This essay will discuss and analyse the main issues that faced the South Glamorgan NHS district in the mid 80’s. The essay will specifically deal with the management of change with in the district due to the implementation of the Griffiths Report that aimed “to produce a more efficient and effective delivery of health care services.” (D. Cowler: 1993: pg177) The essay will then use applicable organizational theories to analyse the change in management structure and its effectiveness in changing roles, culture, politics and power bases within the organisation.
The main aim of the Griffith report was to create a “managerial revolution within the NHS.” (D. Cowler: 1993: pg177) This was proposed by changing from consensus management that was deemed to “lack any kind of managerial direction or control,” to line management which “would give overall executive authority for decision making at all levels of the NHS.” (D. Cowler: 1993: pg177) The introduction of line mangers created a more functional system of management within the NHS. The introduction of an increasingly Taylorist system of management that established control over NHS staff made sure “that all management’s policy decisions could be implemented.” (Huczynski and Buchanan: 2004: pg. 430)
The aim of the new management structure was to create increased control over the NHS staff so that “increased cost-consciousness” and a “corporate approach” could be implemented. (D. Cowler: 1993: pg180) This control was to be achieved by two of Hellreig and Slocum’s management strategies. These included a change in organizational structure that would change “the specification of communication flows and the location of decision making responsibility,” as well as a change in budgetary control (Huczynski and Buchanan: 2004: pg. 828) This resulted in moving control bases away from nurses, clinicians and administrators and toward UGMs and DGMs.
If we use Burns and Stalker’s definitions of organisational structure, we can assess that with a reduction in consensus management and increase in line management, the organisation became more “mechanist” and less “organic.” This meant that, as mechanist line management was introduced, “Decision making became centralised.” (Huczynski and Buchanan: 2004: pg. 527) This new system of organisation was designed to lead to specific “control over resource allocation.” (D. Cowler: 1993: pg178) This lead to more “effective control over costs” (D. Cowler: 1993: pg180)
The creation of a more functional management system was designed to change the culture of the NHS. Pre Griffiths, due to consensus management, a “Task Culture” existed which is defined by Handy and Harrison as; “Having an emphasis on getting things done” which is important in the context of the NHS where decisions need to be changed into actions quickly in order to care for patients. (Source: http://www.brunel.ac.uk/~bustcfj/bola/culture/harrison.htm) However, Hardy and Harrison also acknowledge that “economies of scale are harder to realise” in a Task culture meaning that budgets are hard to control. (Source: http://www.brunel.ac.uk/~bustcfj/bola/culture/harrison.htm)
Post Griffith a role culture was supposed to have formed. Hardy and Harrison comment that a role culture “works by logic and rationality” and “economies of scale are easier to control.” (Source: http://www.brunel.ac.uk/~bustcfj/bola/culture/harrison.htm) However Hardy and Harrison point out that a role culture is only useful if “economies of scale are more important than flexibility or technical expertise.” (Source: http://www.brunel.ac.uk/~bustcfj/bola/culture/harrison.htm) It would seem then that a role culture is not well suited to the NHS due to the fact that the basic assumption of the NHS is health care, which is based upon the technical expertise of clinicians.
The cultural theorist Shein states, “culture is the sharing of basic assumptions in an organisation.” (Huczynski and Buchanan: 2004: pg. 644) Shein then adds that basic assumptions are “taken for granted in an organisation” and go to make up the “values” of an organisation. (Huczynski and Buchanan: 2004: pg. 650) Therefore, health care is clearly a basic assumption of the NHS and an important cultural value. It may then be assessed that this clash of basic values between the newly imposed role culture of management and the existing basic assumptions of the NHS was one of the reasons that conflict arose between those trying to impose management and existing NHS staff. This even led some clinicians to claim, “Medicine and management were incompatible.” (D. Cowler: 1993: pg181)
It is described in the report on South Glam by M. Reed P. Anthony that “the tensions and conflicts of different occupational and professional based interest groups had intensified to the extent that they were more fragmented than they had been post Griffiths arrangement.” (D. Cowler: 1993: pg. 186) The reasons for the conflict between the groups were different for each sub cultural strand of the NHS, whether the groups where clinicians, nurses, management or administrators. Pfeffer, a well known organisational theorist, describes that this “differing of goals between groups in an organisation is one of the main causes of conflict in an organisation.” (Huczynski and Buchanan: 2004: pg.852)
The most blatant conflict came between the doctors and the new management of Unit and District managers. As M. Reed and P. Anthony state, “clinicians were mostly hostile to the changes that were being introduced.” (D. Cowler: 1993: pg. 181) The doctors would loose power in the new management system. This was because “the changes the DGM and UGM were implementing were a direct threat to the their (the doctors) professionally based control continuing.” (D. Cowler: 1993: pg. 182)
In a Task culture (pre Griffith) the doctors were as, Hardy and Harrison state, “part of a team” who were “operating together to deliver a project.” (Source: http://www.brunel.ac.uk/~bustcfj/bola/culture/harrison.htm) The doctors were in a powerful position because, as Hardy and Harrison state, “task culture is based on expert power with some personal and positional power.” (Source: http://www.brunel.ac.uk/~bustcfj/bola/culture/harrison.htm) French and Raven state that expert power can be defined as “the ability of a leader to exert influence based on the belief of followers that the leader has superior knowledge relevant to the situation to the task in hand.” (Huczynski and Buchanan: 2004: pg. 650)
As the core value of the NHS is health care and the treatment of patients, then it is clear that a doctor’s formal training and qualifications give the doctor power over other NHS staff when it comes to clinical decisions. The doctor also has positional/ legitimate power which is defined as “the ability to exert power by use of authority.” (Huczynski and Buchanan: 2004: pg. 650) This is because of a Doctor’s formal title and position in the NHS that is considered key to health care. Therefore the doctors could use their power to influence others within the role culture. This satisfies Huczynski and Buchanan’s definition of power that states, “Power is the capacity of individuals to exert their power will and produce results consistent with their objectives.” (Huczynski and Buchanan: 2004: pg. 828)
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