Lise Elliott and Naomi Chambers
This paper uses data from an ethnographic study of a group of NHS community nurses in England, to analyse their work using labour process theory. A theory influenced by Marxist…
Abstract
Purpose
This paper uses data from an ethnographic study of a group of NHS community nurses in England, to analyse their work using labour process theory. A theory influenced by Marxist thinking, which is concerned with the examination of the labour process. This study of the nurses’ work provides insights into their labour process, as well as proposing theoretical development relating to labour process theory.
Design/methodology/approach
The paper has been developed using data from an ethnographically oriented study of a group of community nurses. Data was produced from 140 h of field observations and also semi-structured interviews with six, community nurses. The data produced from field observations and interview transcripts were analysed thematically and theory building was developed inductively.
Findings
The analysis within this paper highlights two areas of the nurses’ work and both illustrate the theoretical difficulties raised, when using labour process as a tool for analysis, as well as its usefulness. These two areas of work are aspects of invisible work and feelings of joy and sorrow; analysis of both these areas supports a theorising of a distinct relationship between nurse and patient. That is, a relationship between worker and human product, which the paper argues should be accommodated within labour process theory.
Research limitations/implications
More research is required to understand the nature of the proposed social relation in production, particularly with reference to other types of worker, in other caregiving settings. As the demands on healthcare workers and other public sector workers are likely to remain consistently high, improved analytical tools to support research into the nature of caregiving work seem both prudent and timely.
Originality/value
Labour process theory is a useful (but often under-used and rather unfashionable) tool in the analysis of service-based, public sector work. This paper proposes a theoretical development within labour process theory, which would recognise a social relation in production between a worker and their human product, based on empirical data from a study of community nurses. This theoretical development has the potential to improve the usefulness of labour process theory in the analysis of caregiving labour.
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Iain Snelling, Lawrence Adrian Benson and Naomi Chambers
The purpose of this study is to explore how trainee hospital doctors led work-based projects undertaken on an accredited development programme in England.
Abstract
Purpose
The purpose of this study is to explore how trainee hospital doctors led work-based projects undertaken on an accredited development programme in England.
Design/methodology/approach
This is a case study of a leadership programme for hospital-based specialty trainees. The programme included participants leading work-based projects which were submitted for academic accreditation. Accounts of 35 work-based projects were thematically analysed to explore how participants led their projects.
Findings
Leadership was often informal and based on a series of individual face-to-face conversations. The establishment of project teams and the use of existing communication processes were often avoided. The reasons for this approach included lack of opportunities to arrange meetings, fear of conflict in meetings and the personal preferences of the participants. The authors discuss these findings with reference to theory and evidence about conversations and informal leadership, highlighting the relevance of complexity theory.
Research limitations/implications
The data are limited and drawn from the best accounts written for a specific educational context. There is therefore limited transferability to the leadership work of hospital-based specialty trainees in general. Future research into medical leadership might explore the micro practices of leadership and change, particularly in informal settings.
Practical implications
Leadership development programmes for trainee hospital doctors might concentrate on developing skills of conversation, particularly where there are or may be perceived power imbalances. Exploring conversations within the theory of complex responsive processes should be considered for inclusion in programmes.
Originality/value
This paper adds some detail to the general understanding of learning leadership in practice.
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Rod Sheaff, Verdiana Morando, Naomi Chambers, Mark Exworthy, Ann Mahon, Richard Byng and Russell Mannion
Attempts to transform health systems have in many countries involved starting to pay healthcare providers through a DRG system, but that has involved managerial workarounds…
Abstract
Purpose
Attempts to transform health systems have in many countries involved starting to pay healthcare providers through a DRG system, but that has involved managerial workarounds. Managerial workarounds have seldom been analysed. This paper does so by extending and modifying existing knowledge of the causes and character of clinical and IT workarounds, to produce a conceptualisation of the managerial workaround. It further develops and revises this conceptualisation by comparing the practical management, at both provider and purchaser levels, of hospital DRG payment systems in England, Germany and Italy.
Design/methodology/approach
We make a qualitative test of our initial assumptions about the antecedents, character and consequences of managerial workarounds by comparing them with a systematic comparison of case studies of the DRG hospital payment systems in England, Germany and Italy. The data collection through key informant interviews (N = 154), analysis of policy documents (N = 111) and an action learning set, began in 2010–12, with additional data collection from key informants and administrative documents continuing in 2018–19 to supplement and update our findings.
Findings
Managers in all three countries developed very similar workarounds to contain healthcare costs to payers. To weaken DRG incentives to increase hospital activity, managers agreed to lower DRG payments for episodes of care above an agreed case-load ‘ceiling' and reduced payments by less than the full DRG amounts when activity fell below an agreed ‘floor' volume.
Research limitations/implications
Empirically this study is limited to three OECD health systems, but since our findings come from both Bismarckian (social-insurance) and Beveridge (tax-financed) systems, they are likely to be more widely applicable. In many countries, DRGs coexist with non-DRG or pre-DRG systems, so these findings may also reflect a specific, perhaps transient, stage in DRG-system development. Probably there are also other kinds of managerial workaround, yet to be researched. Doing so would doubtlessly refine and nuance the conceptualisation of the ‘managerial workaround’ still further.
Practical implications
In the case of DRGs, the managerial workarounds were instances of ‘constructive deviance' which enabled payers to reduce the adverse financial consequences, for them, arising from DRG incentives. The understanding of apparent failures or part-failures to transform a health system can be made more nuanced, balanced and diagnostic by using the concept of the ‘managerial workaround'.
Social implications
Managerial workarounds also appear outside the health sector, so the present analysis of managerial workarounds may also have application to understanding attempts to transform such sectors as education, social care and environmental protection.
Originality/value
So far as we are aware, no other study presents and tests the concept of a ‘managerial workaround'. Pervasive, non-trivial managerial workarounds may be symptoms of mismatched policy objectives, or that existing health system structures cannot realise current policy objectives; but the workarounds themselves may also contain solutions to these problems.
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In the light of failings of the board highlighted by the mid Staffordshire NHS Foundation Trust public inquiry, this paper seeks to offer insights about how boards in general…
Abstract
Purpose
In the light of failings of the board highlighted by the mid Staffordshire NHS Foundation Trust public inquiry, this paper seeks to offer insights about how boards in general might develop in order to discharge their responsibilities for quality and safety in health care more consistently in the future. The paper also proposes to examine wider questions about the role, purpose, and impact of boards on organisations.
Design/methodology/approach
The paper draws on literature from across the social sciences to assess the evidence for effective board working using a contingency and realist approach.
Findings
The examination leads to the identification of three key issues surrounding the construction and the development of boards. First, there is no evidence or consensus about an “ideal” board form. The rationale and evidence‐base, for example for the 1991 model for NHS boards in the English NHS, has never been set out in an adequate manner. Second, the evidence about effective board working suggests that there are some key principles but also that local circumstances are really important in steering the focus and behaviours of effective boards. Third, there is an emerging proposition that boards, including in healthcare, need to embody a culture of high trust across the executive and non executive divide, together with robust challenge, and a tight grip on the business of delivering high quality patient care in a financially sustainable way (high trust – high challenge – high engagement).
Originality/value
The paper argues that it is advisable to move away from a tendency to faith‐based and exhortative approaches to guidance, training and development of boards and that it is time for a root‐and‐branch inquiry into the composition, structure, processes and dynamics of healthcare boards in the interests of assuring patient safety.
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Lutgart Van den Berghe, Abigail Levrau, Naomi Chambers and Joris-Johann Lenssen
The purpose of this paper is to show how boards can get in touch with their value critical stakeholders, those who can make or break the company.
Abstract
Purpose
The purpose of this paper is to show how boards can get in touch with their value critical stakeholders, those who can make or break the company.
Design/methodology/approach
The paper first develops the hypothesis that boards often are out of touch with reality. It then introduces the concept of value critical stakeholders and proposes that boards introduce an outreach program to get in touch with them. For each of the proposed five elements in an outreach program, the paper reviews what boards already are doing to be in touch.
Findings
The review of existing practice shows that for each of the elements in an outreach program, there is enough practice available for boards to develop a comprehensive approach to get in touch with the value critical stakeholders.
Social implications
To prevent a future governance crisis, get in touch and promote long‐term value creation, boards need an explicit program of reaching out beyond the boardroom, not only to the immediate stakeholders, but also the societal stakeholders, who can make or break the company. This paper shows how it can be done.
Originality/value
The paper introduces the new concept of value critical stakeholders and describes how it can be used to help boards get in touch with reality.
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Heiko Spitzeck, Erik G. Hansen and David Grayson
This paper aims to describe the emerging practice of joint management‐stakeholder‐committees (JMSCs) in which corporate executives take decisions in collaboration with…
Abstract
Purpose
This paper aims to describe the emerging practice of joint management‐stakeholder‐committees (JMSCs) in which corporate executives take decisions in collaboration with stakeholders.
Design/methodology/approach
To identify firms involving stakeholders in their governance arrangements, the authors analysed 51 companies regularly participating in Business in the Community's Corporate Responsibility Index in the UK. The data provided by the index as well as corporate reports were then analysed to evaluate the impact of JMSCs on corporate decision‐making.
Findings
The research finds that JMSCs strongly influence corporate governance mechanisms such as monitoring and measurement as well as the policy development of firms.
Research limitations/applications
The analysis builds on corporate responses given to the questionnaire sent by the Corporate Responsibility Index as well as corporate reports. Future research is encouraged to triangulate findings with stakeholder opinions on the effectiveness of JMSCs.
Practical implications
JMSCs prove to be an effective tool to involve stakeholders in corporate decision‐making processes. Owing to their effectiveness JMSCs are more likely to create trust between firms and their stakeholders.
Originality/value
The paper is the first empirical investigation into the effectiveness of engaging stakeholders in joint management‐stakeholder committees, demonstrating the impact and effectiveness of such engagement.
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Alexander Bukhvalov and Barbara Bukhvalova
This paper aims to explain a new idea for the corporate board's main agenda, which should dramatically increase the scale of problems with which the board deals. This agenda also…
Abstract
Purpose
This paper aims to explain a new idea for the corporate board's main agenda, which should dramatically increase the scale of problems with which the board deals. This agenda also changes the board's interaction with the management providing a new approach to the agency problem.
Design/methodology/approach
The paper is based on the normative method. The authors rely on cases (only a few are presented here) to illustrate uses of the real option analysis in the approach to the board activities. The paper shows that, on one hand, it is impossible to avoid managerial fraud and misconduct by means of the board's (and authorities’) traditional monitoring, even under the maximum possible toughening of the criminal and civil law, but, on the other hand, it is possible to change the content of the board‐management interaction to prevent fateful events.
Findings
The paper shows how “the duty to say no” approach can prevent corporate failure and, at the same time, facilitate growth and innovation. The underlying basic idea is to use the real options analysis (ROA), which gives an approach to designing strategies under uncertainty. The paper illustrates this technique on different real‐life cases.
Research limitations/implications
The paper's strategic approach does not ignore such traditional issues as remuneration and executives and board turnover. It just shifts the priorities of the board. Obviously, further research is needed to articulate the appropriate approach for various circumstances.
Originality/value
The paper proposes and justifies a dramatic change in the board's duties. It suggests an approach to finding the most important business problems, which require strategic rather than technical decisions; a substitution of the existing “forensic” approach with a “large‐scale” one, turning the board from a policeman into a leader; a change to the style of the board's interaction with the top management of the company.
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This paper aims to investigate the role of boards in owner‐managed small to medium‐sized enterprises (SMEs), and seeks answers to the questions of whether boards generally enhance…
Abstract
Purpose
This paper aims to investigate the role of boards in owner‐managed small to medium‐sized enterprises (SMEs), and seeks answers to the questions of whether boards generally enhance good governance in SMEs, and whether the use of outside board members plays a significant role. Finally, the paper seeks to examine the question of whether in practice owner‐managers see their boards as a resource.
Design/methodology/approach
The paper is based on a study of the ownership and control structure in 1,313 SMEs and an interview survey of 1,040 Danish owner‐managed SMEs.
Findings
The analysis of the empirical studies indicates that the role of a board as a resource is more important than its control role, which suggests that there should be a multi‐theory approach to board roles in SMEs. It also indicates that good governance appears to be associated with the existence of boards and of outside board members, and finally that boards in SMEs remain an untapped resource.
Originality/value
The paper contributes to the empirical literature on the role of boards. It contributes to the understanding of the role of boards in SMEs and to whether boards enhance good governance in SMEs. It also gives an insight as to whether boards are an untapped resource in SMEs.