Examines the potential for reducing the dysfunctional consequences of demarcation between work groups and professions in the NHS. Suggests that change may be achieved by interpreting and manipulating rituals which preserve the negative aspects of professional and work group autonomy. Discusses a number of rituals observed in a case study hospital during an extensive research exercise and demonstrates how they help maintain potentially dysfunctional culture norms and behaviours which, consciously or not, serve to resist moves to achieve more flexible, team‐orientated, patient‐centred changes. In addition, explores new rituals which may question current practices, and argues that attention to rituals in the wider change process may facilitate the desired change. Suggests that changes which confront unnecessary demarcation, but which do not undermine professional integrity, can create real benefits for NHS hospitals.
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