A model of organisational dysfunction in the NHS

Pope, Rachael; Burnes, Bernard

doi:10.1108/jhom-10-2012-0207

Cited by 18 publications

(17 citation statements)

References 47 publications

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“…We are capturing another dynamic of 'organisational/institutional bullying' that operates at the organisational/institutional level and should not be explained away by blaming rogue individual managers. 160,161 This does not wholly capture the dynamic we observed. Part of the explanation may reside with the advent of new managerialism exercised within the NHS, 162 which emphasises organisational control, a centralised hierarchy and performance.…”

Section: Institutional Controlmentioning

confidence: 81%

Factors influencing utilisation of ‘free-standing’ and ‘alongside’ midwifery units for low-risk births in England: a mixed-methods study

Walsh

Spiby

McCourt

et al. 2020

Health Serv Deliv Res

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Background Midwifery-led units (MUs) are recommended for ‘low-risk’ births by the National Institute for Health and Care Excellence but according to the National Audit Office were not available in one-quarter of trusts in England in 2013 and, when available, were used by only a minority of the low-risk women for whom they should be suitable. This study explores why. Objectives To map the provision of MUs in England and explore barriers to and facilitators of their development and use; and to ascertain stakeholder views of interventions to address these barriers and facilitators. Design Mixed methods – first, MU access and utilisation across England was mapped; second, local media coverage of the closure of free-standing midwifery units (FMUs) were analysed; third, case studies were undertaken in six sites to explore the barriers and facilitators that have an impact on the development of MUs; and, fourth, by convening a stakeholder workshop, interventions to address the barriers and facilitators were discussed. Setting English NHS maternity services. Participants All trusts with maternity services. Interventions Establishing MUs. Main outcome measures Numbers and types of MUs and utilisation of MUs. Results Births in MUs across England have nearly tripled since 2011, to 15% of all births. However, this increase has occurred almost exclusively in alongside units, numbers of which have doubled. Births in FMUs have stayed the same and these units are more susceptible to closure. One-quarter of trusts in England have no MUs; in those that do, nearly all MUs are underutilised. The study findings indicate that most trust managers, senior midwifery managers and obstetricians do not regard their MU provision as being as important as their obstetric-led unit provision and therefore it does not get embedded as an equal and parallel component in the trust’s overall maternity package of care. The analysis illuminates how provision and utilisation are influenced by a complex range of factors, including the medicalisation of childbirth, financial constraints and institutional norms protecting the status quo. Limitations When undertaking the case studies, we were unable to achieve representativeness across social class in the women’s focus groups and struggled to recruit finance directors for individual interviews. This may affect the transferability of our findings. Conclusions Although there has been an increase in the numbers and utilisation of MUs since 2011, significant obstacles remain to MUs reaching their full potential, especially FMUs. This includes the capacity and willingness of providers to address women’s information needs. If these remain unaddressed at commissioner and provider level, childbearing women’s access to MUs will continue to be restricted. Future work Work is needed on optimum approaches to improve decision-makers’ understanding and use of clinical and economic evidence in service design. Increasing women’s access to information about MUs requires further studies of professionals’ understanding and communication of evidence. The role of FMUs in the context of rural populations needs further evaluation to take into account user and community impact. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 12. See the NIHR Journals Library website for further project information.

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Section: Institutional Controlmentioning

confidence: 81%

Factors influencing utilisation of ‘free-standing’ and ‘alongside’ midwifery units for low-risk births in England: a mixed-methods study

Walsh

Spiby

McCourt

et al. 2020

Health Serv Deliv Res

View full text Add to dashboard Cite

show abstract

“…In the proposed model of organisational dysfunction (Pope and Burnes 2013), the three concepts of organisational silence, normalised corruption and protection of image reflect three aspects and perspectives of the NHS culture. The mechanisms of selective moral disengagement enable the persistence of this dysfunctional culture.…”

Section: Analysis and Discussionmentioning

confidence: 99%

“…Negative Behaviour in the NHS In Pope and Burnes (2013), an extensive literature review was detailed on the topic of negative behaviour within the NHS. The review identified some key themes as follows:…”

Section: Literature Reviewmentioning

confidence: 99%

“…The desire to protect the image and the individual and collective self-esteem was thought to be the dominant influence in the situation. It was concluded in Pope and Burnes (2013) that …organisational behaviour in the NHS can be dysfunctional, not always rational, and perverse…Or-ganisations and the individuals within them can hide and retreat from reality and exhibit denial; there is a strong resistance to voice and to 'knowing'. The persistence and tolerance of negative behaviour is a corruption and is not healthy or desirable.…”

Section: Introductionmentioning

confidence: 98%

“…The local scenario is explored conceptually in Pope and Burnes (2013) and a model of organisational dysfunction in the NHS proposed (Fig. 1).…”

Section: Introductionmentioning

confidence: 99%

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The NHS: Sticking Fingers in Its Ears, Humming Loudly

Pope

2015

J Bus Ethics

Self Cite

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Evidence exists that the UK National Health Service (NHS) has had, over many years, persistent problems of negative and intimidating behaviour towards staff from other employees. The evidence also suggests the organisational responses to negative behaviour can be inadequate. A conceptual model of organisational dysfunction was proposed to assist in explaining those responses and the overall culture in the NHS (Pope and Burnes 2013). Through research this model has been tested. Based upon the findings, an extended and developed model of organisational dysfunction is presented. A qualitative approach was taken to research the organisational responses to negative behaviour, and the reasons and motivations for those responses. Fortythree interviews and six focus groups were conducted.

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A systemic approach to understanding mental health and services

Cohen

2017

Social Science & Medicine

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A model of organisational dysfunction in the NHS

Cited by 18 publications

References 47 publications

Factors influencing utilisation of ‘free-standing’ and ‘alongside’ midwifery units for low-risk births in England: a mixed-methods study

Factors influencing utilisation of ‘free-standing’ and ‘alongside’ midwifery units for low-risk births in England: a mixed-methods study

The NHS: Sticking Fingers in Its Ears, Humming Loudly

A systemic approach to understanding mental health and services

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