Tag Archives: NHS

On organisational culture change

There is a great deal of discussion in contemporary organisational life of the need to ‘change the culture’ in organisations. This is a way of talking that assumes that organizations do have discrete cultures and that they are manipulable, although the discourse can have it both ways with the term: on the one hand culture is known to be symbolic, intangible and abstract, on the other it can be the object of conscious and rational redesign and reframing. A good example of this way of talking about organisational culture can be found in the 4th edition of the eminent management scholar Edgar Schein’s book Organizational Culture and Leadership[1].

Usually a prime role is assumed for leaders or senior managers in making the changes to organizational culture because they are considered to have the necessary abilities and skills to diagnose what is wrong with the current culture and to design a better one: one which fits better with the environment. Schein states this very explicitly in his book: ‘In this sense culture is ultimately created, embedded, evolved and ultimately manipulated by leaders’ (2010: 3).  As a result of their leaders’ efforts, employees will be obliged to commit to a fresh set of values, or reaffirm an existing set which are thought to have become moribund, as well as demonstrating a suite of required ‘behaviours’ or new procedures. The new values and procedures are then set ‘at the heart of everything we do’, are vigorously communicated and disseminated and form the basis of widespread training programmes for staff, and are then subject to regimes of inspection and performance management. Such change programmes can consume weeks and months of organizational time and resources.

The whole process is a good demonstration of the systemic assumptions behind organizational realignment: values, behaviour, systems, procedures, training, communication and quality regimes are all supposed to line up and fit over each other and form a coherent whole. The emphasis is on integration, stability and alignment. It is a huge reduction of the complexity of what is at stake when attempting organisational change.

A book recently published calling for radical change in the NHS is a refreshing attempt to explain why ‘culture change’ in organisations is likely to be highly problematic. [2] Instead of assuming that whatever we might mean by the term culture is contained within one organisation, even one as big as the NHS, Ballatt and Campling, an ex-senior manager and psychotherapist within the NHS, explain why the institution reflects much wider conflictual social processes, as well as provoking profound questions about what it means to be human. That is, they try to bring together society-wide trends in social patterning in the UK and beyond in terms of their impact on changes in the NHS, and they wrestle with the profound human difficulties and dilemmas involved in professionalising the often spontaneous and improvisational human response of caring towards another human being in need. Though written specifically about the NHS, I think the book also raises important questions for anyone thinking about what is involved in processes of organisational change and echoes some of the themes from the perspective of complex responsive processes of relating. There are some key differences, however, which I will also explore below. Continue reading

Values and Norms – insights from Norbert Elias (Part 1)

I was recently reviewing a research narrative in which Max, the researcher, was describing what was happening in a health care organisation that was undergoing an organisational merger. Max had responsibility for leading a programme of work aimed at improving the care of patients with diabetes. This involved redesigning their treatment pathway to improve their disease management and reduce what were regarded by the organisation’s management as unnecessary and expensive admissions to hospital, which it thought could be better managed in the community. This work required him to bring together clinicians and managers from three former organisations, one of which he had worked for prior to the merger. His research interest is in exploring the concept of “transformation” and the narrative describes a series of meetings he is having with staff about the work. These meetings are proving difficult, because it is clear from what is being said that the groups from the three organisations have strong “we” identities arising from their former organisations and are all involved in stigmatising gossip based on their prejudices about each other. Max finds himself defending his former organisation when this is being criticised and also feels surprised and uncomfortable when it begins to appear as though the perceived source of the problem- the hospital- may not be the only cause of the problem – as he and his colleagues had formally perceived.  He describes vividly the detail of a very difficult meeting in which one of the influential Doctors loses their temper and refuses to co-operate with colleagues from one of the other former organisations on the grounds that what is being proposed could compromise patient care. Max describes the frustration and anxiety this raises for him and others – including a discussion with his manager Carl, in which he is told that “failure is not an option”. Continue reading

On Values

On values

This post sets out some thoughts provoked by my reading Ralph and Chris’ contributions. It is intended to provoke further conversation and act as an invitation to others to make a further comment.

The observations made by them that speaking about management differently can appear to others as though I am not taking ‘the game’ seriously or calling ‘the game’ into question can be seen as ‘anti-management’; that re-thinking the dominant discourse invites us to think of ourselves differently and therefore to question our identities as managers, and to rethink management from within the practice of management, resonate strongly with my own experience in my working life as a nurse manager. Hence, as I challenge many of the theoretical assumptions I had previously made about management, so my practice as a manager shifts because, quite simply, it no longer makes sense to do some of the things I was doing before. To try and explain more clearly what I mean. I shall write a short piece of narrative based on a conversation that struck me as interesting. Reflective narrative is an important component of the research methodology we are developing on the D.Man programme as part of the theory of complex responsive processes of relating. Continue reading