Join us at the Institute for Health Policy and Organisation (IHPO) seminar series on 25th January.
Zoom Recording: https://youtu.be/cNTxoap05A0
The informal ‘power and politics’ of healthcare organisations can easily often complicate the implementation of strategic change. In broad terms, this speaks to the idea that competing interests and agenda, manifest in the interactions and negotiations of healthcare professionals, shape the day-to-day organisation of care. Although a developed body of social science research explicates the politics of healthcare organisation, there remains notable theoretical differences in how such politics and power is studied and explained. Some studies explain the ‘micro-politics’ of service organisation in terms of broader structural interests and ideological rationalities, whereas others focus more on the episodic behaviours and strategies used to realise inter-personal influence. And yet, within the burgeoning field of implementation science these ideas have received far less attention than other contextual, organisational, or procedural factors. One goals of this presentation will be to seek some conceptual clarity from which to inform future research.
With growing appreciation that health and care organisations are complex ‘political arenas’, there have been corresponding calls for health and care leaders to develop and use ‘political skills’ to navigate the politics of health system change. This concept has been informed by a particular strand of management thinking that emphasises the individual capabilities and behaviours of leaders to “…ability to effectively understand others at work, and use such knowledge to influence others to act in ways that enhances one’s personal and/or organizational objectives.”
This study investigated health and care leaders’ experiences and understanding of organisational politics and political skill in the context of implementing organisational change. A narrative methodological approach was taken to explore participants’ reflective experiences in terms of their career biographies, involvement in different change agendas, in the context of wider social and cultural influences. Semi-structured narrative interviews (n=70) were carried out with a purposive sample of health and care leaders with the intention of gathering data from people working in different care settings, in different strategic and operational arenas, and at different career stages.
Although there were substantive and stylistic variations in how participants narrative, a number of common features shaped how health and care leaders interpret and give meaning to organisational politics. Most accounts focused on a given ‘controversy’ which was defined less by the character of the given change agenda, and more by the extent of disagreement amongst local actors. In the process of introducing these controversies, participants often talked about the wider ‘political landscape’ highlighting the important connections between the broader political field and the local political context, especially the influence of historical factors and enduring lines of power in conditioning change processes. When elaborating their account of a given controversy, participants tended to focus on particular set of ‘protagonists’ whose competing interests and actions in many ways defined the given controversy and also revealed underlying moral parameters about how and when organisational politics is acceptable. Looking closer at these interests, the narratives revealed important differences between the ‘espoused’, ‘hidden’ and ‘deeper’ interests at play, which revealed different facets of the political landscape. Finally, the narratives describe the different skills, strategies and actions used by protagonists as they engage in organisational politics. Rather than focusing on individualised skills and capabilities, participants described political action as highly dynamic, interactive and iterative, and more significantly, as conditioned by people’s social position within the wider political field. The study offers a more nuanced understand of organisational politics and political action in health and care organisations, that also connects more episodic perspectives on politics to more dispositional and systemic perspectives on politics