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Title: Using complexity theory to understand the organisational response to resurgent tuberculosis across London
Author: Trenholm, Susan
Awarding Body: King's College London (University of London)
Current Institution: King's College London (University of London)
Date of Award: 2013
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This thesis analyses the organisational response to resurgent tuberculosis (TB) across London. Tuberculosis in modern London reached its lowest recorded rate in 1987, but since that time there have been almost annual year on year increases, with the rate climbing by 50% between 1999 and 2009 alone. The rate of drug resistant TB is also increasing at a worrying pace. This research uses a novel complexity theory approach to analysis but empirically finds that positive features of complexity theory were crowded out by an embedded New Public Management paradigm. This study is qualitative and narrative-based, using complexity theory as the main theoretical framework, but also applies the theory of professional dominance and the paradigm of New Public Management (NPM) as possible alternatives. Institutionalism/archetype theory and Kingdon’s (1995) theory of public policy development are also introduced to help theorise the findings. This research found that complexity theory offers a useful, but partial, means of understanding the system responsible for TB control in London. Self-organisation, the key feature of complexity theory, was evident, but often resulted in maintaining the status quo and resisting change, in addition to infrequently resulting in innovation. The effects of highly embedded NPM practices and principles were wide-spread and powerful; its relentless preoccupation with risk aversion and control may have thwarted potentially positive benefits from self-organisation at the system level. Further, extensive NPM-inspired fragmentation almost eliminated co-adaptation (another complexity theory precept) by the TB control system to its changing environment, and reduced system fitness and robustness. TB control was also found to occupy a lowly place in terms of public health priorities. Finally, and rather surprisingly, there was little evidence of professional (medical) dominance observed. Medical consultants, stretched for time and faced with competing priorities, often acquiesced to NHS management efforts.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available