St Andrews Research Repository

St Andrews University Home
View Item 
  •   St Andrews Research Repository
  • University of St Andrews Research
  • University of St Andrews Research
  • University of St Andrews Research
  • View Item
  •   St Andrews Research Repository
  • University of St Andrews Research
  • University of St Andrews Research
  • University of St Andrews Research
  • View Item
  •   St Andrews Research Repository
  • University of St Andrews Research
  • University of St Andrews Research
  • University of St Andrews Research
  • View Item
  • Login
JavaScript is disabled for your browser. Some features of this site may not work without it.

Managing change in the culture of general practice : qualitative case studies in primary care trusts

Thumbnail
View/Open
marshall2003bmj599.pdf (87.11Kb)
Date
13/09/2003
Author
Marshall, MN
Mannion, R
Nelson, E
Davies, Huw Talfryn Oakley
Keywords
Clinical governance
Autonomy
Manager
R Medicine (General)
Metadata
Show full item record
Altmetrics Handle Statistics
Altmetrics DOI Statistics
Abstract
Objectives To explore the potential tension between the need for managers to produce measurable change and the skills required to produce cultural change, and to investigate how managers of primary care trusts are attempting to deal with this tension. Design Qualitative case studies using data derived from semistructured interviews and a review of published documents. An established cultural framework was to used to help interpret the findings. Setting Six primary care trusts in England purposefully sampled to represent a range of cultural, structural, geographical, and demographic characteristics. Participants 42 interviews with 39 different senior and middle primary care trust managers conducted over an 18 month period. Results We found two distinct and polarised styles of management. One group of managers adopts a directive style and challenges the prevailing norms and values of clinicians, an approach characteristically seen in organisations with hierarchical cultures. This group is made up mostly of senior managers who are driven principally by the imperative to deliver a political agenda. Managers in the second group are more inclined to work with the prevailing cultures found in general practice, attempting to facilitate change from within rather than forcing change from outside. This management style is characteristically seen in organisations with a clan-type culture. The approach was manifest mostly by middle managers, who seem to act as buffers between the demands of senior managers and their own perception of the ability and willingness of health professionals to cope with change. The different management approaches can lead to tension and dysfunction between tiers of management. Conclusions The development of primary care depends on high quality managers who are able to draw on a range of different management skills and styles. Managers ate most likely to be effective if they appreciate the merits and drawbacks of their different styles and arc willing to work in partnership.
Citation
Marshall , MN , Mannion , R , Nelson , E & Davies , H T O 2003 , ' Managing change in the culture of general practice : qualitative case studies in primary care trusts ' , British Medical Journal , vol. 327 , pp. 599-602 . https://doi.org/10.1136/bmj.327.7415.599
Publication
British Medical Journal
Status
Peer reviewed
DOI
https://doi.org/10.1136/bmj.327.7415.599
ISSN
0959-8138
Type
Journal article
Rights
© 2003 Marshall et al. This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 3.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited
Collections
  • University of St Andrews Research
URL
http://www.scopus.com/inward/record.url?scp=0141724834&partnerID=8YFLogxK
http://dx.doi.org/10.1136/bmj.327.7415.599
URI
http://hdl.handle.net/10023/4668

Items in the St Andrews Research Repository are protected by copyright, with all rights reserved, unless otherwise indicated.

Advanced Search

Browse

All of RepositoryCommunities & CollectionsBy Issue DateNamesTitlesSubjectsClassificationTypeFunderThis CollectionBy Issue DateNamesTitlesSubjectsClassificationTypeFunder

My Account

Login

Open Access

To find out how you can benefit from open access to research, see our library web pages and Open Access blog. For open access help contact: openaccess@st-andrews.ac.uk.

Accessibility

Read our Accessibility statement.

How to submit research papers

The full text of research papers can be submitted to the repository via Pure, the University's research information system. For help see our guide: How to deposit in Pure.

Electronic thesis deposit

Help with deposit.

Repository help

For repository help contact: Digital-Repository@st-andrews.ac.uk.

Give Feedback

Cookie policy

This site may use cookies. Please see Terms and Conditions.

Usage statistics

COUNTER-compliant statistics on downloads from the repository are available from the IRUS-UK Service. Contact us for information.

© University of St Andrews Library

University of St Andrews is a charity registered in Scotland, No SC013532.

  • Facebook
  • Twitter