Post Griffith a role culture was supposed to have formed. Hardy and Harrison comment that a role culture “works by logic and rationality” and “economies of scale are easier to control.” (Source: ) However Hardy and Harrison point out that a role culture is only useful if “economies of scale are more important than flexibility or technical expertise.” (Source: ) It would seem then that a role culture is not well suited to the NHS due to the fact that the basic assumption of the NHS is health care, which is based upon the technical expertise of clinicians. The cultural theorist Shein states, “culture is the sharing of basic assumptions in an organisation.” (Huczynski and Buchanan: 2004: pg. 644) Shein then adds that basic assumptions are “taken for granted in an organisation” and go to make up the “values” of an organisation. (Huczynski and Buchanan: 2004: pg. 650) Therefore, health care is clearly a basic assumption of the NHS and an important cultural value. It may then be assessed that this clash of basic values between the newly imposed role culture of management and the existing basic assumptions of the NHS was one of the reasons that conflict arose between those trying to impose management and existing NHS staff. This even led some clinicians to claim, “Medicine and management were incompatible.” (D. Cowler: 1993: pg181)
It is described in the report on South Glam by M. Reed P. Anthony that “the tensions and conflicts of different occupational and professional based interest groups had intensified to the extent that they were more fragmented than they had been post Griffiths arrangement.” (D. Cowler: 1993: pg. 186) The reasons for the conflict between the groups were different for each sub cultural strand of the NHS, whether the groups where clinicians, nurses, management or administrators. Pfeffer, a well known organisational theorist, describes that this “differing of goals between groups in an organisation is one of the main causes of conflict in an organisation.” (Huczynski and Buchanan: 2004: pg.852)
The most blatant conflict came between the doctors and the new management of Unit and District managers. As M. Reed and P. Anthony state, “clinicians were mostly hostile to the changes that were being introduced.” (D. Cowler: 1993: pg. 181) The doctors would loose power in the new management system. This was because “the changes the DGM and UGM were implementing were a direct threat to the their (the doctors) professionally based control continuing.” (D. Cowler: 1993: pg. 182)
In a Task culture (pre Griffith) the doctors were as, Hardy and Harrison state, “part of a team” who were “operating together to deliver a project.” (Source: ) The doctors were in a powerful position because, as Hardy and Harrison state, “task culture is based on expert power with some personal and positional power.” (Source: ) French and Raven state that expert power can be defined as “the ability of a leader to exert influence based on the belief of followers that the leader has superior knowledge relevant to the situation to the task in hand.” (Huczynski and Buchanan: 2004: pg. 650) As the core value of the NHS is health care and the treatment of patients, then it is clear that a doctor’s formal training and qualifications give the doctor power over other NHS staff when it comes to clinical decisions. The doctor also has positional/ legitimate power which is defined as “the ability to exert power by use of authority.” (Huczynski and Buchanan: 2004: pg. 650) This is because of a Doctor’s formal title and position in the NHS that is considered key to health care. Therefore the doctors could use their power to influence others within the role culture. This satisfies Huczynski and Buchanan’s definition of power that states, “Power is the capacity of individuals to exert their power will and produce results consistent with their objectives.” (Huczynski and Buchanan: 2004: pg. 828)
However, post Griffith, in a role culture with line management system, Doctors “were incorporated into mainstream decision making in a subordinate role.” (to UGMs and DGMs) (D. Cowler: 1993: pg. 186) This was because in a role culture “power is based on position not personality.” (Source: ) Therefore, as UGMs have increased positional power over doctors and nurses they could, in theory,
impose their will on doctors after the new measures had been implemented. As Hardy and Harrison state, “expert power (which would be exerted by doctors) is only tolerated if it is line worth accepted position.” (Source: ) This meant that doctors could only have an advisory role to the UGMs. Many doctors resented this and, many took the view that, “Medical decision making has to be based on the professional authority of the doctor.” (D. Cowler: 1993: pg. 182) Therefore, as Reed and Anthony state, “the Griffiths style reforms within South Glam generated an organizational climate in which anxiety, distrust and opposition, coupled with a degree of retreat or withdrawal on the part of some individuals were the prevailing responses from key professional groups (including doctors).” (D. Cowler: 1993: pg. 186)
This organisational misbehaviour by the doctors could not be effectively controlled by the UGMs and the new management had little in the way of reward power (the ability to give rewards to create compliance) coercive power (the ability to administer unwelcome penalties to create compliance) or referent power (the ability to use personality traits and desirable abilities to exert influence). These bases are described in detail by French and Raven in their book “The bases of social power.” (1958). The response of the UGM to this conflict was the view of “the natural conflict” theorists and that the conflict should be accepted. Mary Jo Hatch sums up the natural view of conflict as “conflict may be regarded as dysfunctional, however as a natural condition, conflict is unavoidable and should be accepted.” (Hatch M. J.: 1997: pg. 303) This is shown in the fact that the Griffiths measures were supposed to convince staff that there was “no alternative to the permanent revolution that the Griffiths report had instigated.” (D. Cowler: 1993: pg. 186) Thus accepting the fact that there would be conflict but expecting NHS staff to ‘give in’ after time.
The nurses reacted differently to the doctors to the implementation of new management structures. “There was little sign of any coercive resistance on their (the nurses) part, apart from a deep rooted scepticism (toward he new measures)” (D. Cowler: 1993: pg. 184) The Nurses questioned the lack of UGM’s expert power with one nurse quoting the UGMs have no “real understanding of the day to day problems we (the nurses) face.” (D. Cowler: 1993: pg. 184) The nurses “resigned to the imposition of a restructuring process” and accepted it. (D. Cowler: 1993: pg. 183) However there concerns were that in time “the UGMs would become detached from the Hurly burly of everyday hospital life.” (D. Cowler: 1993: pg. 184) This meant that management and nurses became less cohesive. This is supported by Reed and Anthony’s analysis that “occupational interest groups became more fragmented than had been pre Griffiths arrangement.” (D. Cowler: 1993: pg. 186) If we use Hatch’s model of conflict and performance (appendix 1) we see that decreases in cohesion will lead to decreases in productivity. This can lead to either a “poorly focused and unmotivated workforce with increased conflict” or an “uncooperative and politicised workforce with reduced conflict.” (Hatch M. J.: 1997: pg. 305)
The administrators of the NHS also responded negatively to the changes implemented by the management. An uncertainty of the future of the administrator’s role entered the mind frame of many administrators. This was because only a chosen few would become UGMs with increased power bases while “the majority were likely to find themselves in a situation where their decision making authority and organisational status were severely reduced.” (D. Cowler: 1993: pg. 184) Respected organizational theorist, Hofstede states that this organizational uncertainty is not well tolerated in a British society. (Hatch M. J.: 1997: pg. 209) (See appendix 2) Added to this the lack of security in the position of administrator, which was developing under the implementation of new management, meant that the workforce would become less motivated as it “faced a bleak future.” (D. Cowler: 1993: pg.185) Maslow’s hierarchy of needs (see appendix 3) states that without security, the administrators other needs such as affiliation, esteem and self-actualisation could not be effectively met. Therefore it would be hard to motivate administrators under the new regime. This meant that there was, as one administrator speculated, “a lot of uncertainty and apprehensiveness as to the future of the administrators within the authority.” (D. Cowler: 1993: pg.185)
It can be assessed that the Griffith measures did not have the intended effect on the South Glam NHS district. As Reed and Anthony state, “The cultural changes to which the UGMs aspired - in terms of the inclination of a set of attitudes, beliefs more sympathetic to managerially led restructuring – were more piecemeal and ephemeral in there impact.” (D. Cowler: 1993: pg.186) If we look at Lewins three step model of change (see appendix 4), we see that unfreezing, changing and refreezing an organisation is how it changes. Lewin states that unfreezing an organisation involves “producing additional forces for changing or reducing resistance.” (Hatch M. J.: 1997: pg. 305) However, this was not achieved as the “tensions and conflicts between different professional and occupational interest group intensified” under the new measures. (D. Cowler: 1993: pg.186) Therefore, the culture could not be changed or refrozen effectively as the organisation had not been properly unfrozen through an implementation of a change in attitude in the organisation. As Reed and Anthony state, “the underlying status quo values and prejudices that shaped day to day organizational behaviour seemed to be firmly in place.” (D. Cowler: 1993: pg.186)
To try to impose a change in culture in the NHS was very ambitious. To try and install line management that would reduce the autonomy of doctors and nurses seemed to be at loggerheads with the basic assumptions and values of the NHS. Many in the NHS “staunchly resisted the proposition that management budgets could ever play a significant role in clinical decision making process.” (D. Cowler: 1993: pg.181) Therefore, it can be assed that attempts to change culture failed. However this does not mean that there efforts were invalid. Shein states, “The unique and essential function of leadership is the management of culture.” (Shein: 1985: p.317)
Therefore it can be assed that the ideas for changing the NHS culture to increase efficiency were important in a period were funds were limited. However, there was an inability to unfreeze the status quo of the organisation and too many clashes of cultural values between management and clinicians for the scheme to be fully successful.
Appendix 1
Source: Hatch M J: 1997: pg.305
Appendix 2
Source: Hatch M J: 1997: pg.209
Appendix 3
Source: Huczynski and Buchanan: 2004: pg. 248
Appendix 4
Source: Hatch M J: 1997: pg.354
Bibliography
French and Raven: 1958: ‘ The Bases of social power.’ In D. Cartwright “Studies in social power”: Institution for Social Research, University of Michigan Press
Lewin K: 1951: ‘Field theory in social science’: New York: Harper Row
Lewin K: 1958: ‘Group decisions and social change. In E Macocobby, T.M. Newcomb and EL Hartley (eds): ‘Readings in social pyscology.” : Holt, Rinehart & Wilson
References
Cowler, D, Legge K & Clegg C (eds): 1993: “Case studies in organizational behaviour and human resource management 2nd edition.”: Chapman publishing ltd.
Hatch, Mary Jo: 1997: “Organization Theory: Modern symbolic and post modern perspectives”: Oxford press
Huczynski and Buchanan: 2004: “Organizational behaviour: an introductory text 5th edition”: Prentice Hall International
Shein, E. H.: 1985; “Organizational Culture and Leadership.” Jossey- Bass, San Francisco
Web references
