(2015) '"You can't do both -something will give": limitations of the targets culture in managing UK healthcare workforces.', Human resource management., 54 (5). pp. 773-791. Further information on publisher's website:
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AbstractBased on a three-year ethnographic study of four UK National Health Service (NHS) organizations, we explore the everyday cultural experience of managing clinical and administrative workforces. Although NHS organizations claim to function as enlightened HRM employers, we argue that the inflexible application of metricsbased target systems to clinical and administrative tasks, including HRM operations, can result in dysfunctional outcomes for patient care and workforce morale. Reminiscent of the recent Mid Staffordshire healthcare scandal, the priorities attached to NHS personnel meeting the demands of performance management systems can prove incompatible with them also meeting the fundamental 'human' needs of patients. The everyday experience of healthcare organization becomes one of employees reconciling competing logics of business efficiency and integrity of care. Trapped metaphorically between shrinking resources and expanding targets, the inclination -on the frontline and at mid-management level -is to extend the integrity of care, although this is sometimes impossible and can prove problematic in terms of system accountability. In response to such organizational tensions the behaviour of many frontline and mid-management staffs ultimately reflects a form of 'street-level bureaucracy' -a situation in which traditional professional norms are reasserted informally in ways that often transgress prescribed performance systems.