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The purpose of this paper is to draw on the direct experience of a practitioner undertaking real-time research in his organization to offer insights into the dual role of practical insider and theoretical outsider. The duality helps the researcher to live “in” and think “out” of the research context to develop a theory for practice and then transpose it to a practice for theory through the collaboration of an external theoretical insider.

This is a theoretical account of the reflexive experience of the practitioner reintroducing relational ethnography, where the researcher regards processes and spaces as the objects of analysis rather than bounded groups and places. It emphasizes the relational significance of the researcher, researched, and theoretical insider in exploring the structures of relations and meanings in the field of professional practice.

The paper argues that understanding the complementariness and paradoxes of the dual role helps the researcher to identify knowledge gaps and contest commonsense knowledge in search of critical knowledge and theoretical insights. The transition between the bounded (restrained) and unbounded (unrestrained) selves occurs in the holding space of research, influencing the position from which the researcher views himself, his subjects, and his social world.

The paper extends the dimension of ethnographic research, which de-centers the authority and control of the researcher to that of the relationship between the researcher and informants, by focusing on the relational significance between the researcher, researched, and theoretical insider. This perspective gives rise to a deeper understanding of relational ethnography, seen largely in sociological research, as relevant to organizational research, where structures of relations and actions explored in real time could account for the configuration, conflict, and coordination of work practices.

Hospital mergers are common in the United Kingdom and internationally. However, mergers rarely achieve their intended benefits and are often damaging. This study builds on existing literature by presenting a case study evaluating a merger of two hospitals in Oxford, United Kingdom with three distinct characteristics: merger between two university hospitals, merger between a generalist and specialist hospital and merger between two hospitals of differing size. In doing so, the study draws practical lessons for other healthcare organisations.

Mixed-methods single-case evaluation. Qualitative data from 19 individual interviews and three focus groups were analysed thematically, using constant comparison to synthesise and interpret findings. Qualitative data were triangulated with quantitative clinical and financial data. To maximise research value, the study was co-created with practitioners.

The merger was a relative success with mixed improvement in clinical performance and strong improvement in financial and organisational performance. The merged organisation received an improved inspection rating, became debt-free and achieved Foundation Trust status. The study draws six lessons relating to the contingencies that can make mergers a success: (1) Develop a strong clinical rationale, (2) Communicate the change strategy widely and early, (3) Increase engagement and collaboration at all levels, (4) Be transparent and realistic about the costs and benefits, (5) Be sensitive to the feelings of the other organisation and (6) Integrate different organizational cultures effectively.

This case study provides empirical evidence on the outcome of merger in a university hospital setting. Despite the relatively positive outcome, there is no strong evidence that the benefits could not have been achieved without merger. Given that mergers remain prevalent worldwide, the practical lessons might be useful for other healthcare organisations considering merger.

This article has been withdrawn as it was published elsewhere and accidentally duplicated. The original article can be seen here: 10.1108/09513559710156733. When citing the article, please cite: Sue Dopson, Rosemary Stewart, (1997), “The changing role of the regional tier of the NHS”, International Journal of Public Sector Management, Vol. 10 Iss: 1/2, pp. 93 - 107.

The impact of structural change is being substantially felt in middle management, with many commentators prepared to write off this tier of management. Explores the changing role of the middle manager and the implications for Human Resource Management. Drawing on two research programmes argues against the general view and suggests middle management is pivotal to HRM.

The translation of research into practice is currently a high‐profile issue in the NHS. A number of regions have undertaken work in this area. Reports on a project that is part of the Anglia and Oxford Regions′s “Getting Research into Practice” (GRiP) initiative. The work focuses on the use of steroids in pre‐term delivery, a procedure that medical evidence suggests can reduce neo‐natal mortality and morbidity. Presents a number of findings which suggest that getting research into practice does not merely rest on the availability of well‐researched evidence.

Interview data from a two and a half year study of 20 District General Managers (DGMs) from a wide variety of backgrounds confirmed the view that there has been widespread dissatisfaction about the work of the District Medical Officer (DMO). This dissatisfaction was often mirrored by the DMOs themselves. We therefore supplemented the interviews with a questionnaire listing 16 principal functions of community medicine and asked the DGMs and their DMOs independently to rate the amount of attention devoted by the DMO to each function both currently and ideally. We found a contrast between the overall uncertainty and concern expressed about community medicine during discussions, and the enthusiasm for the itemized community medical functions. There was close correlation between the DGMs' and DMOs' mean rates, which were always higher in the ideal than the current rating, and particularly so for the DMO's work in information and assessment of need, in service evaluation, and — only among the DMOs' responses — in the independent advocacy of public health. We present the detailed results for all the functions, and discuss the implications of these and our interview data for the implementation of the Acheson Report and for the managerial education of public health physicians.

Considers the extent to which one organization through rationalization and redundancy programmes has violated its psychological contracts with its middle manager employees by removing the prospect of a traditional career. Offers a review of the issues raised in the literature on careers and the psychological contract and a case study of the impact of change on individual middle managers. Describes the empirical work carried out in British Telecom on which the article is based. Concludes that both the nature of middle management jobs and the career opportunities available have changed considerably, resulting in breaches of the psychological contract. However, individual managers have reacted differently to the changes, depending on their ability and willingness to pursue informal networks and personal contacts.

Reviews the past role of regional health authorities in the the British NHS and gives details of the recent changes to regions associated with the functions and responsibilities paper. Goes on to give details of the research project in which we are currently involved and reports on our interim findings (as of April 1996). In a final discussion section, reflects on those findings in terms of the evolving problems of influence and control in a national service operating in a devolved quasi‐market.

Considers progress made in involving doctors in management, drawing on available ethnographies of local health‐care systems and a small‐scale study of consultants who have moved into clinical director roles or the equivalent. Specifically considers the extent to which the sample believes consultant roles have changed as a result of the recent reorganization of the NHS and general concerns about the involvement of doctors in management.