Rising from the ashes

The third genre of story told during the course of the study was the phoenix story; a tale of overcoming adversity and failure to rise from the ashes stronger than before. This type of story was predominant with speaking to Desmond, the external project manager, and also on analysing the Trust‟s outward facing documents. It, therefore, seemed to be a dominant theme of the quality

improvement strategy of the Trust.

Desmond was employed for a fixed period in the Trust to co-ordinate a programme of quality improvement and provide project management support to particular projects. There were a number of external management

consultancies and project managers in the Trust throughout the study period but Desmond worked as an independent contractor rather than for a

consultancy firm. He had fixed responsibilities on which he had to deliver, but also a floating role within maternity scoping and supporting change. He came from a business background but had built up expertise in healthcare in the last several years and had worked on a number of successful turnaround projects in NHS Trusts. It was on the basis of these successes that he had been invited to work at Olympic.

From the start of our interview, which occurred after the change project meeting, Desmond portrayed himself to me in a language of triumph over adversity; from detailing his route to personal qualifications through to the successes achieved in previous employments and the networks he had forged. Even when talking about aspects of the role that frustrated him, Desmond was liable to focus on his personal accomplishments. As a reflexive researcher, I

112 can acknowledge that Desmond‟s identity construction and my interpretation of it were influenced by aspects of his background and their relation to me as a white, female, professional researcher. Desmond also told tales of Olympic Trust and how it had overcome adversity to reveal new organisational forms. One of these was the story of how restrictions on the maternity unit had been lifted through the concerted efforts of staff to ensure standards were

consistently met. Desmond seemed to view contradiction and tension as troublesome rather than productive and saw consensus and integration as markers of a successful culture. His narrative emphasised staff pulling together across all levels, agreeing change and the emergence of new organisational forms; a classic story of integration where the organisational culture functioned to remove ambiguity and unite values.

“Well, [the CEO] spent a lot of time with me in maternity and really being hands on, walking the shop floor and speaking to staff and patients. Errr, we closed beds for a while to help maintain the staffing ratios but even after the beds have reopened we have managed to maintain the 1 to1 care and high patient satisfaction. But, you know, since the beds reopened everyone has been working in a much more efficient way. The leadership is visible, and there, and it keeps everyone focused on achieving the best care, the safest care” (Desmond, project manager).

However, as highlighted in the previous chapter, these successes were

interpreted ambiguously by other participants, who acknowledged the adverse effects the achievement of the targets had on other areas of the department. From a differentiation perspective, the visit of the Chief Executive to the department and their interest in staff and patient care could be interpreted as reinforcing hierarchy and divisions between Board and clinical staff. Desmond glosses over the closing of beds as a managerial step in the journey towards rising from the ashes, but this act may have had more significant

consequences on clinical staff who had to manage patient flow and expectations and may have interpreted bed closures punitively.

For some, this new, more private sector and business like, organisational form was positive and allowed people to unlearn past behaviours and learn new

113 ones. In this case, Desmond was seen as expert and influential within the wider organisation, bringing in new ideas and ways of working.

“So the advice from the external consultant…he knew what would persuade my colleagues. And because he was external he didn‟t have to please in the same way as others did…[He] was more kind of aware, knew what was needed in the team. You know I was sceptical and he said he would go along with me to the meeting happily” (Ranita, project midwife).

However, for others it generated mistrust and a change in perspective from the more familiar and traditional ways of working.

“Erm…I think it was difficult at the beginning „cause we didn‟t have an office, we didn‟t have computers, so, erm, two of us went out and bought laptops. So when you are brought into an organisation and you‟re not supplied with computers, that‟s when we found it hard, like we weren‟t valued. Especially as there were all these project managers in using up the budget and we don‟t really understand what it is they‟re meant to be doing… It would have been helpful for people to know exactly what was going on. We felt like people just heard, through the grapevine, this project and that project, you know.” (Tracy, senior midwife).

During the study period the Trust redeveloped its website and rebranded itself as a leading provider of maternity care, based on its CQC successes. The home page spoke of the investments that had been made to update facilities. Women were assured of highly trained staff and the high volume of patients was given a positive spin as experience. This seems to be in contrast to the negative spin placed on it by staff, who saw size as a key factor in causing errors, but also in contrast to the Chief Executive‟s view of the Emergency Department, which was too busy to provide high quality care. The image portrayed to external stakeholders was one of transformation. According to Desmond, this had been a conscious decision of the Board, who wanted to portray an organisation with a culture of care and compassion and focus attention on unifying values and assumptions.

“Working on the image and reputation is a key work stream of the Board right now. Yeah…they have to be sure of painting the right picture, you know,

114

making sure stakeholders and patients know that we are all focused on the same goals and want the same thing” (Desmond, project manager).

Therefore, the phoenix story can be viewed primarily from an integration perspective as a manipulation of symbols and signs by leadership that unites staff around a shared success. This appears to be the goal in its telling to an audience. However, it may be interpreted more ambiguously by clinical staff, who are able to see it in its wider context. While some aspects of the story may be used positively and some values may be shared, a change in organisational form can also generate mistrust as it comes up against traditional ways of working. This ambiguity affects the meanings made by individuals within the organisation.

115 CHAPTER SEVEN:

DISCUSSION