Power and Culture in the National Health Service

Harrison, Stephen; Hunter, David J.; Marnoch, Gordon; Pollitt, Christopher

doi:10.1007/978-1-349-22376-3_1

Cited by 80 publications

(124 citation statements)

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“…[3][4][5][6][7][8][9][10] It is clear that culture in large complex organisations is rarely uniform. [11][12][13] One study suggested that NHS staff were united on only two main issues: the need for care to be based on individual need rather than funding and a dislike of "constant interference into healthcare provision by successive UK governments." 13 In reality, cultural divergence of basic beliefs and assumptions is the norm.…”

Section: A Cultural Mosaicmentioning

confidence: 99%

Will prescriptions for cultural change improve the NHS?

Davies

Mannion

2013

BMJ

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It is hard to escape the conclusion from the Francis report into care at Mid Staffordshire NHS Foundation Trust that the primary culprit at the heart of this latest NHS scandal is "the culture" of our healthcare organisations.1 Francis suggests that "a fundamental culture change is needed" and is clear that he is seeking a move to something overarching and comprehensive for the whole NHS.The Francis inquiry, like the Kennedy inquiry into paediatric cardiac surgery at Bristol more than a decade earlier, 2 has gone to considerable trouble to try to understand the meaning of culture in a healthcare context. Yet the subtlety of some of the supporting evidence to the inquiry has not been matched by the same degree of nuance in the inquiry's recommendations about culture, which are somewhat aspirational and broad brush (box 1). This is a pity, since the research literature has much to say about the nature of culture and the possibilities for shaping cultural change to produce benefits. 3-5 Unpacking cultureBy finding fault with culture and providing prescriptions for change, Francis is making several assumptions that require examination. Firstly, he presupposes that we can identify and assess common aspects of culture, 6 as well as identify which aspects are supportive of or inimical to high quality care. Secondly, he assumes that these aspects of culture can be purposely changed, that any changes will lead to improvements, and that the costs and dysfunctions from such prescriptive changes will be outweighed by the benefits.4 7 Finally, while acknowledging that culture may vary "from organisation to organisation and from department to department," Francis emphasises the need for "a positive and common culture throughout." This presumes that common cultures are possible and desirable, even in systems as large and distributed as the NHS. However, research shows more complex and nuanced relations between cultures, practices, and outcomes than Francis implies.

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Section: A Cultural Mosaicmentioning

confidence: 99%

Will prescriptions for cultural change improve the NHS?

Davies

Mannion

2013

BMJ

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“…Indeed, the mix of managerial and professional cultures in which multiple values coexist alongside power imbalances among the various staff groups has been seen as the key distinctive feature of the UK National Health Service (NHS) (Harrison et al, 1992;Dawson, 1999). In such a context, there are risks in any attempt to develop a strong unitary culture which may overlook the richness within the pre-existing cultures and the complex meaning-making processes that they enable (Hawkins, 1997).…”

Section: What Do We Mean By Organisational Culture?mentioning

confidence: 99%

Partnership Working and Organisational Culture

Peck

Dickinson

2009

International Perspectives on Health and Social Care

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In discussions of partnership working between health and social care agencies, one issue seems to recur more than any other: culture. Furthermore, it appears simultaneously to be both an aspiration for partnerships (e.g. to change culture) and an obstacle to partnerships (e.g. conflicts rooted in culture). This concurrent recognition of the importance of, and uncertainty about, culture is reflected in the huge volume of writings about culture in an organisational context where the term has many and varied definitions. As Scott and his colleagues (2003b) point out, '[U]nsurprisingly in view of this diverse array of phenomena, little agreement exists over a precise definition of organisational culture, how it should be observed or measured, or how different methodologies can be used to inform routine administration or organisational change' (p. 925). The aim of this chapter is to bring some clarity to discussions of culture in relation to partnership working.Concern about culture in partnerships is not restricted to the public sector. There is compelling evidence from the private sector that culture is also a central issue in the success of alliances, mergers and acquisitions in the commercial field (see Field and Peck, 2003). Cartwright and Cooper (1996) have examined the cultural characteristics of companies and how these can affect the outcomes of mergers and acquisitions. They argue that the degree of 'cultural fit'can be critical in determining the outcome of a merger or an acquisition; they also suggest that most fail and that poor cultural fit between the new partners -leading to staff experiencing a loss of morale and a loss of commitment -is the main cause. What do we mean by organisational culture?Most accounts of culture assume what Meyerson and Martin (1987) call an integration model. This sees culture as something that organisations possess and which is therefore broadly recognisable and consistent across them. On this view, culture is an influence which promotes integration within organisations (thus two divergent cultures may need to be reconciled when organisations work in partnership) and may be manipulated in relatively predictable ways in order to enhance integration.

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“…Incidents like these clearly give the nurses a great deal of satisfaction and demonstrate that, despite the tightening managerial grip on the NHS, they are not the`passive objects of managers' desires' (Harrison et al 1993).…”

Section: The Humorous Facementioning

confidence: 99%

Changing faces: nurses as emotional jugglers

Bolton

2001

Sociology Health & Illness

196

187

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Nursing has long been distinguished as an occupation requiring extensive amounts of`emotion work'. Various studies highlight the importance of a nurse's ability to manage emotion and present the desired demeanour in a number of health care settings. This paper adds to the existing understanding of the emotional elements of nursing work and proposes that Goffman's (1959Goffman's ( , 1961Goffman's ( , 1967) insights into thè presentation of self' may be a useful approach to recognising a nurse's ability to present many`faces'. Set against the backdrop of structural changes affecting the British public sector services, and using qualitative data collected from a group of nurses working in a National Health Service trust hospital, it will be shown how nurses are able to juggle the emotional demands made of them whilst still presenting an acceptable face.

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Power and Culture in the National Health Service

Cited by 80 publications

References 0 publications

Will prescriptions for cultural change improve the NHS?

Will prescriptions for cultural change improve the NHS?

Partnership Working and Organisational Culture

Changing faces: nurses as emotional jugglers

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