No abstract

The study was undertaken in not-for-profit health service organizations, through a series of 25 semi-structured interviews with Directors of Nursing. The review of the literature was undertaken simultaneously with grounded theory analysis of the interviews. This research suggests that structure does impact on the role, conferring both positive benefits and negative consequences. Structure is identified in this study, in terms of organizational hierarchy, and the locus of control pertaining in each organization. Two predominating structure models are discussed and analysed.

It was demonstrated that strong organizational culture predicted strategic involvement, and supported the importance of middle managers remaining strategically involved in the development of new organizational strategic initiatives. Findings have implications for strategic management in health service organizations.

Findings show that healthcare clinicians and non-clinicians demonstrated a range of values in the delivery of health care, some of which have not been identified before. Should professionals now reconsider the values required in the delivery of health care? The most widely perceived values held by both groups were similar, although clinicians perceived that non-clinicians did not hold the same ethical values and beliefs as they did, and vice-versa, demonstrating a lack of trust in each other's moral and ethical value system.