|dc.description.abstract||The UK NHS which is the largest organisation in Europe provides high quality healthcare free at the point of delivery to all its citizens. NHS managers play an instrumental role within it as they are expected to implement the various government led reforms designed to make the NHS an increasingly efficient, effective and accountable organisation.
This study is concerned with examining the NHS managerial culture in the context of the various challenges and tensions facing the 21st century NHS managers. The study explores the NHS managers’ core values with a view to investigating the relative strength of the managers’ commitment towards altruistic based values befitting the NHS ethos. Furthermore given that it is widely recognised that the NHS managers believe the public hold a generally negative view of them, this study also develops an understanding of the implications of the NHS managers’ negative perceived public image for their self and work identity. The importance of how managers perceive their self and work identity and how they believe they are perceived by others has implications for their work performance, organisational commitment and satisfaction.
Through a qualitative based research design the study draws upon semi-structured interviews with twenty healthcare managers working in the public and private sectors within London and explores their views, perceptions and experiences in relation to the above issues. The interviewees consisted of healthcare managers working in an Acute Care NHS Trust and for comparative reasons also included managers who worked in a large private sector hospital. The comparative interviews were useful in determining the extent to which the key issues central to this study were unique to the NHS managerial culture or whether they were equally pertinent to the wider healthcare managerial sector. The main theoretical framework underpinning this study is derived from and is relevant to Organisation Culture, New Institutional Theory, Self and Work Identity Theory and Corporate Social Responsibility. These relatively disparate fields of study are drawn upon in an integrated manner to explore and discuss the findings as they prove useful in developing a more holistic and deeper understanding of the key issues central to this study.
The study findings demonstrate that the majority of NHS managers had actively sought the opportunity to work in a caring based profession such as the NHS because it was underpinned by altruistic based values thereby demonstrating a high level of commitment to these values. Unlike the private healthcare managers, all the NHS managers interviewed reported that they believed the public viewed them negatively and for many of the NHS managers this caused tensions in relation to their self and work identity. Half of the NHS managers, regardless of whether they came from clinical or non-clinical backgrounds, reported emotions of demoralisation, frustration, irritation and anger as a result of this negative perceived public image. These findings provide unique and hitherto unexplored insights into the challenges and tensions facing NHS managers. Possible mitigating strategies and potential policy implications are explored in this thesis.||en