Use this URL to cite or link to this record in EThOS:
Title: Autonomy in healthcare organisations : a qualitative case study of middle managers in England and Iran
Author: Zahmatkesh, Maryam
ISNI:       0000 0004 8499 6887
Awarding Body: Royal Holloway, University of London
Current Institution: Royal Holloway, University of London
Date of Award: 2017
Availability of Full Text:
Access from EThOS:
Access from Institution:
This thesis explores the extent to which hospital middle managers can exercise autonomy in England and Iran. It aims to explain the impact of public management reforms on middle managers and their response to these reforms. Data were collected from interviews with forty-five middle managers, observational fieldwork and documentary analysis across four teaching university hospitals in England and Iran. The findings show middle managers' autonomy is constrained in the two countries in different ways. In England, middle managers have financial and human resources, but their autonomy is constrained by government policy and targets. In Iran, middle managers are less constrained by government policy and targets, but they do not have financial and human resources to exercise autonomy. This study shows that career path, experience and skills of middle managers are important factors affecting middle managers' views on their autonomy and the identity they adopt. Drawing on the institutional pillars framework of Scott (2000), it is argued that in Iran, middle managers face professionalism as the main logic. Managerialism is not as strong as middle managers are not in control of the managerial resources (e.g., human and financial resources). In England, middle managers face two strong logics of managerialism and professionalism. They work in a clinically driven environment while they have the autonomy to manage as long as they stay within the predetermined financial and human resources framework, follow the standardised policies and procedures and meet the central targets. In both countries, the central government control is a major factor affecting the hospital middle managers' autonomy. According to the notion of institutional work (Lawrence and Suddaby, 2006), it is argued that in England, the majority of middle managers aggregate the competing logics. They do identity reconciliation and use their practical evaluative agency and act as the change agent. In Iran, the autonomy over input, process and outcome is more unbalanced compared to England. Therefore, the majority of middle managers internalise the institutional contradiction and compartmentalise the competing logics (e.g., autonomy/accountability). They develop fragmented identities. They use their practical evaluative agency and similar to middle managers in England, mainly play the change agent role.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available