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Disappointment is common in many organizations. Yet little is known about how individuals' talk about their workplace disappointment shapes their identification with organizations. We conducted an analysis of 104 academics in a prestigious British university to make two contributions to our understanding of the discursive constitution of organizational identification (OID). First, we show how individuals used different types of disappointment-talk to narrate and respond to identification dilemmas in distinct ways. Our findings extend existing research by showing that discourses of emotion do not simply delimit agency but also enable individuals to resist and reject organizational discourses that attempt to anchor them to specific identity positions. Second, we identify a novel way in which individuals can configure the multiple discourses that can be in tension and generate disappointment – unravelling. Here, individuals draw upon one among the multiple discourses in conflict (in our case, prestige) to 'unravel' the knotting between the various discourses that constituted their OID dilemmas. We also consider the implications of our study for academic labour in universities. [ABSTRACT FROM AUTHOR]

Background: Health care professionals face greater uncertainty in their careers as traditional jobs wither and new, organizationally controlled jobs proliferate, reducing economic security and professional autonomy. Purpose: We apply psychological contract and self-efficacy theory to examine the career agency of early-career physicians. We ask the following: (a) What are the unfulfilled expectations and emotions experienced by young physicians at the training and early career stages? (b) What are the forms of career agency exhibited by young physicians in response to unfulfillment? Methodology: We conducted a study on 48 U.K. early-career primary care physicians, known as general practitioners. The sample comprised both trainees as well as newly qualified physicians. Data were collected through in-depth interviews and focus group discussions. Results: Physicians interpreted their early-career experiences based on predominantly ideological expectations around what it means to be a successful professional. However, the realities of practice resulted in highly emotional experiences of violation that were associated with a "reactive" agency and job behaviors that were more transactional and less relational. Conclusion: This study identifies the expectations of early career professionals, which helps understand how and why psychological contract violations occur. It also expands the conceptualization of career agency from a positively framed aspect of professional behavior to one that includes haphazard and self-serving elements. Practice Implications: Our study highlights several implications of the shifts in physician career agency for primary care practice. It discusses the potential effects of the purposeful self-interest among doctors on professional identity and power, as well as patient care. [ABSTRACT FROM AUTHOR]

Objectives: Improving patient experience is widely regarded as a key component of health care quality. However, while a considerable amount of data are collected about patient experience, there are concerns this information is not always used to improve care. This study explored whether and how frontline staff use patient experience data for service improvement. Methods: We conducted a year-long ethnographic case study evaluation, including 299 hours of observations and 95 interviews, of how frontline staff in six medical wards at different hospital sites in the United Kingdom used patient experience data for improvement. Results: In every site, staff undertook quality improvement projects using a range of data sources. Teams of health care practitioners and ancillary staff engaged collectively in a process of sense-making using formal and informal sources of patient experience data. While survey data were popular, 'soft' intelligence – such as patients' stories, informal comments and observations – also informed staff's improvement plans, without always being recognized as data. Teams with staff from different professional backgrounds and grades tended to make more progress than less diverse teams, being able to draw on a wider net of practical, organizational and social resources, support and skills, which we describe as team-based capital. Conclusions: Organizational recognition, or rejection, of specific forms of patient experience intelligence as 'data' affects whether staff feel the data are actionable. Teams combining a diverse range of staff generated higher levels of 'team-based capital' for quality improvement than those adopting a single disciplinary approach. This may be a key mechanism for achieving person-centred improvement in health care. [ABSTRACT FROM AUTHOR]

Background: Changing health care systems depend on strong organizational leadership that realizes the collaborative potential of both physician and nonphysician leaders. Purpose: The aim of this study was to seek insight into the everyday health care leader experience by examining 24 physician and nonphysician leaders working in the U.K. National Health Service. We explored (a) how they make sense of and act with respect to specific collaborative tensions in their interactions and (b) which aspects of their everyday leadership contexts heighten the probability for producing and resolving such tensions. Methodology: We conducted 24 in-depth interviews with physician and nonphysician leaders in job titles including Chief Operating Officer, Managing Director, Medical Director, and Clinical Director. Ideas from the social psychological perspectives of sensemaking, organizational role theory, and organizational citizenship behavior helped frame the study. Results: We identified four areas of ongoing tension between senior leaders. Each of these was linked to a set of underlying drivers, with the strongest support for drivers with interpersonal roots. Effective strategies for resolving tensions involved significant effort by leaders at improving the interpersonal dynamics associated with everyday interaction and forging relational connections through enhanced trust within the leadership team. Conclusion: This study outlines the organizational and individual characteristics that lend to effective collaboration among senior health care leadership and the types of collaborative tensions likely to be experienced by senior health care leaders. Practice Implications: Organizations should provide greater role clarity for senior leadership roles, promote "soft" interpersonal competencies within them, and better assess potential leaders for success in senior roles. Organizational support in the form of facilitation, time, and spaces to learn together can provide a better context for collaborative decision-making. [ABSTRACT FROM AUTHOR]

The objective of this study was to identify staff perceptions of a service improvement for pediatric emergency care at a university teaching hospital. Semistructured qualitative interviews of stakeholders were conducted, and grounded theory approach was used for analysis. Forty-one interviews were conducted with physicians, nurses, managers, and health care workers. Major themes emerging from the analysis included the physical space of and flow within the pediatric emergency department (ED), impact of technology, staffing in the ED, the effects of frontline pediatricians and emergency physicians managing children in the ED, and the need for and expectations of a pediatric emergency medicine (PEM) consultant. Human interactions among health care providers, leadership, and teaching are considered as equally important as providing the appropriate environment and qualified professionals for improving care for children in the ED. Appointment of a PEM consultant was suggested to provide leadership and education to manage relationships and implement changes. Subsequent to the study, the model of care for PEM was changed, the pediatric care delivery became more integrated with the main ED, and two PEM consultants were appointed to the institution. [ABSTRACT FROM AUTHOR]

The last two decades have seen a shift in public services organizations from hierarchies to networks. Network forms are seen as particularly suited to handling 'wicked problems'. We make an assessment of the nature and impact of this shift. Using recent evidence from the United Kingdom (UK) National Health Service (NHS), we explore the nature and functioning of eight different public policy networks. We are also interested in whether there has been a radical transition - or not - from hierarchical to network forms. [ABSTRACT FROM AUTHOR]

We examine a multidisciplinary network established to translate genetics science into practice in the British NHS. Drawing on theory about epistemic communities and objects, we describe three stages in their lifecycle (vision/formation, transformation and reincarnation) and epistemic clashes over knowledge objects. Medical academics captured jurisdiction over the network at formation, through their superior knowledge of the nascent genetics discipline, producing epistemic objects reflecting their interests. A governmental community challenged medical academics for jurisdiction but, unable to transform objects by changing their space of representation in performance reporting, ceased funding the network, which then closed. Afterwards, however, a NHS community successfully ‘reincarnated’ a discarded epistemic object into a technical object in NHS practice. We make a theoretical contribution by developing a processual framework for understanding biomedical innovation, focusing on transforming objects situated between different wider knowledge/power structures. This explains how objects were transformed at micro-level through the interaction and relative power of local communities, influenced by macro-level rules about knowledge formation in wider epistemic, organizational and governmental communities. [ABSTRACT FROM AUTHOR]

Health systems internationally have developed policies to support evidence-based health care (EBHC) for over a decade. As this article shows, the time is ripe to review current policy frameworks in an evidence-based manner. We summarize key themes deriving from qualitative research on the UK EBHC implementation and draw out implications for policy renewal. Our diagnosis is different from current UK NHS (National Health Service) policy since we stress local capacity building rather than top-down frameworks, standardized tools and guidelines. As other jurisdictions demonstrate alternative EBHC policy frameworks, more international comparison and mutual learning is needed. [ABSTRACT FROM AUTHOR]

This article explores the commissioning process introduced into the NHS in 1991. Its purpose is to consider the relevance of this experience for future commissioning structures. In particular the implementation of Changing Childbirth (Department of Health 1993) is discussed as an illustration of the commissioning process in action. The article is informed by empirical data gathered from four research sites within the NHS. [ABSTRACT FROM AUTHOR]

Investigates the role of opinion leaders in the improvement of clinical effectiveness in Great Britain. Government-funded initiatives exploring the transfer of research evidence into clinical practice; Interaction between opinion leaders and the collective process of negotiating a change; Different types of opinion leadership.

Although health and social care workforces are heavily professionalized, the mainstream human resource management literature has been slow to engage with debates in the field of organizational studies on this distinctive group of employees. This lacuna is addressed by focusing on how the search for more flexible working practices in care services has affected the professions and especially their relationship with their assistant coworkers. The character of this relationship is seen as contingent on the logic of professionalization, in turn based on different notions of expertise, with implications for the allocation of tasks. The article distinguishes between a specialist expertise, encouraging the profession to discard routine tasks, and a holistic expertise, nurturing the hoarding of tasks. This distinction is used to explore the nurse professional project in Britain, a critical case where the statutory regulation of the nursing workforce has remained relatively weak. While noting shifts over the years in the British nursing professions' adherence to these two logics, workplace data on the nurse-health care assistant relationship reveal a fragmented pattern of nursing work consistent with a specialist-discard logic, albeit underpinned by a residual ambiguity among nurses about their preferred professional logic. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

This article reports on a two-year, multi-method, qualitative study in two regional offices in the UK National Health Service of the changing role of the regional tier from the autumn of 1994. The nature of the changes from fourteen semi-autonomous regional health authorities to eight regional offices of the NHS Executive, whose staff became civil servants, are described together with the way this reorganization changed the role and relationships of NHS Executive HQ, the regional offices and the field. By the end of our research in the autumn of 1996, the change from regional health authority to regional office had gone well in the two regional offices studied; they had become smaller organizations, had established closer working with HQ and believed they had more influence over policy, while retaining good relations with health authorities. Emerging issues from the changes and some of their implications are discussed, particularly the pressures towards greater centralization and the particular forms that these have taken, despite the aim, and in part the achievement, of greater devolution, and the cultural differences between the NHS and the civil service. We conclude by assessing what the future holds for regional offices, in the light of the recent NHS White Paper (Secretary of State for Health 1997). [ABSTRACT FROM AUTHOR]

This article examines the changing nature of the central organization of the NHS and its relations with the field. It is based on a two-year tracer study of regional health authorities (RHAs) as they were reorganized into regional offices (ROs) and became part of the civil service. The research evidence suggests that the centre of the NHS cannot be treated as one organization; the wider Department of Health, NHS Executive HQ and regional offices have distinct Identities within it. The analysis thereto re looks at relations between these different components of the centre, and between them and the field. The significance of the recent White Paper for the future of regional offices is discussed, with particular emphasis on the tension between centralization and decentralization in performance management, and the opportunity to rebuild strategic coordination, which has been difficult to maintain under the internal market. [ABSTRACT FROM AUTHOR]

Reviews the past role of regional health authorities in the British National Health Service (NHS). Changes to regions associated with the functions and responsibilities paper; Problems of influence and control in a national service operating in a devolved quasi-market; Finance, public health, and research and development; Trust monitoring.

The translation of research into practice is currently a high-profile issue in the NHS. A number of regions have undertaken work in this area. Reports on a project that is part of the Anglia and Oxford Regions's "Getting Research into Practice" (GRiP) initiative. The work focuses on the use of steroids in pre-term delivery, a procedure that medical evidence suggests can reduce neo-natal mortality and morbidity. Presents a number of findings which suggest that getting research into practice does not merely rest on the availability of well-researched evidence. [ABSTRACT FROM AUTHOR]

Using the Care Programme Approach (CPA) as an example, this article examines the difficulties of implementing change within the National Health Service (NHS). A framework is suggested which aims to clarify the nature of change by distinguishing where, when and how decisions are made. It is argued that structural change in the NHS and the related emergence of new institutions, systems, relationships and operational principles, have generated new uncertainties and ambiguities. A fuller appreciation of how the decision-making process operates is necessary to an understanding of how different policy objectives are pursued. [ABSTRACT FROM AUTHOR]

This article considers the move to Agency status in HMSO. A detailed account is given of developments in HMSO over three years, as well as the reactions of a group of middle managers to those changes. [ABSTRACT FROM AUTHOR]

Presents information on a study, which examined how middle managers in the United Kingdom are affected by organizational change, citing their reactions to their changing working lives. Effects of total quality management on middle managers; Information on middle managers' expectations of their roles and responsibilities; Identification of five elements which contain both individual roles and responsibilities of organizational demands for middle managers.

For many years middle managers' work, career and future role have been the subject of gloomy descriptions, assertions and predictions. These are described and compared with studies, including our own, that give a more optimistic picture of what is happening to middle management. We also cite survey information about numbers, salaries and job mobility of UK managers, including middle managers. We argue that before generalizations, either optimistic or pessimistic, can justifiably be made, attention needs to be paid to the complexity of changes affecting middle managers' jobs, to the diversity of organizations in which middle management work and the complexity of individual reactions to these changes. [ABSTRACT FROM AUTHOR]

Health services can and should be improved by applying research findings about good practice, yet it is notoriously difficult to implement research evidence in the face of strong professional views and complex organizational contexts. For the past several years, evidence-based health care has been viewed by many policy-makers, managers and clinicians as an important lever to ensure clinical practice is more effective and represents value for money. UK research policy has sought to increase the number of patients enrolled in randomized controlled trials (RCTs); new synthesizing institutions (such as the National Institute of Clinical Excellence) have been set up to distil the knowledge base and make recommendations as to whether new treatments are clinically and cost effective and UK national service frameworks have facilitated nationally-consistent sets of guidelines with potential for health care. An essentially topdown, formalized approach has been taken to knowledge transfer. But does behaviour really change in front-line clinical practice in response to activity ‘from above’” How is evidence put into practice, if at all, at the individual and small group levels. These are issues that I and colleagues have been working on for the past six years. Dopson and FitzGerald (2005) provides an overview of a related set of seven qualitative case studies of evidence-based innovations in the UK NHS. The data consists of a set of 48 cases and 1400 semi-structured interviews with a range of clinical and managerial respondents, as well as telephone interviews, written questionnaires and documentary analysis.

Purpose: Hospital mergers are common in the United Kingdom and internationally. However, mergers rarely achieve their intended benefits and are often damaging. This study builds on existing literature by presenting a case study evaluating a merger of two hospitals in Oxford, United Kingdom with three distinct characteristics: merger between two university hospitals, merger between a generalist and specialist hospital and merger between two hospitals of differing size. In doing so, the study draws practical lessons for other healthcare organisations., Design/methodology/approach: Mixed-methods single-case evaluation. Qualitative data from 19 individual interviews and three focus groups were analysed thematically, using constant comparison to synthesise and interpret findings. Qualitative data were triangulated with quantitative clinical and financial data. To maximise research value, the study was co-created with practitioners., Findings: The merger was a relative success with mixed improvement in clinical performance and strong improvement in financial and organisational performance. The merged organisation received an improved inspection rating, became debt-free and achieved Foundation Trust status. The study draws six lessons relating to the contingencies that can make mergers a success: (1) Develop a strong clinical rationale, (2) Communicate the change strategy widely and early, (3) Increase engagement and collaboration at all levels, (4) Be transparent and realistic about the costs and benefits, (5) Be sensitive to the feelings of the other organisation and (6) Integrate different organizational cultures effectively., Originality/value: This case study provides empirical evidence on the outcome of merger in a university hospital setting. Despite the relatively positive outcome, there is no strong evidence that the benefits could not have been achieved without merger. Given that mergers remain prevalent worldwide, the practical lessons might be useful for other healthcare organisations considering merger., (© Emerald Publishing Limited.)