, interviews with PALS officers and documentation. From context and role profiles, two conclusions are evident. First, organizational instability, boundary disputes, variable management support, resource limitations, financial insecurity and multi-site working characterize the context in which PALS operate, and the officer role is characterized by problem diversity, overlap with complaints systems, monitoring problems, relationship building and 'serial users'. Second, these context and role attributes restrict PALS to 'repair and maintenance', ensuring that established systems work correctly. While PALS sit on the bottom rung of a 'participation ladder', their contribution is more than tokenistic. However, a processual perspective demonstrates how a fluid, networked, and diversified context isolates PALS structures from management decision-making, constraining their power base, and inhibiting the promotion of substantive change agendas.