Edward Granter

Casting the lean spell: The promotion, dilution and erosion of lean management in the NHS:

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’.

Extreme Work / Normal Work: Intensification, storytelling and hypermediation in the (re)construction of ‘the new normal’

The label ‘extreme’ has traditionally been used to describe out-of-the-ordinary and quasi-deviant leisure subcultures which aim at an escape from commercialized and over-rationalized modernity or for occupations involving high risk, exposure to ‘dirty work’ and a threat to life (such as military, healthcare or policing). In recent years, however, the notion of ‘extreme’ is starting to define more ‘normal’ and mainstream realms of work and organization. Even in occupations not known for intense, dirty or risky work tasks, there is a growing sense in which ‘normal’ workplaces are becoming ‘extreme’, especially in relation to work intensity, long-hours cultures and the normalizing of extreme work behaviours and cultures. This article explores extreme work via a broader discussion of related notions of ‘edgework’ and ‘extreme jobs’ and suggests two main reasons why extremity is moving into everyday organizational domains; the first relates to the acceleration and intensification of work conditions and the second to the hypermediation of, and increased appetite for, extreme storytelling. Definitions of extreme and normal remain socially constructed and widely contested, but as social and organizational realities take on ever more extreme features, we argue that theoretical and scholarly engagement with the extreme is both relevant and timely.

The lost health service tribe: In search of middle managers

This chapter suggests potential consequences for the NHS of widespread denigration of middle management. It is based on ethnographic research in the UK NHS. In 1994 Tony Watson published In search of management, continuing an academic preoccupation with elaborating the lived experience of being a manager. This chapter derives from the opening phases of a study in this tradition. He argued that managers, in shaping their own identities, also shaped organisational work activities and we extend this argument to demonstrate that negative associations to middle managerial identity have the potential to allow for strategic gaps in co-ordination at the middle reaches of NHS organisations as managers have to handle increasingly complex, fluid and heavy workloads, while facing daily challenges from other NHS stakeholders.

Teaching the Crisis: A Primer:

In this article, we provide a ‘road map’ for teaching the global economic crisis (the Crisis hereafter) sociologically, using Kindleberger’s schema of financial crises. The causes of the Crisis are often associated with financial and economic technicalities, and we provide readers who are unfamiliar with the jargon of Collateralized Debt Obligations and Credit Default Swaps with a summary of the role played by these and other financial products. We seek to situate technical finance within the sociological frame of reference, where rationality and reality are areas of contention, rather than mathematical certainty. The article seeks, throughout, to foreground the social processes behind the credit bubble which burst in 2007. We argue for an understanding of the Crisis which takes into account the social totality, taking in culture, ideology and discourse, as well as political economy.

Exploring health work: a critical-action perspective

Purpose The purpose of this paper is to describe a hybrid approach to the research developed during a multi-researcher, ethnographic study of NHS management in the UK. Design/methodology/approach This methodological paper elaborates a hybrid approach to the sociological analysis - the critical-action theory - and indicates how it can contribute to the critical health management studies. Findings After exploring the various theoretical, methodological and philosophical options available, the paper discusses the main research issues that influenced the development of this perspective and the process by which the critical-action perspective was applied to the studies of managerial work in four health service sectors - acute hospitals, ambulance services, community services and mental healthcare. Research limitations/implications This methodological perspective enabled a critical analysis of health service organisation that considered macro, meso and micro effects, in particular and in this case, how new public management drained power from clinicians through managerialist discourses and practices. Practical implications Healthcare organisations are often responding to the decisions that lie outside of their control and may have to enact changes that make little sense locally. In order to make sense of these effects, micro-, meso- and macro-level analyses are necessary. Originality/value The critical-action perspective is presented as an adjunct to traditional approaches that have been taken to the study of health service organisation and delivery.

Strictly Business: Critical Theory and the society of rackets

This article explores the parallels between organized crime – specifically racketeering – and the behaviour of corporate and political actors. It reviews the key literature which has developed around the concept of organized crime as business, and business as organized crime, and discusses the nature of rackets in historical and organizational context. The paper takes as its theoretical inspiration the Frankfurt School’s notion of a racket society, which Writers such as Adorno, Horkheimer and Kirchheimer developed as part of their Critical Theory of society. As such, it builds on a small but developing field of literature which applies theories of the racket society to contemporary contexts. In this case, the paper provides contemporary examples of racket like behaviour at the corporate/political nexus, and highlights the social harms associated with this.

Call for Papers—Special Issue for Organization

The purpose of this Special Issue of Organization is to explore the „taken for granted‟ norms of entrepreneurship scholarship as a whole including its ideologies, dominant assumptions, grand narratives, samples and methods. Even though entrepreneurship is a very diverse phenomenon that calls for divergence and multiplicity in understanding it, the majority of entrepreneurship research is still functionalist in nature (Jennings et al, 2005). There seems to be a normative assumption that entrepreneurship is a good thing and that „the more entrepreneurs the merrier‟ (cf. Weiskopf and Steyaert, 2009). Entrepreneurship has been increasingly eulogised in dominant neo-liberal policy discourses, infiltrating seemingly unrelated aspects of social life in potent, but seemingly innocuous ways (Armstrong, 2005) and few studies have aimed at „peeling away‟ these „layers of ideological obscuration‟ (Martin, 1990).

Multiple Dimensions of Work Intensity: Ambulance Work as Edgework

Working life in public sector professions is undergoing significant change and becoming increasingly demanding. This article explores work intensity in NHS ambulance services in England, describing four distinct but interrelated dimensions of intensity: temporal; physical; emotional; and organizational. We use the concept of edgework to explore the complexities involved in how emergency workers attempt to negotiate the rewards and risks associated with multidimensional work intensity. Although certain parts of ambulance work may be intrinsically intense and can provide an important source of validation, organizational elements have the potential to push work intensity to unnecessary extremes. Ambulance services are ‘professionalizing’, but as work in ambulance trusts continues to intensify, issues over dignity, staff retention and the meaning of work are becoming ever more challenging, just as they are in other public service professions.

Death and the Penguin: modularity, alienation and organising

ABSTRACT The originality of this paper lies in the ways in which it explores how the depiction of organised crime within Andrey Kurkov’s novel Death and the Penguin can inform our understanding of organisational modularity. This non-orthodox approach might open up new avenues of thought in the study of organisational modularity while further illustrating how novelistic worlds can inform accounts of organisational realities. Two main research questions underlie the paper. How can Andrey Kurkov’s novel further our understanding of the complexity of organisational worlds and realities by focusing our attention on different landscapes of organising? How does Kurkov’s novel help us grasp the concept of modularity by drawing attention to new forms of modular organisation? Drawing from our reading of Kurkov’s novel, we primarily explore organisational modularity through Kurkov’s depiction of organised crime and consider the themes of alienation and isolation in the context of modular organising.

What have NHS managers ever done for us

The image of the UK National Health Service manager has not always been positive. Like others in the public sector, NHS managers are sometimes associated in the media with waste and inefficiency, in contrast to those in ‘front line roles’. Thus healthcare professionals and members of the public might ask, in the tradition of Monty Python’s Life of Brian, what NHS managers have ever done for us. In this short article, we outline some of the evidence from the literature on attitudes to, and role of, healthcare managers, before drawing on our own interview and observation based fieldwork with managers themselves. We argue that the role of the healthcare manager is not always well understood, and that in a sector facing ever more intense and large scale organisational challenges, managers should be seen as important partners in a health service focused on clinical outcomes.