Etheridge, Lucinda; (2014) The trouble with culture : an interpretive case study of organisational culture, learning and quality improvement in the National Health Service. Doctoral thesis , UNSPECIFIED.

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Abstract

This interpretive case study investigates the relationship between organisational culture, organisational learning and cultural change in the National Health Service (NHS). Starting from a social constructivist standpoint, it conceives of organisational culture as a dynamic entity, socially and discursively constructed through engagement with surroundings, in contrast to the managerial discourse evident in NHS policy and research literature. The conceptual framework informing the research is based on cultural historical activity theory and a three perspectives theory of organisational culture. This allows exploration of individual and collective learning within the context of organisational social and cultural practice, exploring the organisation at the macro level but also through the lived experiences of individuals. An interprofessional department in an NHS provider organisation was studied for four months as it went through a programme of service improvement. Data was collected and analysed iteratively through a combination of observation, interview, documentary reading and field notes. Analysis using an activity theoretical approach generated a „thick description‟ of the organisation. Organisational stories were analysed to explore meaning making. Findings suggest that organisational culture can be considered a shared epistemic object within fluid networks of activity. Individual and collective learning is linked through practice, mediated by external political motivations and internally generated contradictions. Understandings of professional power play a major part and can lead to unexpected directions of travel. Conceptually, the study shows activity theory to be a useful framework for analysing learning and cultural change in NHS organisations. It adds to the debate on the self and the role of power and contradiction in activity theory through the application of a three perspectives approach to culture. It can help guide practitioners and policy makers in the NHS by encouraging them to rethink their understandings of culture and how cultural change is achieved through mediated practice.

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