Catalysing organisational change within complex networks in the English National Health Service (NHS): an ethnographic account of disciplinary power

McCulloch, Sean James (2022) Catalysing organisational change within complex networks in the English National Health Service (NHS): an ethnographic account of disciplinary power. Doctoral thesis, Northumbria University.

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Abstract

The English National Health Service (NHS) is a complex system, subject to constant change and organisational turmoil. In order for the NHS to deliver care that meets the needs of patients, it needs to be able to effectively manage organisational change. However, the existing literature emphasises planned approaches to change, which are not always suitable for such a complex environment and often fail to take into account underlying power dynamics. Adopting an explicitly Foucauldian research paradigm, the purpose of this research was therefore to explore how individual change leaders engage with power to facilitate the delivery of organisational change within network environments.

Utilising an insider ethnographic research design, data was gathered from the Researcher’s substantive workplace within the English NHS. Taking place over 14 months between 2019 and 2020, the Researcher gathered over 200 hours’ worth of data and produced over 3000 pages of transcripts, utilising a combination of participant observation, interviews and document analysis. To support this triangulated approach to data collection, the Researcher established a forum to enable participants to have input into the emerging research in real-time, which provided multiple opportunities for debate and discussion. The Researcher also capitalised upon their status as a member of the community, to engage in deep and sustained reflexive practice, which added to the richness of the data.

When viewed through a Foucauldian lens, the findings suggested that change leaders were able to engage with disciplinary power via the use of technologies, specific power/knowledge constructs that could be deployed to achieve specific effects. These power effects shaped how individuals worked upon their identities to become productive within a change management context. This complex dynamic, which also included the Researcher shaping themselves as a productive subject, had varying manifestations at the individual, team and network level which shaped how organisational change took place within the network environment. Conceptualising change management as a process of mobilising productive subjectivities therefore has significant implications for how change is approached within healthcare and other public administration settings.

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