Ian Brooks

Leadership of a cultural change process

Explores the successful role of leadership in initiating and sustaining a major process of change. The findings build on the work of others who have so ably demonstrated the influence of powerful leaders. Research is based on qualitative data from an ethnographic study which immersed itself in the minutiae of organizational life. Outlines the processes that have unfolded in the wider context of NHS change. Discusses the findings and debates supporting evidence. The resultant model of change indicates that successful leadership of cultural change requires leaders to think culturally, to be guided by a cognitive model of change and to employ the cultural tools of symbolism while actively focusing on the politics of acceptance. Hard systems and structural changes can be implemented in parallel with soft symbolic and political activity. A highly receptive context, either real or created, assists by providing a trigger for change.

Managerialist Professionalism: The Destruction of a Non‐conforming Subculture

This paper explores the complex relationship between professionalism and managerialism in the National Health Service (NHS) in the UK and argues that professional aspiration now embraces the managerial paradigm. More specifically, it describes a subculture – that of permanent night nurses – which endures a schematic difference from the now dominant day nurse culture, and is in imminent danger of extinction. It is held in contempt by many nursing professionals and managers whose agendas converge to form the unified template which informs their action. It is suggested that night nurses, marginalized and powerless, are a subculture with distinct native-view characteristics. Ward-based, like their day colleagues, but separated by a temporal divide, permanent night nurses recognize their difference, largely reject the new managerialist professionalism, feel unappreciated and cling to their perceived camaraderie and close patient-relationships. This research explores the nature and origins of the new managerialist nursing profession and examines the basis of its claims of professionalism. The ethnographic methodology and research design are outlined and considerable data are presented. The paper draws upon the arguments of fellow professionals and managers who seek to deny the right of existence to this group. It is argued that ‘atrocity stories’ and other discourse, are evidence of evolving closure criteria, which exclude this apparently non-conforming subcultural group.

‘Doing Life’: Gender Relations in a Night Nursing Sub-Culture

This paper explores a night nursing sub-culture which is struggling to survive. The context is the NHS in the UK. This exclusively female group within an organization numerically dominated by women evokes hostile reactions from other cultural groups within the NHS, based on its perceived espousal of ‘female’ ways of being. Increasingly threatened by the new managerialism of the NHS, the permanent night shift faces extinction as a group. This paper describes the night nurse culture as it exists in a general hospital and offers some insights into the way that gender relations evolve to sustain male power in an organization where women are numerically dominant.

The lights are bright? Debating the future of the permanent night shift

Debates a controversial issue in healthcare management, that is, whether internal rotation (day-night) or permanent night shifts is an appropriate shift system for nursing staff. A multidisciplinary approach draws together international research from the fields of occupational psychology, management, ergonomics and medicine. Explores evidence on sleep, physical and mental health, job satisfaction, performance, absenteeism, and social and domestic disruption, all important factors in considering appropriate shift patterns. Suggests that both nurse choice (or non-choice) of shift and adjustment, or otherwise, of circadian rhythms are important causal factors influencing the debate. As no unequivocal picture emerges, recognizes some of the real and potential limitations of a paper of this kind; however, the balance of argument tends to favour the maintenance of permanent night shift nurses as opposed to the further extension of internal rotation systems. This is especially the case as many nurses will still be given a choice of shift pattern which may, in itself, negate some of the potential ill-effects of night working. Decisions further to extend internal rotation may, in the light of the complex, ambiguous and equivocal evidence, be informed by partial knowledge and influenced by a managerial perspective.

Managerial Problem Solving

Illustrates how organizational culture can stifle effective problem solving and decision making. In the organization in question this had critical implications for quality, staff retention and organizational change. The myopic, non‐innovative generation of apparent solutions to major organizational problems made the organization a victim, not a master, of change. Precedent determined action so that “more of the same” becomes the forte of the organization. Investigates the nature of the organizational culture and the mechanisms of influence it exerted over the problem‐solving process. The research utilized a qualitative methodology well suited to investigating organizational culture and was based in a civil service agency. Suggests an alternative, or model, culture, the adoption of which would enable the organization to cope with environmental and organizational change. Offers recommendations which derive from the research.

Using ritual to reduce barriers between sub‐cultures

Examines the potential for reducing the dysfunctional consequences of demarcation between work groups and professions in the NHS. Suggests that change may be achieved by interpreting and manipulating rituals which preserve the negative aspects of professional and work group autonomy. Discusses a number of rituals observed in a case study hospital during an extensive research exercise and demonstrates how they help maintain potentially dysfunctional culture norms and behaviours which, consciously or not, serve to resist moves to achieve more flexible, team-orientated, patient-centred changes. In addition, explores new rituals which may question current practices, and argues that attention to rituals in the wider change process may facilitate the desired change. Suggests that changes which confront unnecessary demarcation, but which do not undermine professional integrity, can create real benefits for NHS hospitals.

Call My Bluff: Multiple Interpretations of an Organizational Process

This paper attempts to illustrate the value of interpreting organizational processes from a variety of perspectives. It demonstrates that this approach reflects the natural richness of organization and avoids the rather blinkered search for single-paradigm explanations. It does not seek to offer the answer, but rather some possible insights. By combining both actor and researcher frames, it sheds light upon a particular process of social interaction within an organization. Both the context, an NHS trust hospital, and the content, a significant change scenario, brings richness and relevance to the debate. The paper outlines the macro and micro context before focusing on the interpretative methodological approach. The research involved collecting and analysing over thirty hours of taped, semi-structured interview discourse with senior and middle management and some junior staff. After describing the change initiative, an attempt at multi-skilling and the response of recipient actors to the proposals, the paper outlines three readings which seek to explain the events that occurred. The reader is invited to play the game ‘Call my Bluff’ and to choose the scenario that represents the most plausible explanation. The three interpretative frames employed are a managerial, a cultural and a political perspective. The paper concludes by raising some important issues in research, organizational change and the NHS.

Motivated teams: an inter‐cultural case

Explores a managerial philosophy which focusses on teamwork. Investigates how a simple yet sound belief in people takes shape on the ground and infiltrates all aspects of organizational activity. The context is a heavy truck assembly plant which is Swedish‐owned yet located in northern France. Outlines the novel processes of work organization employed in this complex multicultural setting. Although both European countries, Sweden and France, are, in key cultural terms, polar opposites, represents an example of a successful inter‐cultural business activity. Based on a series of semi‐structured interviews with senior management from both France and Sweden and considerable observation of activities on the shopfloor, looks at the nature of, and differences between, Swedish and French national cultures in an attempt to account for the success of the plant and the skill of its managers in overcoming potential cultural pitfalls and discusses the contributions made by each culture to the success story.