Changing the Culture of a Hospital: From Hierarchy to NetworkedCommunity
| Date | 01 September 2000 |
| Published date | 01 September 2000 |
| Author | Paul Bate |
| DOI | http://doi.org/10.1111/1467-9299.00215 |
ARTICLES
CHANGING THE CULTURE OF A HOSPITAL:
FROM HIERARCHY TO NETWORKED
COMMUNITY
PAUL BATE
This article is a case study of a large-scale change programme within an NHS hospi-
tal. Drawing upon ethnographic data collected over a two-year period of intensive
research involvement, it tells how the hospital struggled to transform itself from
a rigid and divided ‘hierarchy’ into a more flexible and collaborative ‘networked
community.’ The paper describes the model of change devised for this purpose,
and seeks to capture the lessons learned on the rocky road to network organizing.
It concludes that the full potential of networks will only be realized if there are
correspondingly dramatic changes in culture, relationships and skills, all of which
have to be addressed as part of an overall organization development effort. Net-
works are more than just a new organizational form; they are also a new paradigm
for the professional organization, which is encapsulated in the notion of the ‘net-
work culture.’
INTRODUCTION
This paper describes a two-year project with an NHS hospital trust in the
West of England, which combined ethnographic research into the hospital’s
culture with an organization development project that involved feeding
back the findings and helping those involved work through an ambitious
change agenda. The change centred on a plan to rebuild the hospital on a
new greenfield site using private sector partnership capital raised under the
Private Funding Initiative (PFI)
1
, and on a phased programme to develop a
‘new’ prototype organization which would ‘fit seamlessly inside’ the new
hospital once it was built. The project bore all the hallmarks of a classical
Paul Bate is Professor of Health Services Management Development at the Health Services Manage-
ment Centre (HSMC), School of Public Policy, The University of Birmingham.
Public Administration Vol. 78 No. 3, 2000 (485–512)
Blackwell Publishers Ltd. 2000, 108 Cowley Road, Oxford OX4 1JF, UK and 350 Main Street,
Malden, MA 02148, USA.
486 PAUL BATE
socio-technical systems approach, the central task being to engineer a requi-
site level of fit between the technical (buildings, technologies, business
processes) and social (teams, structures, etc.) dimensions of the new organi-
zation.
Our role, as a research team from the nearby business school, was to help
in the second of these dimensions, and in the design and implementation of
the change process itself. The programme was envisaged as going beyond
structures, systems and processes in order (to use their words) to ‘create a
new culture for the hospital.’ Our brief was to carry out an in-depth investi-
gation of the current organization, its culture(s), conflicts and contradic-
tions, and input our findings into wider discussions relating to the change
programme. Basically it was to be a professional helping role, drawing
upon our previous experiences of working on cultural change issues with
other public service organizations.
BACKGROUND TO STUDY AND RESEARCH METHOD
The project undertaken can best be described by the term ‘action research’
(Burnes 1992; French and Bell 1984; Shani and Pasmore 1985), taking as its
guiding ethos Kurt Lewin’s simple but powerful notion, ‘No action without
research, and no research without action’ (Lewin quoted by Burke 1994,
p. 55). Research of this kind is certainly no stranger to healthcare organiza-
tions, and in many respects ours was no different from the many other
examples found in the organization development literature (Boss 1989;
Golembiewski 1987; Margulies and Adams 1982; Margulies and Dundon
1987). What they all share is the view that action research is not so much
a method as a model for the change process, one which oscillates between
research and action and seeks to generate real change on a grid of flexible
learning and experimentation.
The particular model used for the study, itself an original formulation
and reproduced here in the form in which it was used, is illustrated in
figure 1. One of the important characteristics of the model is that it does
not allow complacency or apathy because the wheel is constantly turning
as the change process (research – informed/intelligent action – further
research – further action) continues to unfold.
Designed to show the links between action research and organizational
learning, the diagram was intended to give all participants an insight into
the logic and rationale behind the study. This was important: action
research is a form of participative or cooperative inquiry (Reason 1994) in
which, to use a familiar cliche
´, research is done with people rather than to
them. Clearly this is only possible if the working framework is visible and
well understood by those involved, and the language of the expert de-mys-
tified so that participants can take ownership over the project.
The aim of the schematic was to suggest how the project might move
from data-gathering and analysis to feedback and discussion, to framework
building, action and evaluation, and on to further research – though not
Blackwell Publishers Ltd. 2000
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