Rhetorical organizations of defense in primary care

The sustained movement towards a more primary health care led National Health Service in the UK has involved individuals and organizations developing more effective ways of working. This has resulted in changes to the structure and functioning of primary care organizations, the development of new workers and, in some instances, handing over work to other health and social care agencies. These changes have contributed to what for many staff is a turbulent organizational and practice environment. Data from a 3-year project, commissioned by the North West Development Agency, is used to explore how staff involved in these changes dealt with this turbulence; 350 staff working within 18 Primary Care Trusts participated in the study. A multi-methods approach was used which facilitated an iterative analysis and data collection process. Thematic analysis revealed a high degree of congruence between the perceptions of all staff groups with evidence of a generally well-articulated, but often rhetorical view of the organizational and professional factors involved in the changes experienced. This rhetoric was used by individuals as a defense mechanism in dealing with the turbulence of change. The article discusses how these defense mechanisms need to be recognized and understood by managers so that a more supportive organizational culture is developed.