Title:
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Integrated governance as an organisational change : a case study of alpha pct
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The integrated governance model was introduced in NHS organisations as part of
the government's initiative to improve governance arrangements which were in
silos. Alpha, as part of the larger NHS, embarked on the implementation of
integrated governance immediately after it was publicised. This thesis explores
the various aspects of organisational change involved in the adoption of a new
governance framework. In particular, this thesis focuses on understanding the
underlying reasons which trigger the need for change, explaining the process of
change involved in the conceptualisation and installation of the integrated
governance approach, and understanding organisational responses to change and
the subsequent implications of the operationalisation of the new governance
approach to the functioning of the board. The sensemaking approach is set out as
an overarching theoretical framework to explain the empirical findings at Alpha.
The sensemaking approach also borrows insights from the 'institutional context'
and 'active agency' arguments to reinforce understanding of the factors that shape
organisational change. Furthermore, it highlights the notion of ambiguity as an
antecedent for sensemaking. This thesis argues that the adoption of integrated
governance is a strategic response to institutional pressure to gain legitimacy from
its higher governing bodies. The timing of the adoption, which was almost
instantaneous despite the lack of guidelines from the government, suggests that
the substantial driving force pushing the integrated governance agenda was
internal. This argument led to the identification of the role of the institutional
entrepreneur as the main impetus for organisational change. The ambiguous
notion of integrated governance also triggers the sensemaking process enacted by
the institutional entrepreneur. The seven properties of the sensemaking process
(Weick, 1995) were appraised in explaining integrated governance change. Some
properties were appraised more explicitly and appeared more relevant than others
in explaining the change occurrence. Because of the context in which the board
operated, the use of the integrated governance approach to inform the board
process during public board meetings was downplayed. Arguably, understanding
the operationalisation of integrated governance inadvertently sheds light onto the
actual processes, challenges, complexities and dilemmas of the workings of a
public sector board like Alpha's. In conclusion, studying the integrated
governance change exemplifies the external and internal factors that jointly
explain the nature, form and timing of change at Alpha. And appraising the
outcome of change penetrates the 'black box' myth of board working, giving
insights into what happens behind the closed doors of the boardroom.
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