Instilling and Distilling Institutional Excellence: Rhetoric, Reality and Disparity

Citation

Greener, I. (2005), "Instilling and Distilling Institutional Excellence: Rhetoric, Reality and Disparity", International Journal of Public Sector Management, Vol. 18 No. 3, pp. 294-296. https://doi.org/10.1108/09513550510591579

Beil‐Hildebrand's book is a study of a German hospital she refers to by the pseudonym “Jo‐Care” in which she examines a cultural change there with special reference to its effects on nurses. The book attempts to combine “a critical review of the managerial and academic claims about changing the culture of an organisation with a critical realist ethnography of its introduction” (p. 13) and is successful to a degree on both counts. There is a very substantial methodology section taking up much of the first 100 pages, and perhaps betraying the roots of the work in the author's doctoral thesis. Even though this section is written well, and would be an excellent example to present doctoral candidates on how to present a literature review in a thematic and persuasive way, it is a less clear to whom the section would be relevant in book form. A general criticism of this early part of the book is that the concept of “culture” is so comprehensively pulled apart the reader is left with little sense of what it means in the context of the study. This takes away from the relevance of the book to understanding cultural change (or stability), and this can surely not have been the author's intention.

Once the book moves on to the study, Beil‐Hildebrand provides us with relevant background to the hospital system in Germany before moving on to the specific context of Jo‐Care itself. She paints a picture of a highly orchestrated and systematic attempt to change the way the hospital operates, with CEOs giving seminars and presentations to the workforce, and apparently engaging in a significant consultation exercise. This part of the study is strong, but perhaps reveals the most significant weakness of the book. Beil‐Hildebrand has produced an extremely interesting and timely ethnographic analysis of hospital change, but she often does not manage to get full value from the material she has so carefully collected. On pages 154‐55 of the text, for example, she gives an extended quotation in which a staff nurse describes the consultation process that led to the creation of the “organisational philosophy” being put together. The quotation is rife with contradictions but Beil‐Hildebrand never manages to capture the tensions between the need to manage the situation she describes (in which it might be hardly surprising that consultants come with ready‐made answers), the need to sell it to staff (through a rhetoric of consultation and participation) and the need to operationalise it (through the instigation of processes and procedures). Instead her interpretation is rather less unclear; she often appears content to leave the reader to draw his or her own conclusions rather than systematising and developing her findings into any kind of coherent analysis. This is also present in the section on “Management by walking about” (Chapter 9), which is, by turns, a Foucaultian panapticonist technique, or an attempt by management to get close to their staff (p. 204) which results, in the end, with them being rather uncertain about the final result. We can read this as a very post‐modern piece of organisational analysis in which there is only uncertainty and contradiction, but this flies in the face of the critical realist ontology that Beil‐Hildebrand suggests she is following.

The book concludes by summarising the “official” and “unofficial” stories of organisational change at the hospital. This is again, rather frustrating. Beil‐Hildebrand has produced a timely and important study of the process of change in a hospital that contains some wonderful stories and examples of the processes involved. But she does not quite ever manage to pull all the threads of her story together, leaving the reader, at the end, with a sense of knowing a lot about the hospital, but rather less able to explain exactly what he or she has actually learned. One way that the author might have resolved this is to perhaps use a more specified framework of analysis (Margaret Archer's work on morphogentic social theory and cultural change come to mind – especially given their explicit use of the critical realist ontology). Without such a framework, the reader, in the end, becomes a little overwhelmed with detail from the study and needs to work hard to place it all in a context that leads to greater understanding.

In all, I can recommend this book. It would serve academics interested in change in hospitals, both in Germany and elsewhere, well in providing a detailed ethnographic study with a number of fascinating cases within it. It serves less well in helping us to understand, however, exactly what happened at Jo‐care because of its lack of synthesis and explanatory sophistication.