Organization, cultures and the management of change in the National Health Service : case studies in one District Health Authority.
This thesis is concerned with the issues of managerial effectiveness,
organizational change and cultures in the National Health Service.
Using the micropolitical and cultural perspectives it is concerned to
offer an approach which builds on existing organization, management
and change theory in order to further an understanding of these issues
in relation to National Health Service organizations as well as other
The focus of attention is on the relationship between structure and
culture at both the official and unofficial levels of the
organization. The three case studies of organizations undergoing
organizational change have allowed the opportunity to understand the
complexity of the relationship between the official and unofficial
arrangements in the organization and the impact of this on managerial
effectiveness and organizational change.
The main finding of the thesis is that within organizations, structure
and culture are inextricably bound and their consonance at both
official and unofficial levels of the organization is a necessary
condition for managerial effectiveness. The types of organizational
culture developed during the investigation indicate how the plurality
of interests, beliefs and cultures within an organization make it
difficult to achieve this condition.
Concerning National Health Service organizations, the researcher
argues that the recommendations contained within the Griffiths Report
(1983) have offered a model of management which is based on cultural
assumptions which are different to those which have traditionally
underpinned the managerial process in the NHS. Following this, the
researcher demonstrates via the cases, that the introduction of these
recommendations has served to offer greater scope for a diversity of
managerial style and philosophy at Unit level. They have also served
to raise conflict between cultures, in particular the medical and
managerial, to the point that the conditions needed for achieving
managerial effectiveness do not exist.