Who are NHS middle managers? What do they do, and why and how do they do it’?
This book explores the daily realities of working life for middle managers in the UK’s National Health Service during a time of radical change and disruption to the entire edifice of publicly-funded healthcare. It is an empirical critique of the movement towards a healthcare model based around HMO-type providers such as Kaiser Permanente and United Health. Although this model is well-known internationally, many believe it to be financially and ethically questionable, and often far from 'best practice' when it comes to patient care.
Drawing on immersive ethnographic research based on four case studies – an Acute Hospital Trust, an Ambulance Trust, a Mental Health Trust, and a Primary Care Trust – this book provides an in-depth critical appraisal of the everyday experiences of a range of managers working in the NHS. It describes exactly what NHS managers do and explains how their roles are changing and the types of challenges they face. The analysis explains how many NHS junior and middle managers are themselves clinicians to some extent, with hybrid roles as simultaneously nurse and manager, midwife and manager, or paramedic and manager. While commonly working in ‘back office’ functions, NHS middle managers are also just as likely to be working very close to or actually on the front lines of patient care. Despite the problems they regularly face from organizational restructuring, cost control and demands for accountability, the authors demonstrate that NHS managers – in their various guises – play critical, yet undervalued, institutional roles.
Depicting the darker sides of organizational change, this text is a sociological exploration of the daily struggle for work dignity of a complex, widely denigrated, and largely misunderstood group of public servants trying to do their best under extremely trying circumstances. It is essential reading for academics, students, and practitioners interested in health management and policy, organisational change, public sector management, and the NHS more broadly.
Preface: The ‘Highest Law’ 1. Deconstructing the Welfare State: Undoing ‘One of the Greatest Achievements in History’? 2. Deconstructing the NHS: The Changing Roles of Junior and Middle Managers 3. Exploring NHS Work: A Critical-action Perspective 4. Ready to do Business: Management and Organizational Change in an Acute Trust 5. Contested Culture: Managerial Work in an Ambulance Trust 6. Staying Afloat: Negotiating Change at a Mental Health Trust 7. When Organizations Disappear: Deconstructing Management at a Primary Care Trust 8. Managing the Impossible: The Challenges of Organizational Change in the NHS
This book represents an impassioned indictment of the misapplication of business principles to healthcare in the NHS. It offers a dystopian peek into the lived experience of dedicated health professionals struggling to maintain their professional integrity and a national institution in the face of a disturbing tension between business imperatives and ethics of care.
Roy Suddaby, Winspear Chair of Management, Peter B. Gustavson School of Business, University of Victoria, Canada and Research Professor, Newcastle University Business School, UK
This fine book deconstructs the English welfare state (notably the NHS) in two ways: it critically explores what current health policy is doing to the NHS; and it tracks the NHS’s possible morphing into a new commercialised entity. It draws on extensive case study work to explore the experience of middle managers in such change, placing empirical work in a theoretical and political economic context. This important contribution informs a major area of policy, political and also public concern.
Ewan Ferlie, Professor, Department of Management, King's College London, UK
This book offers a brilliant analysis of the work of healthcare managers in an age of major public sector reform. Lucid and thought-provoking, it provides much needed insight into the ethical and philosophical issues facing our public services today. Most of all, it offers a deep sociological appreciation of the movement towards ‘marketization’ and the threats this poses to publically-funded healthcare.
Mary Jo Hatch, Professor Emerita, University of Virginia, USA
Shattering the myth that NHS middle managers are costly pen-pushers, this book emphasizes their critical contributions. With financial pressures and constant change, however, they are faced with ‘managing the impossible’. But is this deliberate policy? The authors suggest that the mix of complex governance systems, funding restrictions, and unrealistic targets ensure that the NHS is always seen to be failing, thus reinforcing the case for privatization - which is already happening. This is essential reading for anyone concerned about how the NHS is managed, locally and nationally.
David A. Buchanan, Emeritus Professor of Organizational Behaviour, Cranfield School of Management, UK
This book is a treasure in two important senses. Firstly it showcases first rate scholarly empirical research that seeks to explore what middle managers do in a number of important health care contexts. Junior and middle management roles are often overlooked by organizations and indeed by academics and policy makers. It is refreshing to see a spotlight being placed on these critical roles. Secondly it offers a thoughtful and impactful analysis of the changes seen in health care as part of the welfare state. The stealth revolution is highlighted where the scope of its availability is being questioned.
Sue Dopson, Rhodes Trust Professor of Organizational Behaviour, Saïd Business School, UK