The process and impact of special measures upon an NHS trust
NHS Trusts that perform poorly in inspections by the regulator (Care Quality Commission) are rated inadequate and may be placed into special measures by NHS Improvement. There is a paucity of research on the process and impact of special measures. The purpose of this research was to explore how a Trust comes to be in special measures and how special measures impacts on organisational culture. The ethnographic case study of a Trust that was in special measures at the time comprised a thematic analysis of qualitative data collected via semi-structured interviews, autoethnography and published material. The participants were purposively selected staff from a wide range of roles predominantly at the lower end of the NHS pay bands (groups that have been underrepresented in previous studies of culture in healthcare organisations). The findings revealed that participants perceived a complicated tangle of operational and cultural issues to have led to the Trust’s poor performance. Participants’ perceptions of the Trust’s culture cut across the integration, differentiation and fragmentation perspectives of organisational culture, at times within the context of a single interview. Secondary analysis revealed that participants appeared to have experienced a reaction process to the label of special measures. Participants perceived that some improvement had been made in staff engagement following placement in special measures, which may be more aligned to organisational climate than culture. It is recommended that previously ‘hidden voices’ are included in NHS inspection regimes, as they appear to be an untapped resource in terms of potential organisational improvement. In addition, whereas NHS guidance espouses organisational culture as a route to performance improvement, the investment in managers to improve the climate within work groups is recommended, with the aspiration that these improvements will work their way through the system and have a long-term positive impact on culture throughout the NHS.
special measures, NHS trust, healthcare, organisational culture, quality, performance
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