Harkness Project Title: Tackling Health Disparities in the United States: A Study of Organizational Strategies
Mentor: Eugene Washington, M.D.
Placement: University of California, San Francisco
Biography at time of Harkness Fellowship: Mark Exworthy, a 2002-03 Commonwealth Fund Harkness Fellow in Health Care Policy and Practice, is a Senior Research Fellow in the Department of Epidemiology and Public Health at University College London. His research and policy interests include: policy formulation and implementation, clinician-managerial relations, primary care reform, policies to tackle health inequalities/disparities, and the geographical implications of health policy. He has published in all these areas. Exworthy’s research has been funded by the U.K. government, health care agencies, the Economic and Social Research Council, and the Joseph Rowntree Foundation. He was a cofounder of the U.K. Health Equity Network and is a Fellow of the Royal Geographical Society.
Project: Exworthy’s study examined organizational strategies for tackling health care disparities, including what disparities get addressed, what organizational processes and incentives are used, and how these efforts are assessed. He first conducted a document review and key informant interviews on current policies regarding disparities, and then administered a questionnaire to 800 hospitals identifying the key factors driving their strategies to tackle disparities. Finally, he conducted two case studies on how individual hospitals design and implement such organizational strategies.
Career Activity Since Fellowship
Current Position: Professor of Health Policy & Management, Health Services Management Centre, University of Birmingham (Updated 1/2014)
Exworthy, M., Hyde, P. & McDonald-Kuhne, P. Medical pay: reaping your just rewards? The Health Service Journal, 2013.
Lunt, N. T., Mannion, R. & Exworthy, M. A framework for exploring the policy implications of UK medical tourism and international patient flows, Social Policy and Administration 2013, 47, 1, p. 1-25.
Powell, M., Duberley, J., Exworthy, M., Macfarlane, F. & Moss, P. Has the British National Health Service (NHS) got talent? A process evaluation of the NHS talent management strategy? Policy Studies 2013, 34, 3, p. 291-309.
Sheaff, R., Chambers, N., Charles, N., Exworthy, M., Mahon, A., Llewelyn, S., Byng, R. & Mannion, R. How managed a market? Modes of commissioning in England and Germany. BMC Health Services Research 2013, 13, S1.
Jones, L., Exworthy, M. & Frosini, F. Implementing market-based reforms in the English NHS: Bureaucratic coping strategies and social embeddedness. Health Policy 2013, 111, 1, p. 52-59
Lunt, N., Horsfall, D., Exworthy, M., Smith, R. & Hanefeld, J. Market size, market share and market strategy: three myths of medical tourism. Politics and Politics 2013.
Chambers, N., Sheaff, R., Mahon, A., Byng, R., Mannion, R., Charles, N., Exworthy, M. & Llewelyn, S. The practice of commissioning healthcare from a private provider: learning from an in-depth case study. BMC Health Services Research 2013, 13, S1.
Exworthy, M., Gabe, J. & Jones, I. R. Will publishing surgeon performance improve outcomes? The Health service journal, 2013.
Gabe, J., Exworthy, M., Jones, I. R. & Smith, G. Towards a Sociology of Disclosure: the case of surgical performance. Sociology Compass 2012, 6, 11, p. 908-922.
Anand, P., Exworthy, M., Frosini, F. & Jones, L. Autonomy and improved performance: lessons from an NHS policy reform. Public Money and Management 2012, 32, 3, p. 209-216.
Exworthy, M., Hockey, P. & Gilbert, A. The teacher and the cop: the role of ‘private space' in increasingly transparent clinical practice. Journal of Health Services Research and Policy 2012, 17, 1, p. 60-62.
** Exworthy M, Hockey P, Gilbert A. “The teacher and the cop: the role of 'private space' in increasingly transparent clinical practice.” J Health Serv Res Policy. 2012 Jan;17(1):60-2.
Exworthy, M, “The Illness Narratives of Health Managers: Developing an Analytical Framework,” Evidence and Policy, 2011; 7(3): 345-358.
Macfarlane, F., Exworthy, M., Wilmott, M. & Greenhalgh, T. Plus ça change, plus c'est la même chose: senior NHS managers' narratives of restructuring. Sociology of Health and Illness 2011, 33, 6, p. 914-929.
Exworthy, M., Peckham, S., Powell, M. & Hann, A. Analysing health policy: case study methods and analysis Bristol: Policy Press, 2011.
Exworthy, M., Frosini, F. & Jones, L. Are NHS foundation trusts able and willing to exercise autonomy? ‘You can take a horse to water…’Journal of Health Services Research and Policy 2011, 16, 4, p. 232-237.
Lunt, N., Smith, R., Exworthy, M., Green, S., Horsfall, D. & Mannion, R. Medical Tourism: Treatments, Markets and Health System Implications: A scoping review, 2011 Paris: OECD.
Oborn, E., Barrett, M. & Exworthy, M. Policy entrepreneurship in the development of public sector strategy: the case of London health reform. Public Administration 2011: 89, 2, p. 325-344/
Powell, M., Durose, J., Duberley, J., Exworthy, M., Fewtrell, C., Macfarlane, F. & Moss, P. Talent management in the NHS managerial workforce, 2011 NIHR-SDO programme.
Exworthy, M. & Hunter, D. J. The Challenge of Joined-Up Government in Tackling Health Inequalities. International Journal of Public Administration 2011, 34, 4, p. 201-212.
Exworthy, M. The illness narratives of health managers: developing an analytical framework. Evidence and Policy 2011; 7, 3, p. 345-358.
Whitehead, M., Doran, T., Exworthy, M., Richards, S. & Matheson, D. Delivery systems and mechanisms for reducing inequalities in both social determinants and health outcome, London, Department of Health, 2010.
Exworthy, M., Smith, G., Gabe, J. & Jones, I. R. Open heart surgery? The whys and wherefores of disclosing clinical performance data. Journal of Health, Organization and Management, 2010; 24, 6, p. 571-583.
Exworthy, M. Performance management in the English NHS: potential, pitfalls, and prospects. Eurohealth 2010; 16, 3, p. 16-19.
Exworthy, M., Frosini, F., Jones, L., Peckham, S., Powell, M., Greener, I., Anand, P. & Holloway, J. Decentralisation and performance: autonomy and incentives in local health economies. NIHR-SDO programme, 2009.
Greener, I., Exworthy, M., Peckham, S. & Powell, M. Has Labour decentralised the NHS? Terminological obfuscation and analytical confusion. Policy Studies, 2009; 30, 4, p. 439-454.
Ferlie, E., Dopson, S., Fitzgerald, L., McGivern, G. & Exworthy, M. Networks in health-care: a comparative study of their management, impact and performance. NIHR-SDO programme, 2009.
Exworthy, M. Policy to tackle the social determinants of health: using conceptual models to understand the policy process. Health Policy and Planning 2008; 23, 5, p. 318-327.
Peckham, S., Exworthy, M., Powell, M. & Greener, I. Decentralizing health services in the UK: a new conceptual framework. Public Administration, 2008; 86, 2, p. 559-580.
Exworthy, M. & Frosini, F. Room for manoeuvre? Explaining local autonomy in the English National Health Service. Health Policy 2008; 86, 2-3, p. 204-212.
Exworthy, M. The enduring legacy of Alma Ata, 30 years on. London Journal of Primary Care 2008; 1, p. 81-84.
Exworthy, M. & Peckham, S. Access, choice and travel: Implications for health policy. Social Policy and Administration 2006; 40, 3, p. 267-287.
Exworthy, M., Bindman, A., Davies, H. T. O. & Washington, A. E. Evidence into policy and practice? Measuring the progress of U.S. and U.K. policies to tackle disparities and inequalities in U.S. and U.K. health and health care. Milbank Quarterly 2006; 84, 1, p. 75-109.
Exworthy, M. & Washington, A. E. Organizational strategies to tackle health-care disparities in the USA. Health Services Management Research, 2006; 19, 1, p. 44-51.
* ** Exworthy M, Bindman A, Davies H, Washington AE. “Evidence into Policy and Practice? Measuring the Progress of U.S. and U.K. Policies to Tackle Disparities and Inequalities in U.S. and U.K. Health and Health Care,” The Milbank Quarterly 2006 84(1):75–109.
* Exworthy M, Washington AE. “Organisational Strategies to Tackle Health-Care Disparities in the US,” Health Services Management Research 2006; 19:44-51.
Peckham, S., Exworthy, M., Greener, I. & Powell, M. Decentralizing health services: More local accountability or just more central control? Public Money and Management 2005; 25, 4, p. 221-228.
Peckham, S., Exworthy, M., Powell, M. & Greener, I. Decentralisation, centralisation and devolution in publicly funded health services: decentralisation as an organisational model for health-care in England. NIHR-SDO programme, 2005.
Exworthy, M. & Powell, M. Big windows and little windows: Implementation in the 'congested state' Public Administration 2004; 82, 2, p. 263-281.
Exworthy, M. & Scott, T. Evidence ideas. The human touch. The Health service journal 2004; 114, 5930, p. 18-9.
Exworthy, M., Wilkinson, E. K., McColl, A., Moore, M., Roderick, P., Smith, H. & Gabbay, J. The role of performance indicators in changing the autonomy of the general practice profession in the UK. Social Science & Medicine 2003; 56, 7, p. 1493-1504.
Powell, M. & Exworthy, M. Equal access to health-care and the British NHS. Policy Studies 2003; 24, 1, p. 51-64.
Peckham, S. & Exworthy, M. Primary care in the UK: policy, organisation and management Basingstoke: Palgrave Macmillan 2003.
Exworthy, M., Stuart, M., Blane, D. & Marmot, M. Tackling health inequalities since the Acheson Inquiry Bristol: Policy Press, 2003.
Oliver A and Exworthy M (eds). Tackling Health Inequalities: Evidence, Policy and Implementation. Proceedings from a Meeting of the Health Equity Network. London: Nuffield Trust. 2003.
Exworthy M. "Tackling Health Inequalities in the United Kingdom: The Progress and Pitfalls of Policy," Health Services Research 2003; 38(6 - special supplement Part II).