Management changes in the National Health Service : nursing and organisational theory in relation to the development of a new unit of health care.

This thesis gives an account of research into management
changes in the English NHS following the implementation of
the Griffiths' Report (1983). The research had three aims:
1. To describe and consider the effects of new management
philosophies plans and practices by conducting a case
study of one particular unit of health care.
2. To study theories of nursing and health care
organisation.
3. To assess the relationship, if any, between experience
and theory, suggesting ways to bring theory and
practice closer together.
The academic perspective is multidisciplinary, drawing on
literature from nursing, organisational 'theory and
behaviour, health service management, social science,
philosophy, history, economics and policy studies.
The thesis commences with a discussion of research
methodology, arguing the appropriateness of an interpretive
stance. An account of the development of the NHS and
nursing's place within it is followed by a detailed case
study of one unit, which lasted nine months and involved
more than a hundred interviews. Particular characteristics
of the case study are:-
Data analysis utilising grounded theory methodology
Inclusion of members of the organisational context
A system for participants to validate data pertaining
to themselves.
The style is naturalistic, qualitative and processual.
Presentation of the results recognises the existence of
multiple interpretations of organisational reality; a
metaphor likens the development of the Unit to the weaving
of a tapestry, where the backing is the structure of the
unit, and the pattern the perceptions, values and
aspirations of its staff, patients and context members.
Emerging themes in the thesis are:-
the complexity of the NHS
professional philosophies and their relationship to
management
organising as a process
growth of a distinctive unit culture.
A deliberate choice is made to expose the conflicts and
difficulties of naturalistic inquiry, by reflecting on
research method throughout the thesis, which is written in
the first person.