This dissertation aims to understand and delve deeper into the nature of organisational commitment in a public funded healthcare organisation.

Authors Avatar by tinaoberoi (student)


Commitment and non-cooperation in NHS – A qualitative case study in NHS, UK.

Chapter 1

Research Questions

This dissertation aims to understand and delve deeper into the nature of organisational commitment in a public funded healthcare organisation. It also aims to explore if non-cooperation exists in such organisations and what forms does it present itself in.

The research questions addressed in this dissertation are as follows:

  1. Does commitment exist in a public funded healthcare organisation?
  2. What are the bases of commitment in a public funded healthcare organisation?
  3. If commitment does exist, what is the kind of commitment found in such an organisation?
  4. Does non-cooperation exist in a public funded healthcare organisation?
  5. If it does exist, what is the form of non-cooperation found in such an organisation?
  6. Is there any connection between commitment and non-cooperation in a public funded healthcare organisation?

To find the answers of the above research questions, a case study was carried out at the National Health Service (NHS) in the UK. Accessing data within NHS was easy as the researcher works with NHS and this would help collect information easily for the purpose of this dissertation.

Chapter 2


This dissertation will aim to understand commitment and non-cooperation in a public funded healthcare organisation. This research study will be carried out in the National Health Service (NHS) in the United Kingdom, which is mainly funded through collecting taxes from the public. It does not need insurance payments from its patients unlike healthcare facilities in other countries. This is a very comprehensively networked healthcare facility and it provides a wide range of free health services to the residents of the UK.

The literature available on public funded healthcare organisations suggests that workers are committed to their profession as well as to the cause that NHS works towards achieving, i.e. working with other so as to ensure faultless service to its patients, keeping its patients healthy, reducing inequalities in the provision of healthcare services, prevention and treatment of diseases, etc. In addition, according to the literature non-cooperation in organisations is linked to frustration in workers, etc. Together with the proposed research questions, the relationship between commitment and non-cooperation in a public funded healthcare organisation is aimed at being explored by means of this dissertation.

Chapter 3

Literature Review

The National Health Service (NHS) is the vast health care unit spread in the UK. It controls the health sector in UK. The National Health Service was established by the Health Minister Anreuin Bevan in the year 1948. This service is available for the whole population of the United Kingdom. NHS also works towards providing social services to the needy and helpless people. It provides residence and free home care to them. NHS can be bifurcated into the part, which deals with the strategy, policy and managerial issues and the other, which works on all the medical facets. The one dealing with the medical facet can be further categorized into, Primary care (which involve GPs, dentists, pharmacists, etc), Secondary care (which is based in hospital and can be accessed on GP reference) and Tertiary care (in this highly specialized doctors are involved who deal with particular critical conditions).

However, with the structural changes taking place in NHS, the division between the different care units is less distinctive. The system gives the right to express their views about the service to all service users in all the four countries; England, Scotland, Wales and Northern Ireland. The NHS is the world’s largest public asset to the health services. The main reason for the establishment of the NHS was that the government aim to provide better health care service to all citizens in spite of their less income. Although some sectors like optical, dental and prescriptions are paid services. NHS is financially supported by the tax paid by the employees from their income. NHS is itself governed by DH (Department of Health, 2012).

The History of NHS

In the fifth decade, it became difficult to operate for NHS. There was a kind of agitation in people. Everybody became skeptical about the performance of NHS. The youth thought that whether they should trust on NHS and older ones felt that things were better in the past. Hospital throughput had risen and new radical treatments demanded great stamina of patients. Prior to 1990 Act, a massive bureaucracy administered all the sectors of the NHS. When the internal market established and the purchaser-provider came apart, the 'purchasers' (i.e. health authorities and family doctors) had to buy the health care within a limited budget from the 'providers' (i.e. hospitals, organization providing treatment for the mentally ill, and people having learning disabilities and the elderly, and ambulance services).  In order to become a ‘provider’ in the internal market, health organizations became NHS trusts, which were independent organizations having their own management. Initially it was a collection of 57 NHS Trusts, which came into existence in 1991. By 1995, it was NHS who provided all health care

There were some changes in the arrangement and the working pattern of the NHS trust. 10 Downing Street became integral part of the NHS.  The decade was specialized by the Organisational chaos that involves the configuration, termination and reshuffle of the structure and responsibilities of NHS authorities and trusts, and the NHS Foundation Trust.  The workforce in the NHS decided that if the NHS is a service without payment, the infrastructure should also be not publically owned. Then the private sector associations came for the construction of the hospitals under PFI, and run their clinical services as Independent Treatment Centers and some NHS Walk-in Centers. 

The Performance of the National Health Service in the UK

While making a policy it’s very important to note that how it is executed. The NHS implies with the focus in health policy in UK. After it’s inception since 1948, NHS has become the world’s largest health service unit. Here the question clearly arises that “Does NHS truly is the most competent, most. The question that obviously arises is: is it truly one of the most efficient, most unrestricted unit?” If we review the performance of NHS, the findings are as below:

The NHS is managed by the Department of Health (DoH). If we watch the data of NHS’s official website, it shows a huge scale; more than 1.7 million people employed in NHS, of those, just under half are clinically qualified, including 120,000 hospital doctors, 40,000 general practitioners (GPs), 400,000 nurses and 25,000 ambulance staff. It works on following core principles: The NHS provides a worldwide service for all needy persons who are not able to pay, it also provides wide-ranging services to its patients, it forms its services as per the needs and inclination of the individuals, their families, and their cares, it takes action to different requirements of diverse populations, it works continuously in order to improve quality services and to reduce errors, it supports and values its staff, its patients are treated by the monetary support provided by the public for the purpose of health care, it works together with others to provide an ideal service to the patients, it strives as far as possible to keep people healthy and it respects the privacy of individual and provide open access to information about services, treatment and performance.

Commitment in Organisations

There is a considerable amount of research material available on commitment in the healthcare sector (Allen and Meyer, 1993; Buerhaus, 1999). It has been seen that in the case of health care organisations employees are more committed to the cause that the organisation stands for rather than the organisation itself (Paton and Cornforth, 1992). According to Rebecca Smith, a leaked document reveals a startling fact that the managers at the National Health Service are forcing its workers to accept a pay cut of around five percent. They are also ending overtime payments for night shifts, weekend, bank holidays, etc. They are reducing holidays and are introducing long working hours for each shift (Smith, 2012).  Similar research shows that the workers in this sector are paid much less as compared to what they might receive if they were working for an organisation in the private sector for the same work (Hems and Passey, 1998). A large number of researchers state that organisational commitment is related to the commitment of workers to the cause of the organisation rather than the organisation itself. This is another reason why they are willing to accept lesser pay for the work they do and yet be committed to the work they are doing for patients. Workers may also be committed to the organisation they work for because when they decide to work for a particular organisation they pick one that has causes, aims, goals, etc. that are in sync with the workers own values, goals and aims. The workers are interested in what the organisation does and stands for and they feel that by being a part of the organisation they are making a successful contribution to the society and at the same time are fulfilling their own aims and goals. The underlying reason why a worker would choose to work for such organisations still remains unexplored. Hence, by means of this research study I aim to delve deeper in order to answer such questions in terms of a public funded healthcare organisation in the UK.

Join now!

If we look at it from one perspective, organisations in the healthcare sector seem to provide its workers with numerous conditions for being very committed to the organisation they are working for in the form of shared goals, values and aims. However, if we look at it from another perspective, such organisations have several problems that their employees are faced with such as low pay, unpaid overtime, long working hours, etc. (Alatrista and Arrowsmith, 2003).

According to Legge, commitment in organisations is extremely significant as only with the help of committed employees can an organisation achieve its goals ...

This is a preview of the whole essay