Lean thinking has recently re-emerged as a fashionable management philosophy, especially in public services. A prescriptive or mainstream literature suggests that lean is rapidly diffusing into ...public sector environments, providing a much-needed rethink of traditional ways of working and stimulating performance improvements. Our study of the introduction of lean in a large UK public sector hospital challenges this argument. Based on a three-year ethnographic study of how employees make sense of lean ‘adoption’, we describe a process in which lean ideas were initially championed, later diluted and ultimately eroded. While initially functioning as a ‘mechanism of hope’ (Brunsson, 2006) around which legitimacy could be generated for tackling longstanding work problems, over time both ‘sellers’ and ‘buyers’ of the concept mobilized lean in ambiguous ways, to the extent that the notion was rendered somewhat meaningless. Ultimately, our analysis rejects current prescriptive or managerialist discourses on lean while offering support for prior positions that would explain such management fashions in terms of the ‘life cycle of a fad’.
Mannion and Davies' article recognises whistleblowing as an important means of identifying quality and safety issues in healthcare organisations. While 'voice' is a useful lens through which to ...examine whistleblowing, it also obscures a shifting pattern of uncertain 'truths.' By contextualising cultures which support or impede whislteblowing at an organisational level, two issues are overlooked; the power of wider institutional interests to silence those who might raise the alarm and changing ideas about what constitutes adequate care. A broader contextualisation of whistleblowing might illuminate further facets of this multi-dimensional problem.
Based on case studies in 12 nursing homes in the United Kingdom, the authors illustrate how financial cutbacks affect job quality and the quality of care. The dimensions of job quality that suffered ...most were those directly related to the ability of workers to provide care: reductions in staffing, longer working hours, and work intensification. Cuts to labor costs eroded the quality of workers’ jobs in all 12 homes but with two differential outcomes: in seven homes, care quality was maintained, and in five homes, it deteriorated. Care quality was maintained in homes where a patient-centered care approach and remaining job quality allowed workers to develop work-arounds to protect residents from spillover effects. Care quality declined in homes where custodial approaches to care and low job quality did not provide workers the time or resources to protect residents or to maintain prior levels of care. A tipping point was reached, leading to a spillover into impoverished care.
Delivery of end‐of‐life care has gained prominence in the UK, driven by a focus upon the importance of patient choice. In practice choice is influenced by several factors, including the guidance and ...conduct of healthcare professionals, their different understandings of what constitutes ‘a good death’, and contested ideas of who is best placed to deliver this. We argue that the attempt to elicit and respond to patient choice is shaped in practice by a struggle between distinct ‘institutional logics’. Drawing on qualitative data from a two‐part study, we examine the tensions between different professional and organisational logics in the delivery of end‐of‐life care. Three broad clusters of logics are identified: finance, patient choice and professional authority. We find that the logic of finance shapes the meaning and practice of ‘choice’, intersecting with the logic of professional authority in order to shape choices that are in the ‘best interest’ of the patient. Different groups might be able to draw upon alternative forms of professionalism, and through these enact different versions of choice. However, this can resemble a struggle for ownership of patients at the end of life, and therefore, reinforce a conventional script of professional authority.
Managing Modern Healthcare Bresnen, Michael; Hodgson, Damian; Bailey, Simon ...
2017, 20170210, 2017-02-10, Letnik:
2
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Managing Modern Healthcare seeks to draw a number of important and grounded lessons about how management networks develop and influence the spread of management knowledge and practice; how management ...training and development relates to the needs of managers facing challenging conditions; and how those conditions are shaping the nature of healthcare management.
Critical approaches to leadership studies have sought to challenge the normative position of leadership as residing solely within the formal leader and have gone as far as to undermine the ...traditionally held assumption of leadership as a ""real"" phenomenon.
The book offers a critical account of the nature of leadership and management in modern organizations. Specifically it examines the forces that affect the influence relationships between leaders and followers in public sector organizational settings and thus, how these relationships inform social influence processes. Although the book focuses on the case of a public sector organization in the UK, the findings are placed in the context of both leadership theory and research across the globe and the dissemination of 'new public management' worldwide.
By acknowledging the criticisms concerning the weaknesses of conventional or mainstream leadership study and through the adoption of a critical perspective, Critical Leadership provides a deep and rich interpretation of the empirical material on leadership, thus making an outstanding contribution to the current literature."
The article examines the escalation of commitment to failing strategies from a psychodynamic perspective as an affective process connecting organizational, systemic and individual levels. We propose ...a theory of organizational blind spots to explain how such escalation of commitment occurs. Blind spots develop as an organizational defence mechanism for coping with problems resulting from attempts to implement unrealistic strategy or policy goals. Unrealistic strategic aims mobilize and reinforce blind spots through processes of splitting, blame and idealization, thus enabling organizations to persist with unsuccessful courses of action. Organizational blind spots arise when leadership and/or operational members in organizations are unable to acknowledge unworkable strategies. Vignettes from the National Health Service in England (the NHS) are used to illustrate how blind spots sustain an illusory possibility of success while commitment to a failing strategy escalates. The theory of blind spots offers a novel social-psychological approach to understanding how these dysfunctions of strategy develop and become institutionalized, putting organizations in jeopardy and threatening their survival.
Despite the increasing deployment of formalized boundary spanning roles and practices, the mechanisms and dynamics of their legitimation remain under-explored. Using the Bourdieusian lens, we ...theorize legitimation of boundary spanning as accumulation, mobilization and conversion of several forms of capital unfolding in a configuration of intersecting fields. Drawing on a qualitative longitudinal case study of a collaborative partnership between a university and healthcare organizations, we describe changes in the structure, sources and mutual convertibility of capital assets over time. We also analyse the implications of this evolution for the relationships between the intersecting fields and the social trajectory of boundary spanners. We argue that legitimation of boundary spanning roles and practices is a highly transformative, collective and political process that increases the capital endowments and authority of individual boundary spanning agents but may lead to the erosion of the very same roles and practices that were being legitimized.
While hybrid managers are increasingly important in contemporary organizations (especially in the public sector), we know little about why or how they become hybrid managers, or how this is shaped by ...the interplay of professional experience and organizational circumstances. In pursuit of a more variegated, contextualized and dynamic understanding of hybrid management, this article focuses on how individuals transition into managerial hybrids, emphasizing the dynamic and emergent nature of hybrid management identity. Studying managers in English healthcare, we employ the concept of identity work as expressed through career narratives to examine the influence of career trajectories and organizational experiences on emerging hybrid manager identity. The study identifies three broad managerial career narratives – aspirational, ambivalent and agnostic – and relates them to experiences of doctor and nurse hybrid managers in three healthcare settings. An interpretive analysis of these narratives reveals a more variegated, situated and dynamic interpretation of hybrid managerial identities than previously considered and underscores the importance of personal and organizational experiences in shaping emergent hybrid professional/managerial identity.
For the United Kingdom, the 2008 financial crisis coupled with the subsequent economic austerity programme forced many public institutions to engage in various cost-cutting and fundraising ventures. ...In parallel, corporate ideologies came to dominate how academics, officials and professionals debated public activities, in turn profoundly affecting the provision of communal services. This paper explores how ‘corporate colonization’ (sensu Deetz, 1992), fuelled by austerity, claims public institutions for commercial interests. Drawing on in-depth interviews with senior staff, this paper demonstrates how retrenchment of external support in the UK museum sector has been an uneven process, resulting in the manifestation of three experiential states of corporate colonization: organizational perennity, organizational perseverance and organizational precarity. We thus investigate the differential and uneven ways in which corporate colonization affects organizations pertaining to the UK cultural sector. Overall, we argue that the austerity culture in the UK affects museums in largely negative ways by forcing them to respond to the progressive need to satisfy short-term financial interests.
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