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Article
Publication date: 15 March 2013

Imelda McDermott, Kath Checkland, Stephen Harrison, Stephanie Snow and Anna Coleman

The language used by National Health Service (NHS) “commissioning” managers when discussing their roles and responsibilities can be seen as a manifestation of “identity…

Abstract

Purpose

The language used by National Health Service (NHS) “commissioning” managers when discussing their roles and responsibilities can be seen as a manifestation of “identity work”, defined as a process of identifying. This paper aims to offer a novel approach to analysing “identity work” by triangulation of multiple analytical methods, combining analysis of the content of text with analysis of its form.

Design/methodology/approach

Fairclough's discourse analytic methodology is used as a framework. Following Fairclough, the authors use analytical methods associated with Halliday's systemic functional linguistics.

Findings

While analysis of the content of interviews provides some information about NHS Commissioners' perceptions of their roles and responsibilities, analysis of the form of discourse that they use provides a more detailed and nuanced view. Overall, the authors found that commissioning managers have a higher level of certainty about what commissioning is not rather than what commissioning is; GP managers have a high level of certainty of their identity as a GP rather than as a manager; and both GP managers and non‐GP managers oscillate between multiple identities depending on the different situations they are in.

Originality/value

This paper offers a novel approach to triangulation, based not on the usual comparison of multiple data sources, but rather based on the application of multiple analytical methods to a single source of data. This paper also shows the latent uncertainty about the nature of commissioning enterprise in the English NHS.

Details

Journal of Health Organization and Management, vol. 27 no. 1
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 16 March 2015

Anna Coleman, Julia Segar, Kath Checkland, Imelda McDermott, Stephen Harrison and Stephen Peckham

The purpose of this paper is to explore the early experiences of those involved with the development of Clinical Commissioning Groups (CCGs), examining how the aspiration…

Abstract

Purpose

The purpose of this paper is to explore the early experiences of those involved with the development of Clinical Commissioning Groups (CCGs), examining how the aspiration towards a “clinically-led” system is being realised. The authors investigate emerging leadership approaches within CCGs in light of the criterion for authorisation that calls for “great leaders”.

Design/methodology/approach

Qualitative research was carried out in eight case studies (CCGs) across England over a nine-month period (September 2011 to May 2012) when CCGs were in their early development. The authors conducted a mix of interviews (with GPs and managers), observations (at CCG meetings) and examined associated documentation. Data were thematically analysed.

Findings

The authors found evidence of two identified approaches to leadership – positive deviancy and responsible guardianship – being undertaken by GPs and managers in the developing CCGs. Historical experiences and past ways of working appeared to be influencing current developments and a commonly emerging theme was a desire for the CCG to “do things differently” to the previous commissioning bodies. The authors discuss how the current reorganisation threatens the guardianship approach to leadership and question if the new systems being implemented to monitor CCGs’ performance may make it difficult for CCGs to retain creativity and innovation, and thus the ability to foster the positive deviant approach to leadership.

Originality/value

This is a large scale piece of qualitative research carried out as CCGs were beginning to develop. It provides insight into how leadership is developing in CCGs highlighting the complexity involved in these roles.

Details

Journal of Health Organization and Management, vol. 29 no. 1
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 26 November 2010

Charlotte Goldman and Jane Carrier

This article follows an earlier article in this journal (Goldman, 2010), examines the emerging government policy on integration and considers some of the implications for…

Abstract

This article follows an earlier article in this journal (Goldman, 2010), examines the emerging government policy on integration and considers some of the implications for joint financing. Most primary care trusts (PCTs) and councils with adult social care responsibilities are engaged in joint financing and wider health and social care partnership arrangements. But, with the demise of PCTs and the growth in GP commissioning, there are issues and questions about the future of such arrangements. However, despite these organisational changes, partners must continue to be able to demonstrate the outcomes that integrated health and social care services are achieving.

Details

Journal of Integrated Care, vol. 18 no. 6
Type: Research Article
ISSN: 1476-9018

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Article
Publication date: 1 February 2000

Tony Conway and Stephen Willcocks

This conceptually‐focused paper looks at particular changes implemented in the UK National Health Service. The specific context is the creation of a new organisational…

Abstract

This conceptually‐focused paper looks at particular changes implemented in the UK National Health Service. The specific context is the creation of a new organisational form: the primary care group, which brings together general practitioners and other primary care staff in a given locality. The paper attempts to examine the consequences, for the development of these groups, of the shift from competition (in the internal market) to relationships based on collaboration and partnership. The broad policy objectives envisage much greater emphasis on working in partnership, participating in strategy and planning (via new health improvement programmes), developing joint working, and promoting the integration of service delivery. A relationship marketing perspective is explored as one way of conceptualising the development of new relationships between primary care groups, health authorities, local authorities, trusts and other agencies and the paper suggests that relationship marketing offers a way of facilitating policy change.

Details

International Journal of Public Sector Management, vol. 13 no. 1
Type: Research Article
ISSN: 0951-3558

Keywords

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Abstract

Details

Journal of Integrated Care, vol. 6 no. 2
Type: Research Article
ISSN: 1476-9018

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Article
Publication date: 17 May 2013

Kath Checkland, Stephen Harrison, Stephanie Snow, Anna Coleman and Imelda McDermott

The purpose of this paper is to explore the practical daily work undertaken by middle‐level managers in Primary Care Trusts (PCTs), focusing upon the micro‐processes by…

Abstract

Purpose

The purpose of this paper is to explore the practical daily work undertaken by middle‐level managers in Primary Care Trusts (PCTs), focusing upon the micro‐processes by which these managers enact sensemaking in their organisations.

Design/methodology/approach

The research took a case study approach, undertaking detailed case studies in four PCTs in England. Data collection included shadowing managers, meeting observations and interviews.

Findings

The research elucidated two categories of enactment behaviour exhibited by PCT managers: presence/absence; and the production of artefacts. Being “present” in or “absent” from meetings enacted sensemaking over and above any concrete contribution to the meeting made by the actors involved. This paper explores the factors affecting these processes, and describes the situations in which enactment of sense is most likely to occur. Producing artefacts such as meeting minutes or PowerPoint slides also enacted sense in the study sites in addition to the content of the artefact. The factors affecting this are explored.

Practical implications

The study has practical implications for all managers seeking to maximise their influence in their organisations. It also provides specific evidence relevant to managers working in the new Clinical Commissioning Groups currently being formed in England.

Originality/value

The study expands the understanding of sensemaking in organisations in two important ways. Firstly, it moves beyond discourse to explore the ways in which behaviours can enact sense. Secondly, it explores the distinction between active and unconscious sensemaking.

Details

Journal of Health Organization and Management, vol. 27 no. 2
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 1 June 2003

Steve Willcocks

This paper aims to explore the early experiences of a new primary care organisation in the NHS. It reports the findings of a longitudinal qualitative case study of one…

Abstract

This paper aims to explore the early experiences of a new primary care organisation in the NHS. It reports the findings of a longitudinal qualitative case study of one primary care group in its first year of operation. It concludes and makes recommendations in four key areas relevant to the development of the primary care group: the experiences of individuals and their readiness for change; clarity and consensus about roles and responsibilities in the new organisation; the process of change, and the impact of culture/power structures; and developing relationships with internal and external stakeholders.

Details

Journal of Health Organization and Management, vol. 17 no. 3
Type: Research Article
ISSN: 1477-7266

Keywords

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Article
Publication date: 26 November 2010

Ray Jones

The article follows up a prospective article published just before the Election with a review of the Coalition's vision for health and social care. It concludes that…

Abstract

The article follows up a prospective article published just before the Election with a review of the Coalition's vision for health and social care. It concludes that, despite risks of increased fragmentation, there are new opportunities for integration in both commissioning and provider functions. Local authorities should move quickly to influence and lead the new partnerships.

Details

Journal of Integrated Care, vol. 18 no. 6
Type: Research Article
ISSN: 1476-9018

Keywords

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Article
Publication date: 24 December 2020

Steve Willcocks and Tony Conway

The purpose of this paper is to explore leadership in the context of the policy shift to collaborative working and integration currently being pursued in the UK NHS. As…

Abstract

Purpose

The purpose of this paper is to explore leadership in the context of the policy shift to collaborative working and integration currently being pursued in the UK NHS. As ways of integrating care are being explored in other countries it can be argued that this topic may have wider policy significance. This paper is particularly concerned with leadership in Primary Care Networks in the English NHS.

Design/methodology/approach

This paper is a conceptual paper using literature relating to the antecedents of shared leadership and relevant policy documents pertaining to the English NHS. The paper is informed, theoretically by the conceptual lens of shared leadership. A conceptual framework is developed identifying the antecedents of shared leadership that help to explain how shared leadership may be developed.

Findings

The paper identifies the challenges that may be faced by policymakers and those involved in Primary Care Networks in developing shared leadership. It also reveals the implications for policymakers in developing shared leadership.

Research limitations/implications

The paper is conceptual. It is acknowledged that this is a preliminary study and further work will be required to test the conceptual framework empirically.

Practical implications

The paper discusses the policy implications of developing leadership in primary care networks. This has relevance to both the NHS and other countries.

Originality/value

There is limited research on the antecedents of shared leadership. In addition, the conceptual framework is applied to a new policy initiative.

Details

Journal of Integrated Care, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1476-9018

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Article
Publication date: 17 December 2019

Massimo Contrafatto, John Ferguson, David Power, Lorna Stevenson and David Collison

The purpose of this paper is to provide a theoretically informed analysis of a struggle for power over the regulation of corporate social responsibility (CSR) and social…

Abstract

Purpose

The purpose of this paper is to provide a theoretically informed analysis of a struggle for power over the regulation of corporate social responsibility (CSR) and social and environmental accounting and reporting (SEAR) within the European Union.

Design/methodology/approach

The paper combines insights from institutional theory (Lawrence and Buchanan, 2017) with Vaara et al.’s (2006) and Vaara and Tienar’s (2008) discursive strategies approach in order to interrogate the dynamics of the institutional “arena” that emerged in 2001, following the European Commission’s publication of a Green Paper (GP) on CSR policy and reporting. Drawing on multiple sources of data (including newspaper coverage, semi-structured interviews and written submissions by companies and NGOs), the authors analyse the institutional political strategies employed by companies and NGOs – two of the key stakeholder groupings who sought to influence the dynamics and outcome of the European initiative.

Findings

The results show that the 2001 GP was a “triggering event” (Hoffman, 1999) that led to the formation of the institutional arena that centred on whether CSR policy and reporting should be voluntary or mandatory. The findings highlight how two separate, but related forms of power (systemic and episodic power) were exercised much more effectively by companies compared to NGOs. The analysis of the power initiatives and discursive strategies deployed in the arena provides a theoretically informed understanding of the ways in which companies acted in concert to reach their objective of maintaining CSR and SEAR as a voluntary activity.

Originality/value

The theoretical framework outlined in the paper highlights how the analysis of CSR and SEAR regulation can be enriched by examining the deployment of episodic and systemic power by relevant actors.

Details

Accounting, Auditing & Accountability Journal, vol. 33 no. 3
Type: Research Article
ISSN: 0951-3574

Keywords

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