School of Management

The Centre for Public Services Organisations

Managing Change and Role Enactment in the Professionalised Organisation

Research Officer: Rachael Addicott

This project was a collaboration with the Department of Human Resources Management at De Montfort University, Leicester. Professor Louise Fitzgerald (DMU) is the Principal Investigator and Professor Ewan Ferlie co-investigator. Dr Juan Baeza from Tanaka Business School, Imperial College London is also working closely on the project. The aim of this research was to examine how clinical directors and service managers from non-clinical backgrounds interpret and enact their roles and use them to implement effective service change. The project also recognised that the assessment of 'effective' change would require the use of multiple criteria, and such, the project also sought to identify what additional factors account for individual or organisational differences in the effectiveness of change implementation.

The design of the study was predominantly qualitative and inductive, comparing and contrasting case studies of ten sites that were purposefully selected. This design facilitated the construction of a large-scale database with both internal and external validity. The ten sites consisted of four primary care sites and six acute sector sites in London and the West Midlands.

In each site, the case focused on a selected area of care and our design included three clinical areas of care - cancer; maternity and diabetes (in primary care). These care groups were chosen in relation to the priorities set out in the National Plan. Case study sites were purposefully selected using a two-stage process, to assess case contexts as of 'higher' and 'lower' complexity. The rationale for this selection is to enable the researchers to examine the extent to which complex, contextual pressures affect the interpretation and enactment of roles and relationships. Case analysis involved the gathering of data on the context, roles, interpretation of the roles and the activities undertaken. Data collection methods include archival data, interviews and observations of meetings, but with interviews as a prime data source. Interviews were semi-structured and approximately 200 interviews were conducted. Analysis was an iterative process and occurred in stages. The final stages of the project consisted of local and regional workshops, run collaboratively with professional organisations and user and advocacy organisations, to debate and action plan on the basis of the findings.

Whilst not setting out to focus specifically on context, the conclusions drawn collected emphasised the crucial importance of context for understanding why and under what conditions, clinical service improvements may or may not progress. In order to exemplify these points in greater detail the study developed a typology across all eleven sites. This typology sought to exemplify the links between the positive or negative factors and characteristics of the context and the extent of progress within the specific care area under study.


The National Institute for Health Research Service Delivery and Organisation Programme (SDO)

National Health Service Delivery and Organisation Research and Development Programme (NCCSDO).