This thesis analyses network, networking and interprofessional collaborative features and their potential development within health services. An ethnographic methodology was used that included non-participant observations to provide a background, basic quantitative data as well as a qualitative approach. The qualitative method involved a random sample of twenty-four individuals working in one acute NHS hospital using semi-structured, in-depth interview questions to determine, through thematic interpretation of the analytical data, their perceptions of network, networking and interprofessional collaboration features. This provided insights into how these features manifest themselves and are interlinked.

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Yes / Bryan McIntosh, senior lecturer in health management and organisational behaviour at the University of Bradford, explores the role of partnerships in the health service.

This thesis argues that the creation of the NHS inadvertently created an institution that is fundamental to current British national identity. The NHS exemplifies the core values of the UK, in a way that previous national institutions – the Church, the monarchy, and the Empire – could not due to the societal makeup of the country. The NHS was created for all citizens, regardless of class, and the democratic nature of the institution embodies the ideals at the heart of the nation. The institution pushed the UK to become faithful to its founding ideals of fraternity, community, democracy, and it allowed Britons to have another world-renowned institution. Furthermore, the NHS's creation coincided with one of the last great eras the UK clings to – World War II – therefore, the NHS continually pulls from that the achievements of that period and connects itself to the national pride after victory. / Master of Arts / This thesis argues that the creation of the NHS inadvertently created an institution that is fundamental to current British national identity. The NHS exemplifies the core values of the UK, in a way that previous national institutions – the Church, the monarchy, and the Empire – could not due to the societal makeup of the country. The NHS was created for all citizens, regardless of class, and the democratic nature of the institution embodies the ideals at the heart of the nation. The institution pushed the UK to become faithful to its founding ideals of fraternity, community, democracy, and it allowed Britons to have another world-renowned institution. Furthermore, the NHS's creation coincided with one of the last great eras the UK clings to – World War II – therefore, the NHS continually pulls from that the achievements of that period and connects itself to the national pride after victory.

This thesis seeks to understand the role of audit in managing the performance of the NHS in Scotland and the impact which the relationship between performance and audit has upon key actors, including NHS organisations and national audit bodies. It is informed by Michael Power’s Audit Society (1999) and associated works, which present audit as a collection of ideas which shape how society defines control, accountability and transparency. The premise of this doctoral research is that the age of performance assessment in the NHS is evidence of Power’s Audit Society in action. A longitudinal analysis of annual Overview Reports produced by Audit Scotland, which symbolise the national audit body’s identity relative to the NHS, explores the impact which the performance assessment regime had upon the evolution of the national audit body and demonstrates the capacity of a national audit body to forge its own role in performance assessment and in doing so shift its identity from traditional external auditor to authoritative commentator on performance. A recent performance crisis in a Scottish NHS board is the subject of a case study which explores the role of audit when significant gaming is uncovered in a previously high-trust system. This case demonstrates how the ritual appeal of audit can be mobilised by the government to restore public confidence in reported improvements in performance across the whole NHS. The organisational impact of audit on performance management is explored through an observation-based case study set in a Scottish NHS board, which traces interactions between the main actors in audit and performance networks. These analyses show how audit can permeate the performance assessment of NHS bodies, at both the national and organisational level, even where it is not given a formal role in the assessment framework.

The factors that influence the ultimate level of success or failure of systems development projects have received considerable attention in the academic literature. Two particularly significant areas of interest have been the importance of applying best practice during systems development and the need to explicitly consider organisational issues to ensure a positive organisational impact. However, despite the existence of a well developed best practice literature and an emergent organisational issues literature, many projects still fail. The record of the NHS has been particularly poor in terms of the successful development and implementation of information systems and it was thought that this area would provide a fertile domain for information system research. Whilst the use of information systems in community healthcare has increased greatly over the last ten years the majority of existing research has been conducted in acute hospital environments with little attention devoted to the community sector. Consequently, this research project has two main aims: To identify the key best practice variables and areas of organisational impact associated with the development, implementation and use of a Community Information System (CIS) in National Health Service Trusts; and to examine the relationships between these two sets of variables and the system's resultant level of effectiveness. This research project has a number of positive methodological attributes in that it studies a homogenous organisational sector using a common type of information system and so minimises the potentially confounding influences of sector and system. In addition, the research design involves a three stage approach, combining both quantitative and qualitative research approaches. The research project has produced several key findings. A positive relationship was identified between the adoption of best practice and system effectiveness and similarly, there was a positive relationship between the level of organisational impact and system effectiveness. In order to ensure a positive organisational impact it was found that the successful treatment of key organisational issues is required. In addition, two new variables have been identified, user ownership and positive user attitudes, that play an important mediating role in ensuring system effectiveness. Finally, it was also recognised that the adoption of best practice variables had a dual role, directly influencing the level of perceived system effectiveness but also as a method of effectively managing organisational issues, user ownership and user attitudes. In summary, this study has emphasised the importance of adopting best practice and assessing and managing organisational impact during a community information system development project to ensure system success. These results will be of particular interest to practising IM&T Managers in the NHS and to the wider academic community. A series of practical recommendations are presented at the end of the thesis.

This thesis is a critical and post-structural exploration of the discourse of managerialism in the NHS secondary care sector in Wales. Its central intent is to destabilise the dominant thinking about NHS management practice and to evoke intellectual debate about alternative discourses of management that ontologically perceive the organisation as a complex adaptive human system. The emergent theoretical framework conjoins the discipline of Complexity with post-structural conjecture, posing a novel conceptualisation of a fractal self where relations of power are seen as essential for harmonising diverse influences and legitimising a local discourse that informs and regulates practice. Using Foucault’s insights on power and knowledge the thesis critiques the strategic nature of NHS discourse, exposing the discursive dominance of managerialism and its inherent relations of power and debates what this predicates for a local negotiation and a flexible, safe and innovative environment. The methodological approach employs a reflexive and micro-level interpretative strategy to emphasise the singularity of agents and to explore the way in which the discursive constitution of the self influences agent practice. My profound experience of the secondary care system requires I situate my self reflexively within the context where I explore and liberate my own voice in conjunction with my participants. The research adopts a biographical narrative method of data collection and uses Foucauldian discourse analysis as a framework for exploring the underlying discourse in agent stories. The findings demonstrate the polyphonic nature of the secondary care context and reveal the demonstrate the polyphonic nature of the secondary care context and reveal the diverse ways in which agents legitimise, negotiate or resist the conflicting truth claims of various discourse in order to strategically sustain an image of health care historically constituted in their self. The results portray a web of discourses that endorse conformity or complicity through oppressive mechanisms of disciplinary control and surveillance, perpetuating authoritative and dualist structures, dissipating relations of trust and removing intellectual thinking from the front-line. The conclusion asserts that this significantly jeopardises the ability of agents to legitimise local ‘discourse’, severely limiting their capacity for adaptive practice and the generation of new order.

There is growing evidence that the way patients and families relate to healthcare professionals influences their experience of illness and healthcare, and may affect their psychological and physical wellbeing. Relationships between professional groups may also have a significant impact on healthcare provision to children and families. Previous research has focused on dyadic relationships within paediatric healthcare (mother and child, nurse and parents, doctors and nurses), but little has been published concerning the complex inter-relationships and roles of family members, doctors and nurses. The aim of this research was to undertake a systemic analysis of the roles and relationships of nurses and doctors with children, adolescents and families. A qualitative methodology was used to explore how the three groups (nurses, doctors and families) understand their respective roles and relationships in the care of ill children within a tertiary paediatric hospital. While systemic and social constructionist theory informed the overall conception of the study, grounded theory was the method used for structuring data collection and analysis. Data collection involved semi-structured interviews with doctors, nurses and families. These were audio-taped and each set of transcripts analysed according to grounded theory principles. Theoretical coding then allowed comparisons to be made across each set of data. Two theoretical categories describing key processes involved in the care of ill children emerged from the analysis. These were: “Building emotional connections and focusing on medical goals: complementary or contradictory relationship discourses for families and staff?” and “Shifting relationships around expertise and power: the gains and losses associated with new positionings” The first category highlights that both professionals and families appear to draw on particular societal discourses to inform their roles and relationships. These discourses (about the therapeutic value of emotional connections between staff and families and the need for ‘medical professionalism’) can appear at odds with each other. creating tensions and dilemmas for each group. The second theoretical category highlights that power relationships between nurses, doctors and families are in a process of change. Fundamental change may be hard to achieve however, as each group may experience losses and well as gains in their emerging positions. It is further argued that changes in government policy relating to these core processes creates challenges for each participant group as they struggle to balance positive working relationships, the medical care of the child and status and power issues. Change in any one aspect of these professional and family roles and relationships may have both adverse and beneficial effects, which need to be recognised. These findings raise important questions about the feasibility and desirability of family centred care. The implications of this research for training, consultation and future research are explored. The research adds to a small but growing body of literature focusing on the interface between professionals, patients and families in healthcare settings.

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