Organisation Development in Healthcare

A Critical Appraisal for OD Practitioners

John Edmonstone

• Publisher: Productivity Press
• Year: 2021
• ISBN:
  9781000485301
• Edition: 1
• Topic: Business
• Subtopic: Pharmaceutical, Biotechnology & Healthcare Industry
• Index: Business

Organisational development (OD) as a practice involves an ongoing, systematic process of implementing effective organisational change. OD is both a field of applied science focused on understanding and managing organisational change and a field of scientific study and inquiry. It is interdisciplinary in nature and draws on sociology, psychology, particularly industrial and organisational psychology, and theories of motivation, learning, and personality.

Organisation Development in Healthcare: A Critical Appraisal for Practitioners provides both an overview of the evolution of OD in healthcare as a field of practice and as achallenge to its future development. It examines the underlying assumptions behind OD and tracks its historical growth in healthcare, with special attention devoted to the UK's National Health Service.

The unusual nature of healthcare organisations delivering human services through the work of professionals who are subject to emotional labor and are addressing society's wicked problems provides a unique context. A range of challenges for healthcare OD are identified, including questions of conformists or deviant innovation; organisations as machines or systems; hierarchy versus democracy; the importance of power and emotion and possible future ways forward for healthcare OD are suggested. Examples and short case studies from both the UK and the US to illustrate the benefits of OD are included.

Chapter 1 What Is OD?

DOI: 10.1201/9781003167310-1

This chapter explores the early representations of Organisation Development (OD) and its embodied humanistic values before identifying a set of key underlying assumptions. It notes a major sea change in the evolving context from the 1980s onwards which has transformed OD from an end to be pursued to a set of means towards pre-prescribed ends.

There is no shortage of definitions as to what OD is or is about. One the one hand, and simplistically, it is about what all organisations do – they are created, evolve, expand and contract; become more simple or more complex; are sometimes merged with other organisations and eventually go out of existence. Organisations are the formal structures within which most people accomplish their work and conduct their careers. However, OD has also come to be used as a description of the attempts to plan and implement organisational change using the insights and methods of the behavioural or social sciences which began in the late 1940s and continues to this day. OD was thus variously described in its early days as:

An effort which is planned, organisation-wide and managed from the top, to increase organisational effectiveness and health through planned interventions in the organisation’s processes using behavioural science knowledge [1].

A response to change, a complex educational strategy intended to change the beliefs, attitudes, values and structure of organisations so that they can better adapt to new technologies, markets and challenges, and the dizzying rate of change itself [2].

A long-range effort to improve an organisation’s problem-solving and renewal processes, particularly through a more effective and collaborative management of organisation culture – with special emphasis on the culture of formal work teams – with the assistance of a change agent or catalyst, and the use of the theory and technology of applied behavioural science, including action research [3].

What these definitions have in common is a clearly humanistic value base aimed at changing organisations in a quite particular direction. For example, Bennis, Benne and Chin [4]. identified a series of overarching value commitments dedicated to more collaborative ways of working, the basing of plans for change on valid data and the reduction of power differentials in work settings. Likewise, Beckhard [1] identified a set of “relatively universal” values which he claimed underlay OD:

• That man is, and should be, more independent and autonomous.
• That man has, and should have, choices in his work and leisure.
• That man should be striving to meet higher-order needs for self-worth and for realising his own potential.
• If man’s individual needs are in conflict with organisational requirements, then he may, and perhaps should, choose to meet his own needs, rather than submerge them in the organisation’s requirements.
• That the organisation should so organise work that tasks are meaningful and stimulating and thus provide intrinsic rewards plus adequate extrinsic (money) rewards.
• That the power previously invested in bosses is reducing and should be further reduced. With choices in work and leisure, managers should manage by influence, rather than through force or the giving or withholding of financial or other rewards.

Leaving aside the overtly gendered language, it is clear that this represents an expression of a humanistic viewpoint which takes the human being as the measure of all things and demonstrates a respect for human dignity and the value and agency of all human beings, both individually and collectively. It has been described as “closing the gap between the human condition and the human potential” [5]. The attention to the place of people in change, the importance of individual dignity and the need to hear the voices of all, and not just the powerful, are all key features of this early OD. However, Beckhard’s use of the term “universal” was most likely at the time, and in practice, largely confined to Anglo-American cultures and organisations, given the origins of OD, which are addressed in Chapter 2. The extent to which OD may be culture-bound is also addressed in Chapter 7.

There appear to be a number of key assumptions underlying this initial approach to OD. They are:

• An action research model: An action research approach to OD [6] involves the systematic collection of data on organisational problems and then the taking of a set of actions as a function of what the analysed data indicates. This process has become embedded in both internal and external OD consultancy and is based on a well-known consultancy framework [7] of:
  • Contracting: Agreeing the technical, financial and interpersonal arrangements needed for an internal or external OD practitioner to work within or with a client organisation, including the interpersonal expectations of each party and the shared values underlying the work. Contracting would therefore cover the identification and delineation of the client system and the key stakeholders within it; an initial definition of the work to be done, covering its scope, aims, boundaries and timescales; the major issues to be addressed; the extent of the financial and human resources available; a clarification of mutual expectations regarding intended outcomes and a description of roles, responsibilities, accountabilities and reporting arrangements – effectively a mutually agreed set of ground rules.
  • Data collection: The collection, from within the client organisation, its clients, customers or service users and suppliers, of relevant data of both “hard” (usually quantitative) and “soft” (usually qualitative) nature, which are pertinent to the issues being addressed and which seek to identify the major areas in need of change. This would involve, for example, the mapping of the organisational structures, processes and relationships within the client system and would be undertaken by a variety of means, such as document analysis (including reports, minutes and audit data), focused interviews, focus groups, observation of meetings, questionnaire-based surveys, conferences and workshops. It would be conducted against agreed timescales and with appropriate attention paid to confidentiality matters. Such data could be collected by the OD practitioner and/or the client.
  • Diagnosis: The analysis and use of the data collected to jointly diagnose the causes and effects of organisational problems. This might involve the use of diagnostic models or frameworks on which the collected data could be “hung”. There is no shortage of such frameworks, but there are dangers that they can oversimplify the complex and dynamic nature of the situation and that diagnosis may privilege one set of views over others.
  • Data feedback: The feeding back into the wider client system of the collected data and the resulting diagnosis by the OD practitioner in such a way as to enable ownership and sharing across all professions/functions and all organisational levels. This might involve any combination of, for example, a written report, a presentation, a workshop event or an organisational conference. The provision of such feedback is, of course, itself an OD intervention and would need to be accomplished in a sensitive manner, not least because it might well provoke a degree of anxiety within the client system.
  • Design/action planning: This involves the OD practitioner working with representatives of the client system to design a series of actions or interventions aimed at tackling the problems which were highlighted by the data collection and diagnosis activity. Such action planning is a collaborative process and is based on the valid information previously collected.
  • Change interventions: A range of actions, some involving the OD practitioner, some undertaken by the client system alone, some with other assistance brought in, but all aimed at tackling the diagnosed problems. Some of these interventions would be focused on developing sustainability – the capacity of the client system to handle similar future problems itself, thereby lessening the degree of dependency on the OD practitioner.
  • Evaluation: A review of the entire change process with a view to informing and improving all the previous activities and ensuring that client self-sufficiency is established, maintained or enhanced, thus guaranteeing the “institutionalisation” of change, both in an immediate and continuing sense.
• Personal development enhances organisation development: It was assumed by early OD that by actively pursuing the development of self-fulfilling individuals, organisational effectiveness would therefore almost automatically be guaranteed. The personal development of individuals would lead inexorably to improved organisational learning, and so, in addition to the development of personal human capital, would inevitably lead to the creation of social capital or the “goodwill available to individuals and groups with its source in the structure and content of social relations” [8]. This meant that much early OD work was education and training-based using a range of normative/re-educative strategies, and, as a result, it tended to ignore many of the structural, technological and political aspects of organisational change.
• Shared values: There was a basic assumption that both the OD practitioner and the client system ultimately shared a set of values which were essentially democratic and about broad power equalisation between individuals and groups within and across organisations (and also by implication within and across the wider society). Such humanistic values insisted that organisations both could and should be shaped for people and not the reverse – that people should be shaped for organisations [9].
• A pluralistic frame of reference: Early OD embodied a sense of moving away from a previous, and possibly unconscious, unitary frame of reference [10], which implied one single source of organisational authority and one focus of organisational loyalty, with common organisational objectives and an integration of functions. The unitary perspective saw management alone as the legitimate foundation of organisational control and authority. It assumed that everyone subscribed to, and was dedicated towards, all organisational goals.
  The more sophisticated pluralistic frame of reference suggested instead that organisations were, in practice, loose “federations” of subcultures with differences and conflicts of interest (some of them possibly even intractable) between individuals and groups. This was because organisations were made up of diverse groups of people with different cultures, values and beliefs. As a result, some form of conflict was both rational and inevitable. The challenge was to manage this pluralism through a “negotiated order” – a state of dynamic equilibrium – of “antagonistic cooperation” [11] or “regulated pluralism” [12].
  In healthcare, this was typified as “domain theory” [13, 14]. This proposed that healthcare was made up of three separate but loosely coupled domains. Each domain operated by different and contrasting principles, success measures and work modes ...