Contested terrain. The incomplete closure of managerialism in the health service
| Published date | 01 October 1996 |
| Date | 01 October 1996 |
| DOI | https://doi.org/10.1108/00483489610130904 |
| Pages | 8-22 |
| Author | Graeme Currie |
| Subject Matter | HR & organizational behaviour |
Personnel
Review
25,5
8
Contested terrain
The incomplete closure of
managerialism in the health service
Graeme Currie
Centre for Health Services Management, University of Nottingham, UK
Introduction
This paper concerns itself with public-sector managerialism and how managers
in the health service with a clinical background are encouraged to adopt
business values and associated behaviours. It links to academic work which
sees senior managers in the public sector as promulgating a management-
devised culture which seeks to unite employees around core beliefs of customer
or quality service[1]. This suggests they seek to elicit behavioural changes in
employee’s delivery of public goods and services which reflect those beliefs.
This reflects changes within the health service which see health service
delivery move from a professionally (producer) defined service to a patient
(consumer) defined workplace[2]. The application of business management
approaches into spheres such as health care has been seen as not so much an
empirical issue about how such activities may be organized but as the
transformation of such an organization into a managerial organization[3].
Academic literature suggests that the transformation of the public sector along
these lines, what has been referred to as “managerialism”[4], is problematic.
The very hollowness of managerial discourse has been said to constitute it as a
site of conflict between different interests in the public sector[5], it being seen as
contested terrain[6].
Initially the paper outlines themes which emerged from a series of semi-
structured interviews across a range of health trusts. These focus on feelings
clinical services managers have about culture and change in the health service
and the impact of management development programmes on the change
process. The issues raised in the semi-structured interviews are then taken
forward to a single case study, a medium-sized hospital trust. The researcher
“hangs around and listens into” a management development programme aimed
at middle managers with a mainly nursing background. Here the theme of
ideological conflict comes into central focus. Analysis of outcomes suggests
that the managerial assumptions on which the programme is based result in
resistance from participants. They resist the attempts of facilitators to provide
“closure” whereby managerial ways of doing things are suggested as the
“obvious way ahead”.
To reiterate, the paper emphasizes the importance of competing ideologies in
the health service following exploratory interviews and then analyses how this
manifests itself in a management development programme in a single case study.
Personnel Review, Vol. 25 No. 5,
1996, pp. 8-22. © MCB
University Press, 0048-3486
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