Public Sector Organizational Failure: A Study of Collective Denial in the UK National Health Service

Abstract

This paper argues that public sector organizational failure may be best understood from a perspective of collective denial. The rise of this phenomenon is examined using testimony from a Public Inquiry into the downfall of a UK hospital, where falling organizational standards led to unethical decision making and an unacceptable number of patient deaths. In this paper we show how collective denial, over time, became a process that resided within the fabric of organizational life. To explore the organizational processes associated with collective denial, and how and why it occurs, we identify the influence of a 'narrative of silence'. This narrative allows ever more serious failings to be justified as organizational members lose contact with reality entering a downward spiral with no recovery. The combined impact of assumptions about leadership capability, enculturated professional identities and organizational loyalty create an environment where a narrative of silence can develop.

Speaking up as an extension of socio-cultural dynamics in hospital settings: a study of staff experiences of speaking up across seven hospitals

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