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Management development programmes available to NHS managers focus on a performance orientation and sustain a culture of managerial and medical domination. This paper aims to question whether it is possible to consider NHS management development from a critical (empowerment culture) perspective. Features of the critical management studies approach (CMS) are identified. A new MSc is evaluated against these characteristics, examining the teaching and learning processes and students' perceptions of the programme. The aim is to develop critical thinkers who can return to their organizations and challenge existing power structures and practices to change local cultures and enhance health services.

Empirical research employed anonymous student questionnaires and a focus group.

Student evaluations suggest the MSc can deliver a critical pedagogy and help managers understand issues of power and empowerment, challenge dominant cultures, innovate and effect small, local changes in the NHS culture.

There is a need to continue evaluating the programme and include other stakeholders. Longitudinal research should assess the impact of the managers' changed values, attitudes and behaviours on colleagues, clients and the local cultures.

The paper identifies some of the tensions of developing “critical” health service managers, and the problems they encounter back in the “uncritical” NHS context, as well as some of the challenges in “facilitating” a critical curriculum. It questions the ethics of developing (or not) a critical perspective in a local context unfamiliar with CMS.

Management development in the NHS largely ignores critical pedagogy. This paper makes a small and unique contribution to understanding how developing “critically thinking” managers can challenge the dominant culture. However, the limitations of such a small‐scale study and ethical implications are noted.

National Health Service (NHS) managers as change agents have been given the responsibility for the implementation of the NHS reforms and their views, beliefs and attitudes are therefore paramount to the effective and successful implementation of the reforms. A total of 28 managers from two acute care and one community care NHS Trusts in London were interviewed, after completing questionnaires, with a view to understanding their perceptions of the NHS managerial culture and also what they believed to be their public image. It appeared that managers generally believed that all NHS workers share altruistic core values and they thought that these core values had remained unchanged despite the previous and present reforms. The managers generally saw the recent NHS reforms as being compatible with this pan‐organisational altruistic culture; this should contribute positively towards their successful implementation. The managers, however, believed that the public did not see managers as being a part of this altruistic culture but at the same time they felt that this public view was misguided and unfair. Furthermore the managers do not appear to have allowed their perceived negative public perception to influence or shift their commitment to their altruistic values and ethos.

The current national patient safety strategy for the National Health Service (NHS) in England states that actions need to be taken to support the development of a patient safety culture. This includes that local systems should seek to understand staff perceptions of the fairness and effectiveness of serious incident management. This study aims to explore the perspectives of patient safety professionals about what works well and what could be done better to support a patient safety culture at the level of Trust strategy and serious incident governance.

A total of 15 professionals with a role in serious incident management, from five mental health trusts in England, were interviewed using a semi-structured interview guide. Thematic analysis and qualitative description were used to analyse the data.

Participants felt that actions to support a patient safety culture were challenging and required long-term and clinical commitment. Broadening the scope of serious incident investigations was felt to be one way to better understand patient safety culture issues. Organisational influences during the serious incident management process were highlighted, informing approaches to maximise the fairness and objectivity of investigation findings.

The findings of this study offer original insights that the NHS safety system can use to facilitate progression of the patient safety culture agenda. In particular, local mental health trusts could consider the findings in the context of their current strategic objectives related to patient safety culture and operational delivery of serious incident management frameworks.

This paper explores the reasons for the sometimes seemingly irrational and dysfunctional organisational behaviour within the NHS. It seeks to provide possible answers to the persistent historical problem of intimidating and negative behaviour between staff, and the sometimes inadequate organisational responses. The aim is to develop a model to explain and increase understanding of such behaviour in the NHS.

This paper is conceptual in nature based upon a systematic literature review. The concepts of organisational silence, normalised organisational corruption, and protection of image, provide some possible answers for these dysfunctional responses, as does the theory of selective moral disengagement.

The NHS exhibits too high a level of collective ego defences and protection of its image and self-esteem, which distorts its ability to address problems and to learn. Organisations and the individuals within them can hide and retreat from reality and exhibit denial; there is a resistance to voice and to “knowing”. The persistence and tolerance of negative behaviour is a corruption and is not healthy or desirable. Organisations need to embrace the identity of a listening and learning organisation; a “wise” organisation. The “Elephant in the room” of persistent negative behaviour has to be acknowledged; the silence must be broken. There is a need for cultures of “respect”, exhibiting “intelligent kindness”.

A model has been developed to increase understanding of dysfunctional organisational behaviour in the NHS primarily for leaders/managers of health services, health service regulators and health researchers/academics. Research, with ethical approval, is currently being undertaken to test and develop the conceptual model to further reflect the complexities of the NHS culture.

The NHS began life in 1948 with the noble intention of providing free health care for all from cradle to grave. Today the NHS is the largest employer in Europe employing in excess of one million people and it has commonly been held that, since the NHS is an organisation committed to treating and providing care to patients, those working for the NHS are generally perceived to hold, in the main, altruistic values. Over the last two decades NHS managers have been given the responsibility for the implementation of the various NHS reforms which have been aimed at making the NHS more efficient, effective, accountable and business like. This paper explores the extent to which the managers in this role as change agents believe that they hold core values that are in line with the altruistic service ethos of the NHS and as a result the extent to which they believe they are seen to be performing and behaving in a socially responsible manner. Furthermore this study also provides an insight into understanding the managers' perceptions of their public image and assesses the extent to which this has an impact on the managers’ psyche, performance and commitment to the NHS ethos. Twenty eight managers from two Acute Care and one Community Care NHS Trusts in London were interviewed, after completing questionnaires, with a view to understanding their perceptions of their managerial culture and their public image. It appeared that managers generally believed that all NHS workers, themselves included, share altruistic values and demonstrated a collective commitment to the altruistic service ethos of the NHS. This therefore demonstrates the managers' commitment to behaving and performing in a socially responsible manner. As far as the managers’ perceived public image is concerned the research revealed that the majority of the managers, despite holding values that were altruistic in nature and similar to those held by clinicians, appeared to be convinced that the general public believed that doctors and nurses are the only professionals in the NHS who are motivated by a desire to serve/provide care to society and that these groups alone have an altruistic ethos. The managers indicated that they felt the public viewed them in a generally poor light and did not confer upon them the service driven values that were ascribed to clinicians. It is in the context of being the main change agents within the NHS that NHS managers appear to have become unpopular with the general public who tend to hold the view that “a service which managers are trying to make ever more efficient, rational and controlled cannot at the same time be caring and people centred” [Learmonth, 1997, pg. 219]. Whilst the NHS managers were aware of this negative view held by the public, they felt certain that this public perception was misguided and driven by several unfair and politically motivated agendas. They do not appear to have allowed this perceived negative public opinion to affect how they view their own role and in fact offered various reasons to explain why this public opinion was misguided and misinformed. This paper considers the implications of these views as regards the managers' role and commitment to the NHS.

The purpose of this paper is to identify and explore tensions and challenges experienced by NHS managers while working for a socially responsible organization and the implications this has for the (re)formation of their work and self identities. The consequent impact on their performance and commitment is considered along with the implications this raises for the recruitment and retention of NHS managers.

The approach takes the form of primary research based on interviews with 20 NHS managers. The paper draws on theoretical frameworks and literature relating to identity theory, institutional theory, organization culture and social responsibility.

The NHS managers feel that they are driven by an altruistic NHS value system, although they feel that the public do not share this belief. As a consequence some managers with a clinical background had concealed or were defensive about their managerial titles, demonstrating a tension in their identity work.

The study is based on a relatively small sample of London‐based NHS managers and may not necessarily represent the views of managers London‐wide or nationally.

It is suggested that an explicit recognition of the NHS managers' commitment to behaving in a socially responsible manner within the NHS's CSR strategy may contribute towards challenging and alleviating some of the identity work tensions experienced by the managers. This may also contribute towards mitigating the current recruitment and retention difficulties associated with nurse‐managers within the UK NHS.

The paper attempts to provide a more holistic insight into the (re)formation of the NHS manager's self and work identity through drawing on theoretical frameworks and literature relating to identity theory, institutional theory, organization culture and social responsibility in an integrated manner. The paper would be of interest to a wide range of readership including NHS policy formulators, NHS practitioners, academics and students.

The NHS faces a crisis in terms of staffing and recruitment. Many of the ethnic minority GPs in inner city areas throughout the UK are coming up to retirement age, and there is an insufficient supply of trainees to fill estimated vacancies. Over 2,000 nursing vacancies exist across the UK, and recruitment to the profession and retention within the profession are poor. Nurses have been recruited from overseas for the past 40 years, and are currently being recruited from Finland, Malaysia, and the West Indies, whilst doctors are being sought in India, Pakistan and Africa. Overseas recruitment is not a new phenomenon, and numerous studies have been carried out to examine equal opportunities and racial discrimination within the NHS. The aim of this paper was to examine ethnicity and equal opportunities within the Scottish NHS and record the levels of organisational awareness of ethnicity and equal opportunities’ issues. The paper also examines the link between health service delivery to ethnic minorities and internal cultural attitudes to staff.

The purpose of this paper is to identify and explore the possible underlying reasons for the differences in approaches adopted by organisations regarding the inclusion or exclusion of explicit statements in relation to the personal commitment and contribution of their employees within their publicized CSR strategies.

The approach is based on a longitudinal study involving interviews with 47 UK National Health Service (NHS) managers between 2000 and 2009. Theoretical frameworks and literature related to CSR, organisation culture and institutional theory are drawn upon in an integrated manner to analyse and discuss the findings.

Although the majority of NHS managers report holding core altruistic values they believe the general public does not recognize this and views them negatively. It is suggested that a combination of direct and indirect strategies aimed at highlighting the socially responsible role of NHS managers and their overall commitment and contribution to the NHS would help challenge the existing negative public image of NHS managers.

The study is based on a relatively small number of London based NHS managers consisting mainly of managers occupying senior and middle management positions and who may not necessarily represent the views of all managers nationally.

Whilst issues related to CSR are of concern to a wide range of organisational stakeholders, there appears to be relatively limited research undertaken in the context of directly exploring issues of concern from the employee stakeholder perspective. Within the context of the aims of this paper, this paper addresses this relative gap. The paper is of interest to a wide range of readers including NHS and non‐governmental organisation (NGO) policy formulators and practitioners; academics and students.

The purpose of this paper is to conduct an empirical study derived from the previous literature from the perspective of benefits, tools and techniques, continuous improvement (CI) and quality improvement (QI) methodologies and critical failure factors (CFFs) of Lean and Six Sigma (SS) in the national health service (NHS).

A literature review was carried out to identify previous findings, empirical data and critical variables concerning Lean and SS in healthcare for over ten years. Second, primary research in quantitative surveys and qualitative interviews was carried out with 110 participants who have experience using Lean and SS in the NHS.

Lean and SS have evolved into common practices within the NHS and now have an established list of tools and techniques frequently employed by staff. Lean and SS are considered robust CI methodologies capable of effectively delivering extensive benefits across many different categories. The NHS must overcome a sizable amount of highly important CFFs and divided organizational culture.

This paper has developed the most extensive empirical study ever produced on Lean and SS in the NHS and has expanded on previous works to create new and updated research. The findings produced in this paper will assist NHS medical directors and practitioners in obtaining up-to-date insight into Lean and SS status in the NHS. The paper will also guide the NHS to critically evaluate their current CI strategy to ensure long-term sustainability and deliver improved levels of service to patients.

The purpose of this paper is to delineate the factors responsible for the decline of total quality management (TQM) in the National Health Service (NHS). It is suggested that if these factors were initially identified and eliminated prior to implementation, the decline of TQM as a strategy for improving the provision and delivery of quality patient care could have been prevented.

The case study approach was chosen because it is the preferred method when “how” or “what” questions are being posed. It is applicable as is evident in this paper where the researcher has little control over events and when the focus is on a contemporary phenomenon within some real-life context. The case study enables the researcher to give an accurate rendition of actual events; it contributes uniquely to the knowledge of individual, organisational, social, and political phenomena. The semi-structured face-to-face interview constituted the main data collection technique of the research. Interviews were held with 23 quality management managers in the British NHS. The central focus of the interview was on “what” factors contributed to the rapid decline of TQM in the NHS. The respondents were chosen because they were directly involved with the implementation of TQM. They were in the vintage position to offer a full insight into the TQM initiative. The analysis of the case is based on Yin's analytic technique of explanation building.

The decline of TQM in the NHS could have been prevented if top executives in hospitals had adopted the sequential steps to quality improvement: In the authors opinion, to land a man on the moon needed a belief in the possibility and breakthrough in the attitudes that viewed space travel as pure science fiction as opposed to a practical reality, and so it should have been with TQM in the NHS. However, the attitude of many NHS managers was that TQM was all right for “other institutions” because “they need it” whereas in the NHS, “we don’t”. This negative attitude should have been overcome if TQM was to be accepted as a corporate, all encompassing philosophy.

The limitation of the research may be the sample size of the respondents, which was limited to 23 quality managers that had hands-on experience and the leadership role to lead and implement TQM in the NHS. Future research may consider a broader sample size. It may also be considered for new research to use surveys to identify a broader set of reasons why TQM declined in the NHS.

This paper is the first constructive insight to determine reasons for the decline of TQM in the NHS from the individuals who had the sole responsibility for implementation. Any other, group would have amounted to hearsay. Therefore, to constructively delineate the reasons for failure, it was pertinent to learn from the quality managers directly and to ensure that the reasons was representative of their experiences with TQM. The practical implication is to prepare future managers about how to avoid failure.

The paper clearly suggests the systematic process required for effective implementation of TQM in a healthcare setting by identifying factors that must be avoided to ensure the successful and sustainable implementation of TQM.