An Ethical Approach to Leading Change: An Alternative and Sustainable Application

Cover......Page 1
Contents......Page 8
Acknowledgements......Page 12
Foreword......Page 13
1 Introduction......Page 16
1.1 Aim of the research......Page 23
1.2 Structure of the book......Page 24
2.1 UK government modernisation agenda......Page 30
2.2 The national service frameworks......Page 32
2.3 Structure of the public healthcare sector......Page 33
2.4 Local situation......Page 34
2.5 Positioning in the literature on healthcare reform......Page 35
2.5.1 CMS, NPM and the modernisation agenda......Page 37
2.5.2 Summing up......Page 38
2.6 Management and organisational change in healthcare......Page 39
2.7 Omega\'s local implementation plan......Page 42
2.7.1 Local input to the plan......Page 44
2.7.2 Perceived implementation challenges......Page 45
3.1 Structural conceptions of change......Page 47
3.2 Practitioners and change......Page 51
3.3 Narrative and organisational change......Page 54
4 Turning to Narrative......Page 58
4.1 \'Literary studies\' turn......Page 60
4.2 The narrative turn......Page 63
4.2.1 Narrative genres......Page 67
4.2.3 Critiques of the narrative turn......Page 68
4.3 Narrative- based organisational studies......Page 70
4.4.1 Managing change......Page 72
4.5.1 Meaning of change......Page 73
4.5.2 Multiple meanings......Page 75
4.6 MacIntyre, narrative and organisational change......Page 77
4.6.1 Narrative unity......Page 83
4.6.2 Relationship between virtues, goods, practice and institutions......Page 84
4.7 Concluding comments......Page 86
5.1.1 A short story of my quest......Page 88
5.2 Structural functionalist and social constructionist......Page 90
5.2.1 Narrative social construction......Page 91
5.3 A narrative approach to the study of organisations......Page 93
5.3.1 Organisational change as shifting narratives......Page 94
5.4 Critiques and strategies......Page 96
5.5.1 Research question evolution......Page 99
5.5.2 Method outline – a synthesis......Page 100
5.5.3 Stage one: Participant identification and interviews......Page 101
5.5.4 Stage two: Data processing and analysis......Page 105
5.5.5 Stage three: Feedback and focus groups......Page 109
5.5.6 Stage four: MacIntyre informed analysis......Page 110
5.7 Structure of the data and analysis chapters......Page 111
6 Stories: Epic, Tragic, Comic and Romantic......Page 114
6.1 Story classification......Page 116
6.2.1 \'Finding the flow\'......Page 119
6.2.2 \'Subversive\'......Page 122
6.2.3 \'I\'m not having it!\'......Page 125
6.2.4 Conclusion to the epic stories......Page 126
6.3 Tragic: Three forms of loss......Page 127
6.3.1 \'Cuckoo organisation\'......Page 128
6.3.2 \'Wasted talent\'......Page 130
6.3.3 \'Nobody to get angry with\'......Page 132
6.3.4 Conclusion to the tragic stories......Page 135
6.4.1 \'Bite on the bottom\'......Page 136
6.4.2 \'I shred it\'......Page 138
6.4.3 \'Gone shopping\'......Page 140
6.5.1 \'Rose-tinted glasses\'......Page 143
6.5.2 \'My staff need me\'......Page 146
6.5.3 \'Just absorb that crap!\'......Page 148
6.5.4 Conclusion to the romantic stories......Page 151
6.6 Conclusion to the stories......Page 152
7 Serial: Community Mental Health Team Formation......Page 157
7.1 Community mental health team serial......Page 158
7.1.1 Episode 1 – Beginnings: GPs fight tooth and nail......Page 159
7.1.2 Episode 2 – Bringing the policies of two institutions together: Trench warfare......Page 161
7.1.3 Episode 3 – Spanning health and social care......Page 165
7.1.4 Episode 4 – Underway with a depressed crew and a holed ship......Page 167
7.1.5 Episode 5 – \'Dog\'s dinner\' – the compilation episode......Page 171
7.2 Conclusion to the CMHT serial......Page 175
8 Themes......Page 178
8.1.1 Theme 1 – No authority, deferred vision......Page 180
8.1.2 Theme 2 – Under siege......Page 182
8.1.3 Theme 3 – Comedy – Laughing off the pressure......Page 185
8.1.4 Theme 4 – Improving change management practice......Page 187
8.2.1 Theme 5 – Policies not meaningful on the ground......Page 192
8.2.2 Theme 6 – Financial and \'must do\' pressure increasing......Page 196
8.2.3 Theme 7 – Two \'currents\' or \'atmospheres\' with a widening gap in understanding......Page 198
8.3 Themes conclusion......Page 200
9 Feedback and Focus Groups......Page 205
9.1 Director of mental health meeting......Page 206
9.2 Mental health managers\' meeting......Page 207
9.3 Third-round interviews......Page 208
9.4 Focus groups – All omega managers......Page 215
9.5 Regional workshop and focus groups......Page 217
10.1 Aims of the book......Page 219
10.2 Narratives of the institution......Page 220
10.3.1 Methodological contributions......Page 227
10.3.2 Empirical contributions......Page 228
10.3.3 Theoretical contributions......Page 230
10.4.2 New research agendas......Page 241
10.5.1 Implications for reform policy......Page 242
10.5.2 Implications for theory......Page 244
10.5.3 Implications for management education – a postscript......Page 246
Appendix......Page 249
Notes......Page 251
Bibliography......Page 255
C......Page 266
G......Page 267
M......Page 268
P......Page 269
S......Page 270
Z......Page 271