Management Knowledge and Learning in the UK Healthcare Context: Change and Continuity

Bresnen, Mike; Hodgson, Damian; Bailey, Simon; Hyde, Paula; Hassard, John

doi:10.5465/ambpp.2016.128

Cited by 1 publication

(2 citation statements)

References 40 publications

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“…Magee and Galinski (2008) further characterise hierarchy as a ‘rank order’ of status and power, while Kolodny (2023) describes it as a ‘pecking order’. In consideration of the complexity, variability and fragmented multiprofessional nature of healthcare settings (Launer, 2022; Walston & Johnson, 2022), this review identifies a relative lack of research at the macro level of healthcare organisations (Bresnen at al., 2016; Chen et al, 2021; Johnson et al, 2020; Khayal, 2022; Øyri et al, 2020; Ramanujam & Rousseau, 2006; Vaughn et al, 2019) in leadership, management, organisational dynamics, complexity theory, quality improvement, innovation failure, resilience, regulation, disdain for business management, systems thinking, risk analysis and health expenditure, all of which relate to hierarchy. Hierarchy also exists at the meso and micro levels of healthcare organisations in teams, regardless of how broader societal relations or how a broader organisation is structured; competence and perceived expertise, amongst a range of other factors, are important in explaining how hierarchies are formed and are maintained amongst groups and teams (Bunderson, 2003; Magee & Galinsky, 2008).…”

Section: Introductionmentioning

confidence: 99%

“…Magee and Galinski (2008) further characterise hierarchy as a 'rank order' of status and power, while Kolodny (2023) describes it as a 'pecking order'. In consideration of the complexity, variability and fragmented multiprofessional nature of healthcare settings (Launer, 2022;Walston & Johnson, 2022), this review identifies a relative lack of research at the macro level of healthcare organisations (Bresnen at al., 2016;Chen et al, 2021;Johnson et al, 2020;Khayal, 2022;Øyri et al, 2020;Ramanujam & Rousseau, 2006;Vaughn et al, 2019) in leadership, management, organisational dynamics, complexity theory, quality improvement, innovation failure, resilience, regulation, disdain for business management, systems thinking, risk analysis and health expenditure, all of which relate to hierarchy.…”

Section: Introductionmentioning

confidence: 99%

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A scoping review exploring the impact and negotiation of hierarchy in healthcare organisations

et al. 2023

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Healthcare organisations are hierarchical; almost all are organised around the ranking of individuals by authority or status, whether this be based on profession, expertise, gender or ethnicity. Hierarchy is important for several reasons; it shapes the delivery of care, what is prioritised and who receives care. It also has an impact on healthcare workers and how they work and communicate together in organisations. The purpose of this scoping review is to explore the qualitative evidence related to hierarchy in healthcare organisations defined broadly, to address gaps in macro‐level healthcare organisational research, specifically focusing on the (1) impact of hierarchy for healthcare workers and (2) how hierarchy is negotiated, sustained and challenged in healthcare organisations. After a search and screening, 32 papers were included in this review. The findings of this review detail the wide‐reaching impacts that hierarchy has on healthcare delivery and health workers. The majority of studies spoke to hierarchy's impact on speaking up, that is, how it shaped communication between staff with differential status: not only what was said, but how it had an impact on what was acceptable to say, by whom and at what time. Hierarchy was also noted to have substantial personal costs, impacting on the well‐being of those in less powerful positions. These findings also provide insight into the complex ways in which hierarchy was negotiated, challenged and reproduced. Studies not only detailed the way in which hierarchy was navigated day to day but also spoke to the reasons as to why hierarchy is often entrenched and difficult to shift. A number of studies spoke to the impact that hierarchy had in sustaining gender and ethnic inequalities, maintaining historically discriminatory practices. Importantly, hierarchy should not be reduced to differences between or within the professions in localised contexts but should be considered at a broad organisational level.

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