"You Can't Do Both-Something Will Give": Limitations of the Targets Culture in Managing UK Health Care Workforces

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"You Can't Do Both-Something Will Give" : Limitations of the Targets Culture in Managing UK Health Care Workforces. / Mccann, Leo; Granter, Edward; Hassard, John; Hyde, Paula.

In: Human Resource Management, Vol. 54, No. 5, 18.09.2015, p. 773-791.

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@article{a2805410d16347348c6b0611f0ebbb99,
title = "{"}You Can't Do Both-Something Will Give{"}: Limitations of the Targets Culture in Managing UK Health Care Workforces",
abstract = "Based on a three-year ethnographic study of four UK National Health Service (NHS) organizations, we explore the everyday cultural experience of managing clinical and administrative workforces. Although NHS organizations claim to function as enlightened HRM employers, we argue that the inflexible application of metrics-based target systems to clinical and administrative tasks, including HRM operations, can result in dysfunctional outcomes for patient care and workforce morale. Reminiscent of the recent Mid Staffordshire health care scandal, the priorities attached to NHS personnel meeting the demands of performance management systems can prove incompatible with them also meeting the fundamental {"}human{"} needs of patients. The everyday experience of health care organization becomes one of employees reconciling competing logics of business efficiency and integrity of care. Trapped metaphorically between shrinking resources and expanding targets, the inclination-on the frontline and at mid-management level-is to extend the integrity of care, although this is sometimes impossible and can prove problematic in terms of system accountability. In response to such organizational tensions the behavior of many frontline and mid-management staffs ultimately reflects a form of {"}street-level bureaucracy{"}-a situation in which traditional professional norms are reasserted informally in ways that often transgress prescribed performance systems.",
keywords = "Conflict, Health care management, National Health Service, Performance management, Performance targets, Professionalism, Street-level bureaucracy",
author = "Leo Mccann and Edward Granter and John Hassard and Paula Hyde",
year = "2015",
month = sep,
day = "18",
doi = "10.1002/hrm.21701",
language = "English",
volume = "54",
pages = "773--791",
journal = "Human Resource Management",
issn = "0090-4848",
publisher = "Wiley",
number = "5",

}

RIS

TY - JOUR

T1 - "You Can't Do Both-Something Will Give"

T2 - Limitations of the Targets Culture in Managing UK Health Care Workforces

AU - Mccann, Leo

AU - Granter, Edward

AU - Hassard, John

AU - Hyde, Paula

PY - 2015/9/18

Y1 - 2015/9/18

N2 - Based on a three-year ethnographic study of four UK National Health Service (NHS) organizations, we explore the everyday cultural experience of managing clinical and administrative workforces. Although NHS organizations claim to function as enlightened HRM employers, we argue that the inflexible application of metrics-based target systems to clinical and administrative tasks, including HRM operations, can result in dysfunctional outcomes for patient care and workforce morale. Reminiscent of the recent Mid Staffordshire health care scandal, the priorities attached to NHS personnel meeting the demands of performance management systems can prove incompatible with them also meeting the fundamental "human" needs of patients. The everyday experience of health care organization becomes one of employees reconciling competing logics of business efficiency and integrity of care. Trapped metaphorically between shrinking resources and expanding targets, the inclination-on the frontline and at mid-management level-is to extend the integrity of care, although this is sometimes impossible and can prove problematic in terms of system accountability. In response to such organizational tensions the behavior of many frontline and mid-management staffs ultimately reflects a form of "street-level bureaucracy"-a situation in which traditional professional norms are reasserted informally in ways that often transgress prescribed performance systems.

AB - Based on a three-year ethnographic study of four UK National Health Service (NHS) organizations, we explore the everyday cultural experience of managing clinical and administrative workforces. Although NHS organizations claim to function as enlightened HRM employers, we argue that the inflexible application of metrics-based target systems to clinical and administrative tasks, including HRM operations, can result in dysfunctional outcomes for patient care and workforce morale. Reminiscent of the recent Mid Staffordshire health care scandal, the priorities attached to NHS personnel meeting the demands of performance management systems can prove incompatible with them also meeting the fundamental "human" needs of patients. The everyday experience of health care organization becomes one of employees reconciling competing logics of business efficiency and integrity of care. Trapped metaphorically between shrinking resources and expanding targets, the inclination-on the frontline and at mid-management level-is to extend the integrity of care, although this is sometimes impossible and can prove problematic in terms of system accountability. In response to such organizational tensions the behavior of many frontline and mid-management staffs ultimately reflects a form of "street-level bureaucracy"-a situation in which traditional professional norms are reasserted informally in ways that often transgress prescribed performance systems.

KW - Conflict

KW - Health care management

KW - National Health Service

KW - Performance management

KW - Performance targets

KW - Professionalism

KW - Street-level bureaucracy

UR - http://www.scopus.com/inward/record.url?scp=84942549855&partnerID=8YFLogxK

U2 - 10.1002/hrm.21701

DO - 10.1002/hrm.21701

M3 - Article

AN - SCOPUS:84942549855

VL - 54

SP - 773

EP - 791

JO - Human Resource Management

JF - Human Resource Management

SN - 0090-4848

IS - 5

ER -