Management Seminars: Ian Kirkpatrick (University of Warwick)

13 February 2018, 2.30 PM - 13 February 2018, 4.00 PM

Ian Kirkpatrick (University of Warwick)

G15, 15-19 Tyndall's Park Road

Title: Regulatory change and the adaptation of a professional status hierarchy: Management reforms in the English NHS


In recent years, there has been a growing interest in the phenomenon of status hierarchies in organisations and their implications for decision making.  Graffin et al. (2013; p. 314) note how “status hierarchies that rank social actors on valued attributes are ubiquitous in human society” and perpetuate inequality by channelling benefits to high status individuals or groups regardless of performance or skills. In organisations, this tendency for power, authority and rewards to gravitate to higher status actors often runs directly counter to modern paradigms of management which emphasise the centrality of rational, objective criteria, based on merit, for career advancement. However, although status hierarchies are self-sustaining and inherently conservative, they are not entirely static. It has been suggested that change may be triggered by exogenous events, at the field level, that question the legitimacy and perceived utility of status hierarchies.  Sauder et al. (2012: 276), for example, refer to “broad transformation in a field’s organizing belief system or logic that alters how the field defines what is status worthy”. 

In this talk I report the findings of a study (conducted with Professors Gianluca Veronesi and   Alessandro Zardini) which explored this possibility of externally driven change. Drawing on ideas from institutional theory (Greenwood et al., 2011) the study focused on how and when the emergence of alternative beliefs (or logics) linked to changing government regulation may trigger adaptations in status hierarchies. To develop these arguments, as an empirical case, the research focused on attempts to reform professional status hierarchies (of medicine), in English public hospitals. In this context governments have tried to establish a new professional-management hierarchy (of formal authority) based on different criteria for seniority (management competency). But while formal ‘management’ roles are universally established in English public hospitals, will new logics influence hiring practices for hybrid professional-manager roles and if so, under what conditions?

To address these questions, as a proxy for the influence of different logics, the study focused on the background (human capital) of doctors who occupy the highest ranked positions in the new professional management hierarchies: membership of boards. It combined historical, routine data from three main sources: a database of NHS managers (Binley’s) collated by a commercial organisation; information relating to the professional background of medical managers taken from the General Medical Council (GMC) register; and contextual information on the organisational (public hospitals) context taken from NHS Digital. This data were then analysed using a fuzzy set/Qualitative Comparative Analysis (fsQCA) approach.

The results of this analysis demonstrate the continued influence of externally derived professional status criteria for access to the highest ranking professional-manager roles. However, they also reveal that in situations where hospitals have achieved greater formal autonomy (what we term corporatisation), newer organisational criteria (emphasising management competency) have been influential (a combining of logics). These findings lead to the development of a model for understanding how exogenous pressures, in the form of coercive regulation, might under certain organisational conditions, trigger the defensive adaptation of status hierarchies. 


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