The gradual corporatization of the English NHS has created conditions which have precipitated an increasingly commercialized and entrepreneurial healthcare system

Recent healthcare reforms in England, combined with financial austerity, have accelerated both the corporatization and commercialization of the NHS. This combination has encouraged greater public sector entrepreneurialism, argue Damian E. Hodgson, Simon Bailey, Mark Exworthy, Mike Bresnen, John Hassard, and Paula Hyde. They examine the meaning and experience of corporatization in the sector, illustrating their argument with qualitative data from a specialist hospital

Management Knowledge and Learning in the UK Healthcare Context: Change and Continuity

Major recent changes witnessed within UK healthcare have had dramatic consequences for management, while the increased expectation that healthcare managers demonstrate leadership has put the spotlight firmly on their managerial knowledge. As yet, however, we know comparatively little about how healthcare managers acquire and apply management knowledge, and how this is influenced by their professional development. Drawing upon situated learning theory and Blackler’s framework of knowledge types, we examine managers’ orientations to knowledge in the context of recent policy changes. Recognizing that healthcare management is complex, comparative case study evidence is presented from three types of hospital trust (acute, care and specialist) and across three generic managerial groups (clinical, general and functional). Our research highlights the obstacles faced by managers in developing their knowledge and learning, and how contemporary changes are reinforcing long-established preferences for embodied (‘tried and tested’) knowledge as well as locally encultured (‘home-grown’) management solutions

Implementing disruptive technological change in UK healthcare: exploring development of a smart phone app for remote patient monitoring as a boundary object using qualitative methods

Purpose Developing technological innovations in healthcare is made complex and difficult due to effects upon the practices of professional, managerial and other stakeholders. Drawing upon the concept of boundary object, this paper explores the challenges of achieving effective collaboration in the development and use of a novel healthcare innovation in the English healthcare system. Design/methodology/approach A case study is presented of the development and implementation of a smart phone application (app) for use by rheumatoid arthritis patients. Over a two-year period (2015–2017), qualitative data from recorded clinical consultations (n = 17), semi-structured interviews (n = 63) and two focus groups (n = 13) were obtained from participants involved in the app's development and use (clinicians, patients, researchers, practitioners, IT specialists and managers). Findings The case focuses on the use of the app and its outputs as a system of inter-connected boundary objects. The analysis highlights the challenges overcome in the innovation's development and how knowledge sharing between patients and clinicians was enhanced, altering the nature of the clinical consultation. It also shows how conditions surrounding the innovation both enabled its development and inhibited its wider scale-up. Originality/value By recognizing that technological artefacts can simultaneously enable and inhibit collaboration, this paper highlights the need to overcome tensions between the transformative capability of such healthcare innovations and the inhibiting effects simultaneously created on change at a wider system level

Hybrid managers, career narratives and identity work: a contextual analysis of UK healthcare organizations

While hybrid managers are increasingly important in contemporary organizations (especially in the public sector), we know little about why or how they become hybrid managers, or how this is shaped by the interplay of professional experience and organizational circumstances. In pursuit of a more variegated, contextualised and dynamic understanding of hybrid management, this paper focuses on how individuals transition into managerial hybrids, emphasizing the dynamic and emergent nature of hybrid management identity. Studying managers in English healthcare, we employ the concept of identity work as expressed through career narratives to examine the influence of career trajectories and organizational experiences on emerging hybrid manager identity. The study identifies three broad managerial career narratives – aspirational, ambivalent and agnostic – and relates them to experiences of doctor and nurse hybrid managers in three healthcare settings. An interpretive analysis of these narratives reveals a more variegated, situated and dynamic interpretation of hybrid managerial identities than previously considered and underscores the importance of personal and organizational experiences in shaping emergent hybrid professional/managerial identity

Mobilizing management knowledge in healthcare : institutional imperatives and professional and organizational mediating effects

Recent changes within UK healthcare have had dramatic consequences for management and put managerial capabilities firmly under the spotlight. Yet, despite extensive research on managers, comparatively little is known about how they acquire and apply their management knowledge and how this is influenced by their professional background and organizational context. Drawing upon work that distinguishes between different forms of knowledge, managers’ mobilization of management knowledge is examined in the light of recent changes in healthcare. Case study evidence is presented from diverse managerial groups across three types of hospital trust (acute, care and specialist). The analysis demonstrates the mediating effects of interactions between professional background and organizational context on knowledge mobilization and highlights how current pressures on public services are reinforcing a reliance on existing management practices, creating enormous challenges for management learning in this sector

Being careful what we wish for? Challenges and opportunities afforded through engagement with business and management research

Despite the proliferation of work within construction management that draws upon management and organizational theory, two omissions stand out from the body of published work: the absence of any real debate about the values of rigour and relevance in research; and the under-use of dominant perspectives in business and management research (such as institutional theory) to frame construction management and organizational issues. Drawing specifically upon the ideas of institutional logics and institutional work, this paper explores the tensions, ironies and contradictions of the rigour-relevance debate; and the challenges and opportunities facing construction management research (CMR) and its institutions in furthering management and organizational research agendas. In doing so, attention is directed to the complex, contested and changing nature of the knowledge base within the business and management field; as well as key differences between that community of practice and CMR

Models and metaphors: complexity theory and through-life management in the built environment

Complexity thinking may have both modelling and metaphorical applications in the through-life management of the built environment. These two distinct approaches are examined and compared. In the first instance, some of the sources of complexity in the design, construction and maintenance of the built environment are identified. The metaphorical use of complexity in management thinking and its application in the built environment are briefly examined. This is followed by an exploration of modelling techniques relevant to built environment concerns. Non-linear and complex mathematical techniques such as fuzzy logic, cellular automata and attractors, may be applicable to their analysis. Existing software tools are identified and examples of successful built environment applications of complexity modelling are given. Some issues that arise include the definition of phenomena in a mathematically usable way, the functionality of available software and the possibility of going beyond representational modelling. Further questions arising from the application of complexity thinking are discussed, including the possibilities for confusion that arise from the use of metaphor. The metaphor of a 'commentary machine' is suggested as a possible way forward and it is suggested that an appropriate linguistic analysis can in certain situations reduce perceived complexity

Living the dream? Understanding partnering as emergent practice

The ‘practice turn’ in organizational studies has recently emerged as an important set of perspectives which has implications for understanding processes of knowing and learning within and between organizations. Consisting of a range of different approaches, it emphasizes the situated nature of knowing and learning in practice and offers an alternative to understanding human action that transcends the dualism of structure and agency effects on action. The ontological and epistemological underpinnings of a practice‐based approach are explored before attention is directed towards assessing the implications for understanding the knowledge, learning and change in project‐based organizations associated with the emergence of partnering.Partnering, practice‐based perspective, organizational learning,