Financial Constraints: An Inhibitor or Stimulator of Innovation?
A Case Study of the Countess of Chester Hospital NHS Foundation Trust
MASTER THESIS
MSc PUBLIC ADMINISTRATION
FACULTY OF GOVERNANCE AND GLOBAL AFFAIRS UNIVERSITEIT LEIDEN
THE NETHERLANDS
Author: Abbey Roberts s1914987 Supervisor: Dr. Joris van der Voet Second reader: Prof. Dr. Sandra Groeneveld
TABLE OF CONTENT
CHAPTER 1 P.3
1.1 Introduction and research question 1.2 Academic and social relevance 1.3 Thesis structure: a reader’s guide
CHAPTER 2: LITERATURE REVIEW AND THEORETICAL FRAMEWORK P.8 2.1 Innovation in the public sector
2.2 ‘Necessity is the mother of rigidity’- Threat Rigidity Theory 2.3 ‘Necessity is the mother of invention’- Prospect Theory 2.4 Finding middle ground- A contingency framework
CHAPTER 3: RESEARCH DESIGN P.21
3.1 Research design and case selection
3.2 Methods for data collection and interview strategy 3.3 Operationalisation of variables
3.4 Strategy for analysis 3.5 Reliability and validity
CHAPTER 4: DATA ANALYSIS P.31
4.1 Results concerning threat-rigidity theory 4.2 Results concerning prospect theory 4.3 Summary table of findings
CHAPTER 5: DISCUSSION AND CONCLUDING REMARKS P.49
5.1 Discussion 5.2 Academic Implications 5.3 Study Limitations 5.4 Practical Implications 5.5 Future Research REFERENCE LIST P.59
ABBREVIATIONS
A&E = Accident & Emergency
HR = Human Resources
IM&T = Information, Management & Technology NHS = National Health Service
U.K. = United Kingdom
CHAPTER 1
1.1. Introduction and Research Question
The public sector in any country around the world plays a pivotal role in the society of that given country; from being the provider of social welfare, healthcare and education, to the management of finances, the economy and the administration of courts. Indeed, the purpose of public services is not to generate profit, but rather to collectively provide services needed by society outside the realm of market relationships (Flynn, 2007). In dealing with its role as the main service provider to citizens, the public sector must continuously create feasible and workable solutions to both current and future problems within all services areas. Defined as a necessary condition for the modernisation of government (Bekkers, Edelenbos & Steijn, 2011), one such way of providing the required solutions is through the concept of innovation. Aimed at increasing the overall effectiveness and efficiency of the public sector, the need for innovation has never been so paramount since the onset of the 2007-2008 global financial crisis. As both widely known and acknowledged, the crisis forced governments to impose across-the-board cutback programmes on public sector service organisations in order to compensate for the expenditures made in ensuring the survival of the banking sector (Bekkers et al., 2011; Torfing & Triantafillou, 2016). Fuelling a high degree of uncertainty within the public sector, such cutback programmes served to compromise the sector’s capacity to deliver services equalling the level of quality experienced prior to the crisis (OECD, 2014).
In the decade since 2008, the imposed cutback programmes within developed economies have done much to focus attention upon the added value innovation can bring. Along with this, and future predictions for periods of austerity, cutback programmes have initiated a search for
ability to be innovative (Bekkers et al., 2011), there is still a strong lack of consensus within academia on whether or not imposed financial constraints act more to stimulate innovation or to inhibit innovation (Mone, McKinley & Barker, 1998). On one hand, some academic studies have concluded that external threat (such as financial constraint) results in an organisation conserving currently available resources and becoming overly reliant upon familiar routines, which leads to innovation being inhibited (Staw, Sandelands & Dutton, 1981; Latham & Braun, 2009; Muurlink, Wilkinson, Peetz & Townsend, 2011). However, on the other hand, alternative studies conclude that organisations experiencing external threat stimulate innovation as a means of adaption and solution seeking (Manns & March, 1978; Kahneman & Tversky, 1979; Koberg, 1987; Zajac & Kraatz, 1993).
Whilst the aforementioned studies display an abundance of available research conducted in an attempt to understand the relationship between externally imposed constraints and innovation, further research in this sub-field of public administration is required. The majority of the studies to be conducted so far have adopted a quantitative research design. As with research on any topic, it is imperative that in-depth qualitative studies are conducted and their results included. Qualitative research allows for the detailed examination and exploration of the various mechanisms and themes in play within a particular organisational setting (Rubin & Rubin, 2012). This permits an analysis of how, in this instance, financial constraints impact innovation. Additionally, the settings of previous research heavily centre on universities, government agencies and also private enterprises and organisations, with there yet to be any form of systematic research that draws in on the relationship between financial constraints and innovation within a public health sector context. Given this, it would be fruitful to qualitatively research the financial constraint-innovation relationship within a health sector context, of which NHS England is currently a pertinent example. Through this, the research problem of
whether financial constraints act as an inhibitor or stimulator of innovation can be analysed to see which is more valid. This brings us to the following central research question:
‘How do financial constraints affect innovation within the Countess of Chester Hospital NHS Foundation Trust?’
1.2. Academic and Social Relevance
Academically, this research will build upon the existing research regarding the literature on both cutbacks and innovation, as well as contributing to the broader field of public administration. As previously mentioned, the 2007-2008 global financial crisis triggered a renewed focus on the study of financial constraints and the subsequent effects such constraints could have on public sector organisations and their employees (Bozeman, 2010; Kiefer, Hartley, Conway, Briner, 2014; van der Voet and Vermeeren, 2017). One such possible affect was on innovation, and whether or not financial constraints would act to inhibit innovation or stimulate it. Consequently, two contrasting frameworks have been utilised by academics when formulating theoretical propositions regarding the constraint-innovation relationship. The first framework, threat-rigidity theory, stipulates that external threat causes an organisation to conserve current resources and to rely upon familiar routines already embedded within the organisation (Staw et al., 1981) Ultimately this results in a lack of innovation within the said organisation. On the contrary to this, prospect theory argues that when experiencing constraint an organisation will become more risk-seeking in search for solutions to the situation, in turn stimulating innovation as a coping mechanism (Kahneman & Tversky, 1979).
undertaken in order to further analyse which theory is more apparent and most valid within a particular case. Further, by use of a qualitative single-case study research design, the thesis will be adding to existing research in a different way. It will serve to provide a detailed analysis of how innovation is affected by financial constraints, through the first-hand experiences of NHS employees.
Deemed as ‘the closest thing the English have to a religion’ (Lawson, 1992), NHS England is a publically funded national healthcare organisation that has been met continuously by imposed financial constraints, at a time when user demand for the service is on an ever increasing upward trajectory (Kings Fund, 2016). Given this current situation, it can be argued that innovation could be the key tool to aid the NHS in delivering high quality care in an effective and efficient manner. Further, innovation is necessary in order to not only sustain the service, but also to meet the continuously growing demand. Therefore, it is of both societal importance and relevance today that research into the effects of financial constraints on innovation within NHS England is studied. Such research will allow for the unearthing of how innovation is being affected within the organisation, as well as seeing which theoretical proposition, whether it be financial constraints as in inhibitor or a stimulator, is most applicable in the case of NHS England.
1.3. Thesis Structure: a reader’s guide
The thesis is divided into a series of five chapters to allow for ease of reading. Succeeding this first chapter, chapter two will undertake a systematic review of the current literature on innovation, as well as the competing scholarly theoretical work concerning threat-rigidity theory and prospect theory. Chapter three will detail the research design, case selection and the chosen strategy for data collection and data analysis. It will also further discuss both the attributable strengths and weaknesses of the study. In chapter four, the results of the data will
be presented. In concluding the thesis, chapter five will begin with an overall discussion of the data results. The theoretical and methodological implications of the study will also be explored, alongside a discussion of the study limitations and practical implications. Possible areas for future research will also be proposed. Finalising the document is the reference list.
CHAPTER 2
LITERATURE REVIEW AND THEORETICAL FRAMEWORK
In this chapter a review of the current literature will be conducted. Firstly, an overview of the literature on innovation in the public sector will be presented, with particular attention being paid to the different types of innovation that exist. Secondly, a review will be conducted of the two competing theories on organisational decline; threat-rigidity theory, which states that in times of constraint, an organisation will rely on current resources and embedded routines (Staw et al., 1981) and secondly prospect theory, which on the contrary states that adverse conditions stimulate risk taking and innovation within organisations (Kahneman & Tversky, 1979). In concluding the review, an outline will be presented of a contingency framework that identifies moderating variables forecasting either the obstruction of innovation or the stimulation of innovation (Mone et al., 1998). Whilst no propositions will be drawn from the framework, it will serve as an important point of reference when considering potential contextual factors arising from the case. Thus, with the objective of the research to see which of the two theoretical explanations is most applicable in a given case, throughout the review, a series of propositions will be made. Based upon the literature, the propositions will present expectations of what we may be able to observe in the research data. It is also worthwhile to note that not all mechanisms contained within both theories will be selected for observation, but rather those particular mechanisms which will be most observable in the data.
2.1. Innovation in the Public Sector
Undoubtedly, organisations within both the private sector and the public sector deal with innovation on a continual basis, however, their needs for doing so differ to a noticeable degree. Organisations in the private sector are required to be innovative and embrace the concept in
order to maintain their competitivity and retain, if not increase their overall market share. Contrary to this, in the public sector, as these organisations do not possess the same competitive element, innovation has instead increasingly been utilised as a key tool in the delivery of public services that are more efficient and of better quality (Walker, 2006). Additionally, innovation has been said to contribute in enhancing the problem-solving capacity of public sector organisations in dealing with both current and future societal challenges and problems (Torfing & Triantafillou, 2016). These two pointers for the utilisation of innovation by the public sector was reinforced by the U.K. Prime Minister’s Strategy Unit, announcing that innovation is a core task of public organisations that acts to improves responsiveness and efficiency (Mulgan & Albury, 2003).Arguably, however, the most important reason for the public sector to adopt innovation is to achieve legitimacy (Bekkers, Edelenbos & Steijn, 2011). Through engaging with the public in a transparent manner, public organisations can foster public trust in their ability to deliver innovative programmes, as well as confidence in their legitimacy to enact such programmes (OECD, 2017).
Despite a clear emphasis being placed upon the importance of the public sector utilising innovation, some claim that ‘innovation in the public sector’ is essentially a contradiction of terms (Bekkers et al., 2011, p. 18). Arguments supporting this claim stem from the idea that the inherent bureaucratic culture of public organisations, in which formalisation and standardisation are highly valued, act to discourage risk-taking behaviour and individual initiative (Bekkers, van Duivenboden & Thaens, 2006). Further, the very fact that the public sector lacks any form of competition, whilst competition is deemed a necessary pre-requisite for innovation impedes the sector’s ability to be innovative (Bekkers et al., 2006). For these reasons, the perception held by some is that ultimately the public sector cannot be innovative,
by accidental events (Torfing & Triantafillou, 2016). More recently however, the negative perception of public innovation has changed, with studies arguing that public sector organisations can, and should be perceived as innovative (Bekkers et al., 2011; Walker, 2014). Indeed, through the observation of public administration in practice, innovations in quality, budgeting, performance management, ICT and citizen participation are all visible (Bekkers et al., 2011). Further, due to the environmental complexity and diversity of public sector organisations, they are capable of being innovative in meeting the varying divergent goals set (Bekkers et al., 2011). Reiterating this revised perception of public sector innovation, Zouridis and Termeer (2005) go as far to state that it is in the inherent nature of the public sector to be an innovative sector. Evidence of this positively revised perception is available when looking at the health care sector. Indeed, it has been noted that new innovative structures and techniques have been implemented in rationalising overall health care delivery (Van der Scheer, Noordegraaf & Meurs, 2011).
It is important now to clarify the different types of innovation defined and discussed within the existing literature. Remarkably, in a systemic review of the innovation literature, De Vries, Bekkers & Tummers (2016) found that the majority of academic articles fail to provide a working definition of innovation. Alternatively, when a definition was given, it was often found to be unspecific and very general in its nature (De Vries et al., 2016). One explanation for this lies in the fact that as innovation itself as a concept is extremely broad, researchers will tend to specify certain types of innovation (Moore & Hartley, 2008). The three most commonly distinguished types of innovation are; product innovation, process innovation and ancillary innovation (Walker, 2006). Firstly, product innovation refers to the creation of a new product or service, and the level of quality concerning the particular good or service (Archibugi, Evangelista & Simonetti, 1995). Secondly, process innovation looks at changes within an
organisation’s rules, procedures, structures and communication channels, and also any changes that occur between the relationships of organisational members (Walker, 2006). Process innovation can further be sub-divided into two categories; ‘technological innovations’, which are associated with changes to physical equipment such as software and information technology, and secondly, ‘organisational innovations’, which are associated with innovations to structural, strategic and administrative processes (Damanpour, 1987). Lastly, ancillary innovation is linked to innovations across organisational boundaries that utilise other organisations in order to implement programmes (Walker, 2006). Most interestingly, it is ancillary forms of innovation that illustrate the potential overlap between product innovation and process innovation (Walker, 2006). For example, in the case of the creation of a new public service, commonly defined as a product innovation, could be implemented by way of new policy arrangements, which by means of definition is a process innovation (Walker, 2006). Whilst it is both necessary and fruitful for discussion to explain the main different types of innovation, it is also worthwhile to present a more general, workable definition of the concept. As such, innovation can be thought of as ‘a process through which new ideas, objects and practices are created, developed or reinvented and which are new and novel to the unit of adoption’ (Walker, 2006, p. 313).
2.2. ‘Necessity is the Mother of Rigidity’ – Threat Rigidity Theory
Of the literature centered around organisational decline, a substantial amount of it has drawn the conclusion that imposed constraints act to inhibit innovation (Mone et al., 1998). The premise behind such conclusion emanates from threat-rigidity theory, which suggests that in times of constraint organisations have an increased tendency to exhibit rigidity and/or the inability to do anything new (Shimizu, 2007). By acting in such a way, organisations attempt
managerial level, threat-rigidity theory argues that under such circumstances, managers will retreat from risk-taking, which consequently inhibits both departmental and organisational level adaption or change (Latham & Braun, 2009). From this, threat-rigidity theory states that the flow of information within an organisation will become restricted and control is constricted to the top levels of the organisational hierarchy (Mone et al., 1998).
In testing threat-rigidity theory, studies have generated evidence to support the above theoretical propositions. It has been identified that commonly, organisations utilise slack resources (resources that are currently available to an organisation) to fund their innovation projects or processes. However, Cameron, Whetten & Kim, (1987) found that when no slack resources are available, as in times of constraint, the organisation is no longer able to innovate. Consequently, the imposed constraint on the organisation acts to inhibit innovation. Further, Latham and Braun’s (2009) study of 327 publically traded software firms, in the wake of the 2001-2002 technological downturn, found behaviour within the organisations to be aligned with the theory of threat-rigidity. They conclude that such restrictive behaviour is more likely to occur in periods whereby the organisation is experiencing imposed constraints (Latham & Braun, 2009). More recently, in their analysis of medium-sized Australian enterprises Muurlink, Wilkinson, Peetz and Townsend’s (2011) results indicated that managers equipped with extensive formal knowledge of business practices, were, if anything, handicapped by their knowledge when faced with imposed constraints to their organisation. As with the two aforementioned studies, their study also found that threat to an organisation does indeed lead to rigidity (Muurlink et al., 2011).
The above academic research has gone some way in providing an understanding of the constraint-innovation relationship, however, the vast majority of these studies have chosen to
adopt a quantitative research design approach. Whilst quantitative research acts to provide valuable generalisations regarding the phenomenon under study, it cannot show precisely the workings of various mechanisms that underpin a particular relationship. This given, by using the following theoretical model of threat-rigidity to formulate observable propositions, the study will uncover the blind spots of the constraint-innovation relationship.
In seeking to understand the apparent failure of organisations to utilise innovation when experiencing adverse conditions, Staw, Sandelands and Dutton (1981) set out to create a multi-level framework which analysed potential effects at the individual, group and organisational level. It is through Staw et al.’s model that the propositions concerning possible support for threat-rigidity theory within this study’s chosen case, will be formulated. Their model of organisational response to threat is as follows:
Figure 1. A model of organisational response to threat. (Staw, Sandelands & Dutton, 1981)
result in the restriction of information processing (Staw et al., 1981). For example, narrowing the field of attention to information within the organisation, or reducing the number of channels available to process information would result in an overall restriction of information processing. Secondly, when facing an adverse environmental condition, an organisation may implement a constriction in control (Staw et al., 1981). Consequently, power and influence within the organisation will become more highly concentrated and of a hierarchical nature (Staw et al., 1981). Both effects, if evidence is found to support their presence, serves to indicate that an organisation’s system will become less open and flexible towards innovation.
Returning to the multi-level nature of the model, at the individual level of analysis, the effects of an adverse environmental condition are most commonly identified in terms of psychological stress and anxiety (Staw et al., 1981). Linking such effects to threat-rigidity theory, studies have found that when asking individuals to develop strategies for solving an arithmetic problem, those individuals experiencing stress and anxiety were less flexible, and more rigid in their choice of solutions to the problem (Cowen, 1952a, 1952b). In fact, those individuals experiencing stress and anxiety were found to be more inclined to use a previously learned solution, despite such a solution being inappropriate for the given problem (Staw et al., 1981). Overall, research on the individual level suggests that psychological stress and anxiety will very often result in a combination of inadequate task performance and a tendency to utilise familiar courses of action and embedded routines (Staw et al., 1981). Given this, it would be prudent to propose the following:
Proposition A: Imposed financial constraints can initiate psychological stress and anxiety amongst individuals.
At the group level, it is believed that adverse affects can have a detrimental impact upon intergroup cohesiveness (Staw et al., 1981). As the availability of resources decline (due to financial constraints in this study), groups of employees within different functional departments of the organisation will compete to gain the most resources for their department. Given this, it is postulated that the group gaining the least amount of resources for their department may suffer from a decrease in group cohesiveness (Staw et al., 1981). Further, on the intergroup level, rivalry between groups serves to decrease the overall level of cohesiveness. Therefore, the aforementioned effect leads to the following proposition:
Proposition B: Imposed financial constraints can lead to a decrease in group cohesiveness.
Finally, are the effects of an adverse environmental condition upon the organisational level. At the organisational level, there is often found to be a ‘mechanistic shift in which there is an increased centralisation of authority, more extensive formalisation, and standardisation of procedures’ (Staw et al., 1981, p. 513). The most widely confirmed aspect of such a mechanistic shift is the centralisation of authority (Rubin, 1977; Starbuck, Greve & Hedberg, 1978; Staw et al., 1981). Indeed, in regards to cutbacks, Rubin’s (1977) study on a university’s response to budget cutbacks found that departments began to utilise more explicit decision-making and allocation criteria in a way to centralise authority and implement increased standardisation. Given this, a third proposition can be presented:
Proposition C: Imposed financial constraints can lead to the centralisation of authority, extensive formalisation and the standardisation of procedures.
To summarise, threat-rigidity theory poses that in times of adverse environmental conditions, organisations have the tendency to restrict information processing, constrict overall control,
and conserve currently available resources. Consequently, an organisation will ultimately become more rigid in its ability to change and adapt, thus inhibiting innovation.
2.3. ‘Necessity is the Mother of Invention’ – Prospect Theory
Contrary to the empirical evidence owing support to threat-rigidity theory, other literature indicates that imposed adverse environmental conditions, such as financial constraints, serve to stimulate innovation within organisations (Mone et al., 1998). Underpinning this alternative argument is prospect theory, which stipulates that decision-makers that face certain losses towards their organisation will exhibit more risk-seeking behaviour in the hope of positively effecting recovery (Kahneman & Tversky, 1979). During periods of constraint, the theory argues that the opportunities for gain within an organisation receive more attention than opportunities for losses, and given this, organisations facing constraint are more likely to be risk-seeking in their quest for new and positive gains (Shimizu, 2007). Such behaviour is said to stimulate new innovations (Kahneman & Tversky, 1979). Champions of this theoretical standpoint suggest that through stimulating innovation, performance advantages, as well as long-term competitive advantage can be gained (Van de Ven, 1986; Damanpour, 1991). Corroborating this, other scholars have concluded that cutbacks on innovation during a period of constraint can actually serve to compromise an organisations position in the future (Singh, 1986; Wiseman & Bromiley, 1996).
In testing the premises of prospect theory, studies have accumulated evidence exhibiting support. In response to resource scarcity and financial distress, Zajac and Kraatz (1993) found that universities, public schools and liberal arts colleges set out to procedurally and strategically restructure both their institution’s educational curriculums and organisational processes. Further, McKinley (1984) in a study of plant sales, found that a decline in overall sales was met with subsequent product modifications. Such modifications were interpreted as
confirmation that the response to a decline was met with an innovative strategy (McKinley, 1984). Whilst such studies are valuable in providing counter-evidence to studies in support of threat-rigidity theory, they are again mainly of a quantitative research design. Therefore, likewise to threat-rigidity theory, the premises of prospect theory will be taken and used to formulate propositions that can be observed in-depth to gain an insight into how the relationship works between financial constraints and innovation.
Within the literature on prospect theory, three main premises form the theory’s foundation. Firstly, that alternative options are framed as either losses or gains, dependant upon comparison to a reference point (Shimizu, 2007). Behind this lies the notion that individuals make decisions based upon the perceived gains they can acquire, rather than perceived losses (Shimizu, 2007). Given this, it is more likely that individuals will choose to innovate based on the potential gains in doing so. Therefore, the following proposition is;
Proposition D: Imposed financial constraints act to initiate decision-making based on perceived gains.
Secondly, it is thought that in the instance whereby constraints are imposed, an organisation will perform a problemistic search; ‘a search that is stimulated by a problem… and is directed toward finding a solution to that problem’ (Cyert & March, 1963, p. 121). In this, when the performance level of a particular department, or the entire organisation is perceived to be falling below the intended aspirations, the likelihood of innovation levels being increased is much greater (Greve, 2003). Linked to this premise is the concept of ‘organisational learning’ (Cyert & March, 1963). According to organisational learning, managers of organisations that display below-par performance will tend to actively seek out new innovations to form solutions
to their particular performance related problems (Mone et al., 1998). Therefore, the following proposition can be made:
Proposition E: Imposed financial constraints act to initiate a problemistic search for innovative solutions.
Third and finally, the premise of risk-seeking comes into play. Advocates of prospect theory propose that individuals display tendencies towards risk aversion when faced with possible gains, and tendencies towards risk seeking when faced with possible losses (Shimizu, 2007). Such thinking indicates that in periods of financial constraint, organisations faced with such kinds of losses will naturally be more risk seeking in their quest to enact positive recovery. Behind this lies the thinking that organisations currently experiencing a positive and healthy climate have a good reason to avoid risky behaviour and changes that could turn out negatively, whereas those organisations experiencing constraint and decline have less of a reason to maintain the status-quo and avoid risk-taking (Greve, 2003). Therefore;
Proposition F: Imposed financial constraints act to initiate more risk-seeking behaviour.
Developing the main crux of prospect theory, the premises laid out by Tversky & Kahneman (1992) serve to progress the theory in several ways. Entitled ‘cumulative prospect theory’, their development extends the original theory to uncertain as well as risky prospects, and gives rise to varying evaluations of gains and losses (Tversky & Kahneman, 1992). With this, and the above theoretical exploration, we can conclude that the main argument proposed by prospect theory is that in periods of organisational constraint, and when facing losses, organisations will be more inclined to be risk seeking. Thus, an environment is created whereby innovation can be stimulated, in order to find new and effective ways of dealing with the imposed constraint.
2.4. Finding Middle Ground – A Contingency Framework
Both threat-rigidity theory and prospect theory present competing frameworks as to how imposed environmental constraints can affect innovation within an organisation. Acknowledging this, another strand of research has attempted to adjudicate between the two theories, by suggesting a relationship between constraints and innovation which is contingent upon various factors (Latham & Braun, 2009). These such factors serve in influencing the decision to allow either the obstruction or stimulation of innovation. Formulating a contingency framework, Mone, McKinley and Barker (1998) identify variables that moderate the constraint-innovation relationship. They further suggest that managers will choose to act either innovatively, or non-innovatively depending upon a collection of environmental, organisational and individual level factors (Mone et al., 1998). All three levels of factors ultimately influence an organisation’s response to the constraint or threat they are faced with (Mone et al., 1998).
Regarding the different levels of analysis, the framework proposes that at the environmental level, a highly institutionalised organisation is expected to restrict efforts to create innovations, compared with a lowly institutionalised organisation which is thought to facilitate innovation (Mone et al., 1998). Concerning the organisational level, a diffused power structure and a low amount of uncommitted resources limit the ability of an organisation to innovate (Mone et al., 1998). Rather, a concentrated power structure and a high level of uncommitted resources provide slack for an organisation to facilitate innovation (Mone et al., 1998). Lastly, on the individual level, when decision-makers attribute temporary or uncontrollable causes to a constraint, they are less likely to innovate due to high levels of uncertainty (Mone et al., 1998). However, when attributing a permanent cause to a constraint, decision-makers will be more
likely to permit innovation, given the controllable and long-standing nature of the constraint (Mone et al., 1998).
Whilst the contingency framework bridges threat-rigidity theory and prospect theory together under one umbrella, and is worthwhile to include, the applicability of the framework to this thesis is limited to being reference point. As the aim of the proceeding study is to take threat-rigidity theory and prospect theory in seeing which is most apparent in a particular case, the contingency framework can serve only to provide a thinking point as to whether any contextual factors in the study could possible explain the reasoning behind one of the theories being more predominant over the other.
CHAPTER 3
RESEARCH DESIGN
Chapter three will detail the methodology of the thesis. To begin, the chosen research design will be outlined and the reasons behind the selection of such a design explained. Secondly, a description of the chosen case will be presented, with specific focus upon both the relevance and the appropriateness of the case for this particular research. Thirdly, the methods for data collection will be discussed, as well as the interview strategy that was adopted. Following this, the operationalisation of key variables will be presented, and the subsequent strategy for the analysis of data will be explained. Concluding this chapter will be a discussion of the reliability and validity of the study, drawing upon both the attributable strengths and weaknesses.
3.1. Research Design and Case Selection
The chosen research design for this thesis is a case study. The decision to opt for a case-study approach is that it allows for the examination of the selected ‘case’s internal features as well as the surrounding situation’ (Neuman, 2014, p. 42). Hence, in the case of the Countess of Chester Hospital, the organisation’s internal position with regards to innovation within the wider context of imposed financial constraints can be examined. Further, a case-study research design has the ability to make visible the details of how one mechanism can affect another mechanism (Neuman, 2014). This will permit the study to observe the mechanisms at play within the case concerning the six propositions assumed in chapter 2. More specifically, it is a single case study which has been chosen as part of the research design. The reason for a single case study as opposed to a comparative case study lies in the fact that comparative case studies are most useful when there is variation on the variables. However, all hospitals within NHS
comparisons. Rather, it is of greater advantage to delve into more in-depth detail within one single case. Overall, such an approach to the research is deemed appropriate when wishing to conduct a detailed examination of a specific case and to observe mechanisms in an in-depth setting (Neuman, 2014). Given this, the chosen research design seems fitting of the intended aims of the study. To note, the single-case study will be accompanied by a qualitative approach to data collection, specifically by means of interviews.
In adopting a qualitative approach to the research, it is important to note that the results of the study will contribute in reducing the existing research gap. It is currently the case that large-N quantitative studies dominate this particular sub-field of public administration research (McKinley, 1984; Cameron et al., 1987; Zajac & Kraatz, 1993; Latham & Braun, 2009). Unfortunately, given the nature of their design these quantitative studies do not shed light on the mechanisms at play between financial constraints and innovation.
Given the central crux of the debate between threat-rigidity theory and prospect theory lies within the theoretical mechanisms that are at play, and whether it is they serve to inhibit or stimulate innovation, a qualitative single-case study research design will allow for an understanding to be gained of how the mechanisms work together in a real-world setting. Further, it has been noted that within-case analysis grants the exploration of alternative predictions and mechanisms of competing theories (Toshkov, 2016). As such, it will be possible to reach a judgment as to which theory is most valid in this particular case. In making this judgment, the level of analysis in the study will be conducted on the individual level. Conducting the analysis on an individual level through talking to employees will not only allow for the examination of the mechanisms at play on an individual basis, but will also permit one to see how the mechanisms come to interact both at the group level and organisational level.
Perhaps most interestingly however, we will see precisely how these mechanisms work through the eyes of NHS employees, who have been experiencing first-hand the effects of imposed financial constraints since their implementation. Ultimately, the above will serve in contributing to the prior quantitative research that has been conducted.
Prior to discussion of the selected case, it is worthwhile for the purpose of clarification to note that the NHS is the collective name for the four public health services within the United Kingdom: NHS England, NHS Wales, NHS Scotland and Health and Social Care in Northern Ireland. Each of the four services operate independently of one another, and are also each politically accountable to their respective government; NHS England to the U.K. Government, NHS Wales to the Welsh Government, NHS Scotland to the Scottish Government and Health and Social Care in Northern Ireland to the Northern Ireland Executive. Given this, it is important to acknowledge that the case selection was not based from within the four health services, but from only within NHS England. Out of the four, NHS England is by far the largest organisation, serving a population of approximately 55 million citizens as of 2016 (Office of National Statistics, 2016). Therefore, from within NHS England, the selected case for this study is the Countess of Chester Hospital NHS Foundation Trust. Located within the city of Chester, North West England, United Kingdom, the hospital is 600-bed facility, catering for approximately 445,000 patients each year (COCHa, 2017). Classified as a general hospital site, departments within the hospital range from Accident and Emergency (A&E), Major Trauma and Intensive Care, to Maternity, Paediatrics and General Surgery (NHS, 2017). Alongside the medical facilities, the hospital is supported by administrative functions such as Procurement, Human Resources (HR), Information Management and Technology (IM&T), Finance Services and Service Improvement (COCHa, 2017).
In terms of selecting a typical case within NHS England, the Countess of Chester Hospital can be deemed representative of the wider collective of hospitals for the following reasons. Being classified as a ‘General Hospital’, the Countess of Chester Hospital is made up of all the varying departments one expects to be available within a hospital (see previous paragraph for the list). As such, the daily tasks dealt with by the hospital are similar to those dealt with by every other General Hospital throughout the country. In terms of the overall quality standard of the hospital, in 2016 it was rated as ‘good’ by the Care Quality Commission (COCHb, 2017). This rating indicates that the hospital would serve as a suitable case, given that the rating falls within the middle; it is not an outstanding hospital, but neither is it a hospital requiring improvement. It is also important that the hospital selected for this study is in fact having to deal with imposed financial constraints, as is the case across the much of the NHS. The Countess of Chester Hospital is no exception to this phenomena, having been tasked in 2016/17 with saving £10.6 million and deliver a deficit of £3.6 million (COCHb, 2017). Moreover, it was important when selecting a particular hospital for the case study that the concept of innovation was something the hospital was familiar with. Indeed, this proved to be the case given the fact the Countess of Chester Hospital has a specific department called ‘The Model Hospital’ which specifically deals with enhancing productivity and efficiency. Thus, given the fact this particular hospital is dealing with financial constraints and innovation matters simultaneously, it was deemed a more than suitable candidate to be selected as the case for this study.
3.2. Methods for Data Collection and Interview Strategy
The chosen method of data collection for the study was qualitative interviewing, as this method best allows for the discovery of personal experiences and opinions (Bleich & Pekkanen, 2013; Mosley, 2013). In total ten interviews were conducted via means of telephone. Whilst a higher
number of interviews would have enriched the collected data, it is felt that the quality of the interviews conducted provided a sufficient amount of good quality data in which to work with. Moreover, the amount of interviews conducted was limited owing to practical reasons and time constraints linked to the completion of this study. In terms of conducting the interviews by telephone, there are often potential drawbacks attributed to such method, for example, being unable to engage in face-to-face contact. However, given the fact that the topic is not deemed a sensitive topic for individuals, and the required data was gathered, conducting the interviews via telephone is not thought to have impacted the validity of this study. The process of selecting participants for interview was non-random; seven of the interviewees were on secondment from their clinical or administrative roles to the Model Hospital department within the hospital, and the other three participants were secured for interview through snowballing. Whilst it is of great importance within some research that participants are selected entirely at random, interviewees for this study needed not to be selected at random. The importance for this research is that individuals were able to provide their personal experiences and insight on the topic of financial constraints and innovation, which allows for the observation of the theoretical mechanisms. Having said this, the ten interviewees are wide-ranging in terms of their different roles, length of employment and wider experience within NHS England. They are also employed at different levels, ranging from senior management to assistant level, as well as from both medical departments and administrative functional departments within the hospital. Such variation permitted the collection of a broad range of different view points.
Prior to each interview taking place the interviewee was given a consent form to sign, and informed that the entirety of the interview would be recorded. In ensuring participant confidentiality, all interviewees have been given a number in replacement of their name, both
interview was comprised of a series of ended questions. The decision to opt for open-ended questions is that whilst providing the interview with body and structure, open-open-ended questions simultaneously permit the interviewee to answer freely, in their own way and without being forced into selecting a certain answer that may not be suitable (Neuman, 2014). Moreover, from the researcher’s perspective open-ended questions allow for the inclusion of additional sub-questions which can probe further into the interview topic (Mosley, 2013). Such information would not be acquired with the use of either fixed or closed types of questions. In ensuring that both the topics of financial constraints and innovation was covered, each interview commenced by asking the interviewee for their opinions on innovation within the NHS. Each interview then proceeded to cover the concepts within threat-rigidity theory and prospect theory. For example, interviewees were asked questions relating to themselves individually within their job, as well as how their team worked together on a daily basis. By going through the six concepts laid out in chapter two, it ensured that each observable proposition was covered.
3.3. Operationalisation of Key Variables
‘Operationalisation is the translation of abstract concepts and their attributes (dimensions) into less abstract ones that can be detected, classified, and measured in the empirical world’ (Toshkov, 2016, p. 100). Thus, in order to make the key concepts observable via means of telephone interview, each one will be operationalised. In doing so several indicators (both words and topics) will be presented, which will all serve to make the abstract concepts recognisable within the interviewees accounts. The below table demonstrates which indicators for each variable will be used:
VARIABLE (S) KEY INDICATORS
Individual level: Psychological stress
Words: Stress, pressure, anxiety, busy, tension, strain, fear, demands. Topics: Workload, busyness, human resources.
Group level: Team cohesiveness
Words: Team, unity, togetherness, trust, collaboration, connected. Topics: Teamwork, intergroup work, projects.
Organisational level: -Centralisation of authority
-Formalisation -Standardisation of
procedures
Words: Power, central, management, executive, rigid, hierarchical, authority, rules, procedures, permission, red tape.
Topics: Decisions, announcements, policies, processes, formal procedures.
Decision-making based on perceived gains
Words: Decisions, decision-making, gains, improvements, Topics: Decision-making, thought processes.
Search for innovative solutions
Words: Innovation, creation, transformation, change, development, challenge.
Topics: New projects, new ideas, services.
Risk-seeking behaviour Words: Chances, invention, investment, returns, losses. Topics: Risky projects, behavioural traits.
3.4. Strategy for Analysis
The primary strategy for analysis of the interviews will be conducted by means of coding. Coding is the process in which the researcher takes diffused communication and converts it into precise and objective data (Neuman, 2014). As such, the transcripts of each interview will
example, in identifying psychological stress within interviewees, words such as pressure, busy and fear, alongside topics like workload or human resources will be coded as indicators of psychological stress being present. This will be repeated in each of the ten interviews for each of the six variables. The results of the coding process will be analysed in chapter 4, whereby quotations extracted from the transcripts will be presented in either supporting or refuting the six theoretical propositions.
3.5. Reliability and Validity
As with any academic research conducted, both strengths and weaknesses can be attributed to the reliability and validity of this study. Whilst qualitative research embraces the core principles of reliability and validity, it has been said that the terms are rarely evident in such an approach because of them being so closely attributed to quantitative research (Neuman, 2014). Given this, when concerning reliability researchers have acknowledged the fact that because data collection within qualitative research is an interactive process, the ability to replicate a particular study’s findings again may be unachievable (Neuman, 2014). However, one such way to enhance these chances is through the maintenance of consistency when making observations (Neuman, 2014). Therefore, this study has aimed to increase its reliability by ensuring that each interview covered the same concepts relative to the six theoretical propositions. This given, if a further study was to be undertaken within an organisation experiencing the same constraints, it would not be unimaginable to assume that similar findings could be derived from the interviews. Additionally, through the transcription of each interview and the subsequent coding for each variable reliability of the data has been increased, in that communication from the interviewees has been turned into precise and objective data. The concept of reliability also concerns the trustworthiness of data. By interviewing NHS employees that are faced with imposed financial constraints on a daily basis, their personal
accounts serve in providing a true insight into the effects such constraints are having within the organisation.
Secondly, when discussing the level of validity within the study we concern ourselves with internal validity and external validity. Before discussing both types, it is important within qualitative research to provide data rich in authenticity; ‘offering a fair, honest, and balanced account’ (Neuman, 2014, p. 218). It is through asking each interviewee how they feel and what their opinions are towards the central concepts of both theories that a balanced account can be presented. In terms of internal validity, a high level can be attributed to this research. Through in-depth interviews it is possible to see precisely how innovation is being affected by financial constraints, whether that be positively or negatively. Given that the main purpose of this study is to identify such mechanisms at play internally, it needs to be acknowledge that this may come at the expense of high external validity. Moreover, it could be said that a single-case study is not the best research design to choose when wishing to produce a high level of external validity, however, as the Countess of Chester Hospital is fairly typical of the wider conglomerate of hospitals within NHS England, it would be reasonable to suggest that the findings derived from this case may well be applicable to the wider NHS England population.
However, some limitations of the research design and data collection do need to be discussed. The most important of such limitations concerns the qualitative nature of the data, by which we are referring to the inherent subjectivity derived from conducting interviews. Whilst it is a great strength of the data in the fact that individual accounts bring out personal memories, opinions, experiences and anecdotes, interviews are open to a number of pre-determined biases, which are difficult to entirely eradicate. As the topic of financial constraints is a ‘hot topic’
the topic, which could have influenced the way in which they answered questions. Moreover, consideration of the fact that the interviewees may have withheld, purposefully or un-purposefully, certain information of which they did not want to disclose needs to be given (Toshkov, 2016). Further, it is often the case that when interviewing participants regarding the organisation they are currently employed by, most interviewees will be reluctant to criticise or provide negative insights regarding their organisation. Taking all of the above into account, one has to be mindful of the potential drawbacks associated with qualitative interviewing.
CHAPTER 4
DATA ANALYSIS
In this fourth chapter, the results of the data will be analysed. To begin, data relating to threat-rigidity theory will be taken and analysed against the formulated propositions, with the same then being repeated for prospect theory and the three corresponding propositions. The presentation and analysis of the data will subsequently allow for an overall discussion in Chapter 5 to be undertaken, in which the data concerning the two theories is brought together in order to explore which of the theoretical mechanisms are most prominent in the case of the Countess of Chester Hospital.
4.1. Results Concerning Threat-Rigidity Theory
Proposition A
The first observable mechanism taken from threat-rigidity theory relates to the notion that imposed constraints upon an organisation can result in employees becoming psychologically stressed (Staw et al., 1981). It is postulated that if such stress is present, a reliance upon familiar routines already firmly embedded within the organisation will ensue (Staw et al., 1981), rather than employees actively searching for new ways of working. Results from the data suggest support for proposition A, that financial constraints can initiate psychological stress; seventy per cent of the interviewees directly spoke of either themselves experiencing stress within their role at the hospital, or of their colleagues having experienced it at some point.
In order to gain an insight into both the kind of stress and the levels of stress present amongst employees within the hospital, each interviewee was asked firstly how they coped with their
implementation of financial constraints. As will be displayed in the data, the majority of answers to these questions related the word ‘stress’ to the topic of ‘workload’. When responding to whether financial constraints had impacted upon their workload, the interviewees discussed how they now face higher workloads, which they felt contributed to the level of stress they themselves, or their colleagues experience. Interviewee 6 stated ‘it’s difficult because erm I think it does take its toll because everybody’s worked to the max at the moment and that does take its toll and sometimes that can show on tough days’, and later on in the interview stating ‘I think you’d probably struggle to find a midwife that hasn’t said, a midwife or a nurse, that’s hasn’t said they haven’t been stressed at some point because of workload’. Similarly, interviewee 9 stated ‘I think people are more stressed definitely, I think it’s a lot harder than it ever was’, whilst interviewee 3 claimed ‘I think it certainly does cause stress within some individuals’. At its extremity, interviewee 6 talked about how because of an increase in workload some employees have been medically signed off from work due to stress; ‘a lot of people go off with stress because you know we’re working erm all the time, I say all of the time, the majority of the time’.
Interestingly, when discussing workload in relation to imposed financial constraints, some interviewees did not attribute the stress experienced directly to financial constraints, but rather they spoke of the lack of available human resources since the implementation of financial constraints. This human resource scarcity they felt was causing their workload to increase, in turn creating stress amongst employees. Regarding this, interviewee 9 spoke of the more than fifty vacancies for nursing positions that the hospital currently has, which they stated ‘is the pressures that we’re under, the workforce that you know, the gaps in nursing they face now […] they’re doing extra shifts er they’re mopping up for people who aren’t there you know, that is very very difficult’. Likewise, interviewee 10 stated; ‘I’d definitely say that because of
budget constraints midwives are more stressed, I’d completely agree with that, you know, especially when you’re having to work extra shifts and we’re short staffed, I think you know, it does add to the extra stress’. Similarly, when discussing the possibility of having to lose a member of staff and the kind of impact that would have upon the team, interviewee 5 said;
‘for the possibility of then having to lose a member again would be harsh on the rest of the team because they’ve got used to being able to obviously work in a less stressful environment, they’re able to get things done, erm, so I think it would if that situation obviously came to fruition it would have a negative impact on the team’.
Threat-rigidity theory postulates that as a consequence of not only psychological stress, but also fear and anxiety, employees will come to rely upon familiar routines already embedded firmly within the organisation (Staw et al., 1981). Four interviewees provided evidence to suggest that employees are inclined to rely on the routines and ways of working that are familiar to them. Interviewee 8 spoke on two occasions of the experience they have had with employees wishing to work within ways familiar to them, claiming that ‘it’s changing the culture within the organisation and that’s very difficult because one of the things that happens is people always do what they’ve always done, so its its difficult to change’. Additionally, interviewee 1, when discussing a new process and the resistance it was met with thought it was because employees ‘are just thinking this is just more time from me and I’m being expected to do more’. Adopting a slightly different perspective, interviewee 2 believed that the continuation of familiar ways of working, rather than adopting new ways was due the ‘fear of the unknown’. The above experiences of these employees are indicative of threat-rigidity theory.
interviewees spoke about the topic in relation to the increasing levels of stress experienced since the implementation of financial constraints. Interestingly however, the interviewees did not attribute their experience of stress directly to financial constraints, but rather to the fact that budget constraints had initiated a sever staffing shortage, of which caused them to experience the stress of an increasing workload. With regards to Staw et al’s. (1981) idea that stress causes employees to rely upon embedded routines they are familiar with, some support for this was shown in the data presented above. However, consideration needs to be given for the fact that those interviewees speaking in support of the idea all hold managerial level positions. Therefore, whilst support is shown for employees relying upon embedded routines, full plausibility for such support cannot be given.
Proposition B
The second observable mechanism of threat-rigidity theory proposes that imposed constraints on an organisation act to decrease group cohesiveness (Staw et al., 1981). A decrease in group cohesiveness can occur both within departmental teams themselves and also amongst the wider collective of different teams throughout an organisation. The logic for such a notion lies behind the thought that imposed constraints act to reduce the amount of available resources throughout an organisation, and consequently teams will become less cohesive and fraught as they compete to gain the available resources for their respective teams (Staw et al., 1981). In the case of the Countess of Chester Hospital, the data gathered seemingly refutes proposition B. The majority of interviewees discussed group relations in a positive way.
To gain insight into whether imposed financial constraints affected group cohesiveness positively or negatively, interviewees were asked both how they felt their team worked, and whether they felt the current climate of imposed financial constraints affected in any way the
team dynamic. Speaking of general relations within a team and how a positive team spirit has helped them in times of financial constraint, interviewee 4 explained how ‘there’s a good humour in the group as well and that helps, but erm yeah we we all get on, yeah it’s been stressful but I think that team spirit has definitely like kept us going… yeah they’re a good bunch’. Likewise, interviewee 5 stated that ‘there’s generally a good team dynamic […] you know have a bit of banter, you know a laugh and a joke, but we’ve always got to try and remain professional at the same time […] and the majority tend to stick to that, they they can have a good laugh and a joke but they still get the job done’. Whilst remaining positive with regards to group relations, other interviewees also acknowledged and spoke of the daily realities faced with when working within a team. For example, when asked if their team works well together, interviewee 10 stated ‘I think we do, I think you have to really, you know, I mean there’s obviously always gonna be you know some members of staff that don’t really gel well’, whilst interviewee 3 discussed how ‘given the current climate that we are in I think team work is essential erm for us to be erm successful really […]. I do think you will always get fractions within teams because you can’t always get an overall consensus on opinions and changes to process’. Such experiences serve to refute the proposed assumption that imposed constraints lead to a decrease in team cohesiveness. Instead, the data above presents uniformity in agreeing that, despite financial constraints, teams are largely cohesive.
Contrary to group cohesiveness, mixed evidence regarding intergroup cohesiveness across the organisation has been derived from the data. When asked about how well different teams across different departments within the hospital worked together under financial constraints, interviewee 9 spoke positively about how intergroup work is aiding the organisation under the current climate;
‘We’re working much more together and I think this year we’re probably working much more together as a system than we ever have and that is because the pressures are now being sought by on everybody […] I think the pressures have got to a point where people are now having to work together now and are therefore now seeing the benefits of working together, whereas perhaps we didn’t before […] we’re all under pressure, we all have to work together’ (Interviewee 9).
‘Everybody’s feeling the pressure so you either whinge about it until it’s done or you work together and try and do the best and I think that’s what’s happening, people are starting to work together, you know mental health services with acute, er, the wards working with A&E, whatever, radiology with A&E, whatever it might be erm, I think there is better working now but I think its because of those pressures, I mean we have to’ (Interviewee 9).
Whilst the experiences of intergroup work discussed by interviewee 9 present a powerful account of how there has been an increase in intergroup cohesiveness given the financial pressures the hospital faces, when asked for their opinion on the same topic, interviewee 10 presented an opposing account. Instead, light was shed on the problems they have faced when attempting to work with other departments;
‘You’d have to refer them to the gynae [gynaecology] assessment unit and sometimes despite what the policy says, you know if they needed to be seen immediately you’ll have a plan put in place, sometimes you know they were quite reluctant to take these women despite the fact that you know they’re in need of that, and you literally, we’ve had to forcibly say on the phone, we’ve literally had to say I’m bringing this patient up and I’m bringing her now and we’ve had to physically walk the patient to the department you know to make sure that she actually gets seen and not fobbed off’ (Interviewee 10).
Given the above data for both team cohesiveness and intergroup cohesiveness, proposition B can be refuted. The experiences of the interviewees regarding group cohesiveness present a shared feeling of positivity in how well their respective teams work together, both speaking in general terms and since the onset of financial constraints. Further, despite their being a lack of commonality between the data gathered in relation to intergroup cohesiveness, the richness of the account recalled by interviewee 9 of how several different teams within the hospital are increasingly working together as a consequence of the pressures felt because of financial constraints, overpowers the negative sentiments expressed in other accounts.
Proposition C
The final observable mechanism of threat-rigidity theory centres around the notion that imposed constraints lead to the centralisation of authority, extensive formalisation and the standardisation of procedures. With this, it is proposed that as resources become restricted, authority becomes increasingly centralised and processes become both formalised and standardised (Staw et al., 1981). The data gathered does not lend support to this proposition, but instead suggests that employees of the organisation retain a degree of autonomy and have a level of flexibility with regards to processes and procedures.
To gauge the extent of authority becoming centralised and the level of autonomy retained by employees, all interviewees were firstly asked whether they felt they themselves held any degree of autonomy within their job role. Over half of the interviewees responded positively when asked this question and discussed how, whilst acknowledging the fact that within a hospital environment there are restrictions in place for patient safety, they do retain a level of autonomy to do as they see fit. Interviewee 6 explained how;
‘The role that we do is about being autonomous but there is only so much of that they can allow at the same time erm you know, you know we do still have policies and procedures that we have to adhere to and we can’t branch out from those, but within reason we do have an awful lot of autonomy as a midwife’.
Similarly, interviewee 7 stated that ‘we do do our own thing because we just know’. Moving on to the interviewees in supervisory or management positions, they also spoke of the high level of autonomy they had retained. Speaking of the autonomy permitted by their line manager, interviewee 5 discussed how;
‘He’s more than happy for me to have those decisions and usually if I’m, just if I feel like I need to be comfortable running something by him he’s happy with that, but I do get a lot of freedom to do that sort of thing […] so I would say I’ve been allowed, I’ve been allowed a good deal of freedom’.
Likewise, interviewee 9 stated that they have;
‘Pretty much free reign to do whatever we can, to er instigate, encourage, do change erm, absolutely, we erm you know the event we had yesterday was just an idea that me and one of our members of our team had, we said should we do this? Oh let’s do it, and we just did it and we had all our execs there supporting it, participating in it’.
Secondly, in order to understand if authority had become centralised since the imposed financial constraints, the interviewees were asked whether they thought decision-making had been taken away from them, and also to what extent they retained the ability to suggest and implement new ways of working. In echoing the positive sentiments presented above, the interviewees again answered positively, in turn refuting the proposition that authority becomes
centralised under periods of constraint. Interviewee 4 said ‘I certainly feel that we’re heard by that sort of exec level er, and they you know, they fully appreciate our ideas that we feed them’ and that ‘I’d definitely say we get a lot of input into what happens’. In the same vein, interviewee 1 discussed at length how within their department they are actively encouraged themselves to suggest and implement new ideas;
‘Within our department we are very comfortable in in bringing new ideas, as we would have support to run with that, we’re very actively encouraged to do that, and I think as a Trust we are as well’ and ‘what Tony’s motto is, is ‘proceed until apprehended’. So you know that’s our Chief Executive who’s saying go forward if you think you’ve got ideas and get things, move things forward and get things done’.
When supervisory and management level employees were asked the same questions they also refuted the proposition that authority becomes centralised. Speaking of the open culture the hospital has maintained through the current climate, interviewee 3 stated;
‘I think as I think as a culture here we are er very adaptable, we are always seeking to improve our practice and improve the service we provide, erm, and from that comes a drive to change and so with change comes innovation and new ways of working so I I do think erm there is a risk it can become centralised but I don’t think we do that as an organisation here because we’ve worked hard at maintaining an open culture where there is the opportunity to suggest and and work and rework different areas of what we do’.
Similarly, interviewee 5 spoke of how ‘I am always looking for my team to to offer up ideas and not just let me come up with the answers or solutions, I want them all to be involved’. Likewise, interviewee 9 discussed how individual employees are actively encouraged to
