Control is impacted by the organisation structure, as a mechanistic structure with a Weber bureaucracy such that at the NHS with high complexity, high formalisation and high centralisation (Hatch 1997:76) allows its tall hierarchy to define distinct lines of command.
However, the contingency theory from the Classical school of thought disagrees with this theory and proposes that bureaucracy would lead to decentralisation because the increase in scale, internal structural complexity and length of hierarchy makes centralisation infeasible (Clegg 1999:53).
Instead of facilitating the interaction of organisational members and improving the quality of work, control acts as a constraint and demoralises staff (Hatch & Schultz 2004: 456). This is called the ‘vicious circle of control’, where the top management’s perceived need for control results in the creation of low-skill jobs, which increase job dissatisfaction and a drop in efficiency, which in turn needs further control (Huczynski & Buchanan 2004:78), and of -course more costs to the NHS. More recently, control over work has shifted from specialised to generalised work, with a change from narrow range of prescribe tasks to a wider range (Huczynski & Buchanan 2004: 439) as the domestics “can on occasion, respond to domestic emergencies and alter their normal routines” [section 3; line 34-36].
It can also be argued the multiskilling concept can be a positive implication for the employees as well, because “They would be multiskilled and consequently able to undertake a full range of domestic and portering roles, including cleaning, transporting patients, moving equipment and serving food” [section 3; line 15-19], which provides an opportunity for higher promotions in the future.
The way the communication system works presently within the NHS Trust, is another change which have occurred. Organisation change has mainly caused negative implications for employees, with a Weber bureaucracy, whereby there is job specification, a hierarchy of authority and discipline regulations (Huczynski & Buchanan 2004:499). The fact that there is top down communication from senior management means workers believe the senior managers has legitimate authority over them and fear losing their job if performance is poor. This negative implication is further exacerbated by the fact that the NHS has an informal communication system, where “rotas will be displayed” on notice boards and the employees “would apply for which rota they wanted”. A Directorate General Manager, Terry Abra, commented: “One minute they were going to be doing XYZ and then the next minute it was ABC” [section 6; line 44-46]. Another manager argued that the rotas are so difficult to follow, that at sometimes porters do not even have a job, when they checked on the board. Instead, the Trust could have adopted Fayol’s theory of ‘esprit de corps’ from the classical school of thought, which combines the Weber bureaucracy of ‘span-of-control’ and hierarchy with Mayo’s human relations approach of prioritising emotional factors, by stating “unity of sentimental and harmony can contribute greatly to the smooth functioning of an organisation” (Hatch 1997:32).
Generally, employees have the expectation that local factors are considered before working practices are set. However, unfairness can be created due to political and socio-cultural differences when not taken into account. This is explained by part of the equity theory, a process theory of motivation, which states that unfairness in an organisation leads to tension (Huczynski & Buchanan 2004:246). This is evidenced by the group known as ‘ward hostesses’ who “enjoyed a somewhat privileged position…with patients or clinical personnel” [section 8; line 14-18]. However, the second part of the equity theory, namely ‘tension’ motivating the individual to resolve the unfairness, is ambiguous in the NHS. Although employees in the Trust have legal support from the union, it is unclear to what extent the unions influence management decisions. However if the unfairness cannot be resolved, this will cause employees to become demotivated, and wanting to leave the organisation (Huczynski & Buchanan 2004:246), which is of course a negative implication from a manager’s perspective.
According to Morgan (1998), the NHS can be categorised as a health organisation, as it uses Taylor’s scientific management principles “to determine the most efficient way of doing work” (Morgan 1998:27) by comparing performance between staff. As a result, it had a negative implication for employees, as they are subject to routine work with little scope of variety or motivation to improve performance. More recently, top management has realised this and has adopted a Post-Fordist perspective to management after accepting all domestic and portering staff to be based at ward level.
The positive implication for employees would be the “undertaking of a wider array of tasks and embrace flexibility and teamwork” [section 4; line 6-7]. The fact that they will no longer be carrying out specific tasks and that ‘multiskilled staff’ will be working at any location within the Trust, is a sign that there has been a recent shift from Weber bureaucracy to a more post-modern approach, with the post-Fordist reorganisation involving multiskilling and demarcation of job boundaries (Baker 2002:158). However, it can be argued that there still are elements of Marxist functionalism, as the focus is on exploiting the workers by achieving the maximum output from a reduced input “Some staff would be required to change their shift pattern and total hours they work in one week. The change directly involved about 250 people and included taking on an extra 35,000 hours a year” [section 4; line 17-21]. In this respect, the only positive implication from the employees’ perspective can be viewed as a negative one by a critical theorist, who would claim that workers are subject to low pay and would have to work in condition that stifle their autonomy and creativity (Crowther & Green 2004:124).
Abrahamsson (2000) point out that the modern organisation, focuses on integration and decentralisation, challenges the gender order, which is a strong system, built on segregation and hierarchy. This is clear evidence of Maslow’s ‘lack of need satisfaction’ at the NHS as the managers do not take into considerations what the porters wanted and what will make them feel comfortable in their job, but how to make the implementation of the generic worker concept a success, as Deborah Lion argued “Women will go for it to see the men cleaning” [section 5; line 39-40]. This causes conflicts within the Trust and the male “openly express their unwillingness to undertake cleaning duties, which they thought were women’s work” [section 8; line 2-3], and is termed as occupational segregation, which is a negative implication for the employees. A Foucault approach which means in the 70’s and 80’s union had great power, from which the porters got this view, after it has become a conversation between themselves.
On the other hand, the issue of ‘ownership’ of tasks arises where Hotel Service believes “their staffs are better trained to carry out food dispensing duties” [section 6; line11-12]. This means the NHS adopts a post-modern approach, which means that there is exploitation of uncertainty where ancillary nurses have ‘feel threatened’ and responded with “Oh well, that’s your job now, I’m not doing it” [section 6; line 14-15].
This has brought about negative implication for the managers, as this thought can affect the level of services provided, and indicate a bad image for the organisation as a whole.
However, a positive implication is that differences in views were generally resolved through discussion between the Hotel Service and the Trust’s manager with a successful example of Performance Related Pay (PRP).
The NHS is keener to encourage motivated capitalist view without the use of coercion (Clegg 1989:99) that rewards should be given to people working harder, due to their greater output and efficiency as “many staffs were to be upgraded and all would receive a basic pay rise” [section 4; line 11-13]. Although performance related pay (PRP) attempted to adopt Hertzberg’s motivation and hygiene factors within both the employees and managers by linking pay with achievement (Huczynski & Buchanan 2004:255), it did not fully satisfy any further factors, as the highly centralised structure with little delegation meant junior staff would feel powerless and demotivated. Instead, if the NHS had adopted Drucker’s theory of decentralisation to increase service level and effectiveness, and had allowed ward managers to set their own guidelines based on what the employees are satisfy with, many of Hertzberg’s motivator and hygiene factors could have been met due to increase autonomy and individual satisfaction.
Although the NHS strategy transformation is to embed continual improvement in quality and value for money in a post-modern environment, there was a major divide between the two groups. This resulted in power hierarchies, with senior managers at the decision making and ward managers with some authority to change unfavourable guidelines. Implications for managers and employees were on most part negative, with lack of autonomy being the primary issue, and post-modern approaches such as multiskilling were more for increasing service level efficiency. Although multiskilling offers positive implications for employees, which is beneficial in both long term and short term, the way it was introduced in the NHS, was not for the benefit of the employees but the organisation, in order to improve service level efficiency and cost savings. If on the other hand, a human relations approach combined with contingency theories was used, whereby the management would consider employee emotions and alters its approach based on the context, staff motivation and therefore service level efficiency could have been improved and employees will be more satisfied.
Word Count: 2,191 words.
References:
Journals
Abrahamsson (2000), Restoring the order: gender segregation as an obstacle to organisational development, Department of Human Work Sciences, Luleå University of Technology, Sweden. Available online: ? [Accessed 22/03/2008].
Lemieux, V. (1998) Applying Mintzberg’s theories on organisational configuration to archival appraisal, Archivaria 46, 9 34.
Books
Barker, C. (2002) Making Sense of Cultural Studies: Cultural Problems and Critical Debates, London: Sage, p 158.
Clegg, S.R. (1989) Organisation Theory and Class Analysis: New Approaches and New Issues, New York: Walter de Gruyter, p 99.
Clegg, S.R. (1999) Studying Organisations: Theory and Method, London: Sage, p 53.
Crwother, D. and Green, M. (2004) Organisational Theory, London: Chartered Institute of Personnel and Development, p 14, 35, 58, 124, 183.
Cummings, T.G. and Worley, C.G. (2005) Organisation Development and Change, 8th ed., Mason: Thomas South-Western, p 159.
Hatch, M.J. and Schultz, M. (2004) Organisational Identity: A Reader Oxford: Oxford University Press, p 456.
Hatch, M.J. (1997) Organisational Theory: Modern symbolic and Postmodern Perspectives, New York: Oxford university Press, p 32, 76.
Hollensen, S. (2003) Global Marketing Harlow: FT Prentice hall, p14
Huczynski, A. and Buchanan, D. (2001) Organisational Behaviour: An introductory text, 4th ed., Harlow: FT Prentice Hall, p 78, 242, 243, 246, 248, 255, 439, 478, 499, 805, 807, 814.
Morgan, R (1998) Environmental impact assessment: a methodological perspective, Kulwer Academic, London. p 27.
Schultz et al (2000) The Expressive Organisation: Linking Identity, reputation and the corporate brand, Oxford: Oxford University Press, p102.
Bibliography:
Journals
Abrahamsson (2000), Restoring the order: gender segregation as an obstacle to organisational development, Department of Human Work Sciences, Luleå University of Technology, Sweden. Available online: ? [Accessed 22/03/2008].
Armour, L. (1997) The logic of economic discourse: beyond Adam Smith and Karl Marx International Journal of Economics Vol 24, No 10.
Lemieux, V. (1998) Applying Mintzberg’s theories on organisational configuration to archival appraisal Archivaria 46.
Books
Barker, C. (2002) Making Sense of Cultural Studies: Cultural Problems and Critical Debates, London: Sage.
Clegg, S.R. (1989) Organisation Theory and Class Analysis: New Approaches and New Issues, New York: Walter de Gruyter.
Clegg, S.R. (1999) Studying Organisations: Theory and Method, London: Sage.
Crwother, D. and Green, M. (2004) Organisational Theory, London: Chartered Institute of Personnel and Development.
Cummings, T.G. and Worley, C.G. (2005) Organisation Development and Change, 8th ed., Mason: Thomas South-Western.
Hatch, M.J. and Schultz, M. (2004) Organisational Identity: A Reader Oxford: Oxford University Press.
Hatch, M.J. (1997) Organisational Theory: Modern symbolic and Postmodern Perspectives, New York: Oxford university Press.
Hollensen, S. (2003) Global Marketing Harlow: FT Prentice hall.
Huczynski, A. and Buchanan, D. (2001) Organisational Behaviour: An introductory text, 4th ed., Harlow: FT Prentice Hall.
McGuigan, J. (1996) Culture and the Public Sphere, London: Routledge.
Montana, P.J. and Charnov, B.H. (2000) Management, 3rd ed., New York: Barron’s.
Morgan, R (1998) Environmental impact assessment: a methodological perspective, Kulwer Academic, London.
Mourad, R. (1997) Postmodern Philosophical Critique and the Pursuit of Knowledge in Higher Education, London: Bregin & Gravey.
Schultz et al (2000) The Expressive Organisation: Linking Identity, reputation and the corporate brand, Oxford: Oxford University Press.
Watson, T. (2003) Sociology, Work and Industry, 4th ed., London: Routledge.
