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Culture and climate in health organisations
Edited by P. Hyde, J. Braithwaite and A. Fitzgerald
Introduction and background
This paper contributes to the development of a critical pedagogy in healthcare management development. Much of the work associated with critical management studies (CMS) has ignored the health sector. The British National Health Service (NHS) has its own management development training programmes and universities have designed various postgraduate programmes. However, these tend to reinforce a managerialist culture and performance orientation. Is it possible to consider health service management development from a critical perspective, and if so, what are the implications for managers and the NHS?
The NHS has been subjected to considerable change since its inception in 1948, and [19] Handy (1976, p. 67) asks "So you want to change your organization? Then first identify its culture."
There has been considerable focus on organizational culture in the NHS. [25] Mannion et al. (2007) review how organizational culture in the NHS has evolved. An important change was the introduction of general management, following the Griffiths Report, in an attempt to introduce greater financial accountability and shift power and control of resource allocation from medical professionals to managers. Associated developments included the introduction of the internal market, a move towards a competitive business culture ([9] Davies and Mannion, 2000), and a focus on quality and performance improvement ([17] Goddard and Mannion, 1998).
Central to "achieving meaningful and sustainable quality improvements in the NHS requires a fundamental shift in culture ... to enable and empower those who work in the NHS to improve quality locally", (paragraph 5.6, [10] DoH, 1998). Following the tragic events at the Bristol Royal Infirmary, the [20] Kennedy (2001) Public Inquiry concluded that there were inadequacies in management and a prevailing "club culture" ([19] Handy, 1976), which afforded senior managers excessive power and fostered "a climate where dysfunctional behaviour and malpractice were not effectively challenged" ([25] Mannion et al. , 2007, p. 10). This drew greater attention to the NHS culture and Kennedy identified the need to transform the NHS. In response, the NHS Plan ([11] DoH, 2000) was a package of reforms to shift the balance of power to patients and frontline NHS employees, by empowering staff to develop innovative services, empowering patients to...