This thesis thus provides a unique ongoing 'insider view' of my experiences as a senior manager over five years, and five NHS reorganisations. It is grounded in practice due to the high profile leadership role I took with regard to the implementation of the HlmP and its related initiatives. Significantly, I explore how disciplined attention to my own role and practice over time, opened up opportunities for others and myself for ongoing reflexive eo inquiry. This took active account of the intended and unintended consequence of my own approaches to policy driven collaborative planning, and my own role of managing tensions at the interface between the organisation and the performance managers above me. As such this thesis makes a significant contribution to existing limited literature on insider action research. I have evolved the notion of a poly-systemic environment and practice (poly- systemicity) as a method of conceptualising the context in which I and others were attempting to implement policy across multiple systems, sub-systems and boundaries. It is important that policy is developed within the context of these multiple systems and that it takes account of people's practice and experience (or at least allows for assimilation of these factors). I have found that taking account of these factors is key in people's ability to engage and create a sense of shared meaning and identity. Self and identity, in poly-systemic terms, is a set of multiple socially constructed roles shaping and adapting to the range of diverse contexts that people find themselves in at the multiple interfaces of systems within the NHS. A major conclusion of this research is that DOH driven performance management processes which are intended to improve the impact of the policy in practice, often have unseen or discounted effects. I argue that systemic tensions will be reproduced over and over again at different levels of the NHS, unless learning on the part of the system as a whole includes reflexive ongoing inquiry. The multi-directional and mutually influencing systemic effects of multiple systems and interface need to be kept in view through new forms of research and change. Change that still tends to be understood as a merely technical rational process in a very complex system has huge costs in terms of closing down choices for action and innovation at all levels of the system. This is especially true when those upon whom success in the NHS depends, repeatedly experience disenfranchisement and de-motivation in relation to policy implementation.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:573582 |
| Date | January 2011 |
| Creators | Wilkinson, Peta |
| Publisher | University of the West of England, Bristol |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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