Critically evaluate the practices/behaviours in an organisation.

This essay will explore organisational culture through the postmodern lens and critically evaluate the practices and behaviours of the NHS. The NHS has been chosen as life in the UK and the NHS are inextricable, whilst culture provides a moral compass for workplace struggles (Reid, 2012; Bennett & Williams, 2013; Hatch, 2018). I was drawn to the postmodern perspective of culture as education tends to be rooted in modernistic views and one way to explore alternative perspectives is to write about a culture you have experienced (Geyh, 2003).

The NHS claim culture “matters” and “shapes the whole organisation”, yet there are reports that there is a culture of blame, silencing and bullying (NHS Improvement 2017; BBC, 2015; Triggle, 2013). To understand what is really happening, without presenting the NHS as a sacred hero or a sinking ship, it is important to look at how the NHS discuss their culture, how others discuss their culture, and what is excluded (Scott, Mannion, Davies & Marshall, 2003; Matthew, 2009).

The choice of perspective will be justified in section two, followed by a critical literature review of postmodernism and culture in section three. A critical evaluation of behaviours and practices in the NHS follows in section four, leading to final conclusions.

Hatch (2018) describes the postmodern perspective as a stance of critical appreciation in which reality and truth do not exist, and any assertion is merely an exercise of power. Whilst this encapsulates the perspective, any attempt to define postmodernism would be paradoxical as it avoids fixed definitions and meanings (Geyh, 2003; Schultz & Risberg, 1992). Therefore, this essay will embrace a plurality of realities and highlight the ambiguity of culture by relinquishing ultimate truth (Boje, 1991; Martin, 1992; Hancock & Tyler, 2001). This adds a fruitfulness to evaluation and the opportunity to explore new interpretations as well as unravelling current assumptions (Hancock & Tyler, 2001). However, postmodernism may subconsciously commit to modernist presumptions when expressing disapproval (Gergen & Tojo, 1996). The postmodern perspective fails to offer alternatives or solutions, despite critiquing others, and it does not acknowledge its own position of power (Hatch, 2018). Despite these limitations, the postmodernist perspective can raise important questions around the moral and political intentions of accepted organisational practices whilst unveiling many truths and voices (Gergen & Tojo, 1996).

This essay will include personal experiences of working in the NHS. This offers the opportunity to investigate any gaps between first-hand experiences and external information (Hancock & Tyler, 2001). Furthermore, it presents an account with less embellishment as the perception of experience, and its chain of signifiers, is closer to the original experience (Churchill, 2005). However, it is essential that the author is suspicious and critical of their own assumptions and experiences (Clegg & Kornberger, 2003). Furthermore, including personal experience can raise epistemological limitations, as a writer may assert their experiences as reality (Churchill, 2005).

Postmodern literature is varied and complex, supplying an unparalleled foundation to review the concepts which construct our reality, or the lack of (Geyh, 2003; Hatch, 2018). Postmodernism also presents a rich source of tools to analyse organisational culture such as intertextuality, antenarrative and deconstruction (Hatch, 2018). These tools highlight the importance of text and its ability to create an illusionary narrative intertwined with power dynamics and silenced voices (Hancock & Tyler, 2001). This literature review will evaluate key authors through a fluid discussion of culture and the three key analytic techniques.

Hancock and Tyler (2001) suggest that postmodernism looks beyond accepted ideals and discards the modernist idea that organisational culture is always for the common good. Foucault, Dreyfus & Rabinow (1982) propose that organisational culture is intertwined with power, control and government rationality which reduces a worker’s autonomy. Similarly, Payne (1991) states culture is rooted in the control of a worker’s behaviours and beliefs. However, Clegg and Kornberger (2003) and Martin (1992) suggest that defining culture does not align with the postmodern view of avoiding fixed truths. But in a constant search for ambiguity, postmodernists often look only where they will find uncertainty, by ignoring all quantitative data, ultimately creating power in their own rationale (Martin, 2002). Despite this, Martin (1992) suggests that seeking conclusions on culture would be abandoning the postmodern lens.

Hatch (2018) and Martin (2002) suggest abandoning the accepted truth that culture is fixed and easily changed and proclaim that we are falling into the traps of modernist thinking. Interestingly, postmodernism would struggle to formulate a truly critical perspective without acknowledging the very notions it strives to dismantle (Hancock & Tyler, 2001). Postmodernism focuses on acknowledging the fragmented and fluid meanings of culture with flexible cultural boundaries and interpretations (Sanger, 1995; Schultz & Risberg, 1992; Hancock & Tyler, 2001). Whilst modernism focuses on culture creating a path to achieve outcomes, the postmodern perspective argues this is merely an assertion of control (Martin, 2002). However, Munro (1999) suggests this notion could reject human agency and our ability to accept or understand control as a fundamental part of existence and functioning.

Kristeva’s (1986) theory of intertextuality can analyse and unpack organisational culture through text. She introduced the term following the work of Bakhtin and Saussure on the social contexts and systematic qualities of language (Martin, 2011; Allen, 2011). Intertextuality assumes texts of culture do not stand alone, and instead are a patchwork of quotations with interwoven sources that transform and evolve meaning, ultimately leaving behind the original intentions of the author (Kristeva, 1986; Raj, 2015; Hatch, 2018).

Intertextuality shows the constant evolution of organisational culture, actors, symbols and actions and demonstrates that ongoing referencing can change meanings (Hatch, 2018; Orr, 2010). However, some postmodernists disagree with the holistic approach of intertextuality, and lean towards tools such as antenarrative, which demonstrate the fragmentation of meaning (Hatch, 2018; Martin, 2002).

Boje’s (1991; 1995; 2006) antenarrative theory argues that organisations destabilise accepted attributes of storytelling by ignoring linear explanations, instead proposing fragmented, speculative narratives. This builds a new story to change the future and alter the past, by silencing multiple voices and trialling various narratives until one is accepted (Hatch, 2018; Ray & Goppelt, 2011). However, Schultz & Risberg (1992) argue that antenarrative rejects evidence that many people seek culture as a way of life, despite the exploitative qualities, as they focus on sharing experiences.

Antenarrative is a significant theoretical lens as it explores the compromising process of understanding fragmented work stories (Thorpe & Holt, 2008; Ray & Goppelt, 2011). Vaara and Tienari (2011) argue that antenarrative is essential in analysis as it unfolds the organisational techniques that build culture. Humle and Pedersen (2015) agree, as antenarratives reveal the use of doubt to shift culture. However, antenarrative has little practical value as it simply diagnostic (Ray & Goppelt, 2011; Martin, 2002).

Mumby’s (1998) theory of deconstruction looks to undermine the dominant narrative by unearthing opposing perspectives (Papa, Daniels & Spiker; 2008; Clegg & Kornberger, 2003). Deconstruction can be used as a response to the reproduced and tailored narratives, and thereby organisational cultures, as it reveals power imbalances and excluded voices (Hatch, 2018). Deconstruction does not aim for one interpretation to win but to unearth different lenses (Hatch, 2018).

Rosen’s (1985) deconstructive study of Breakfast at Spiros found that employees were coerced into conforming with culture to exploit them. However, this could ignore individual sense of self and the influence of personal enjoyment (Munro, 1999; Cohen, 1994). Boje (1995) used deconstruction to uncover unheard voices and stories of Disney employees, and in combination with the dominant narrative showcased the many organisational truths (Hancock & Tyler, 2001). Rowlinson & Hassard (1993) discovered that one organisational culture was rooted in quaker values to mask exploitative management practices (Hatch, 2018). In a similar study, Ezzy (2001) found that a family-like culture exploited worker’s good nature in return for financial gain, creating an alternative simulacrum of their workplace community (Hatch, 2018). Whilst important, Jencks (1988) suggests deconstruction is subversive and requires an ideology to unravel. It must dance a fine line to ensure it does not become a dominant power, a rule, a box and a definitive (Jencks, 1998; Clegg & Kornberger, 2003).

The dominant narrative suggests that culture is fixed, but postmodernism transcends this, focusing on the fragmentation of cultures and the exertion of power (Hancock & Tyler, 2001; Schultz & Risberg, 1992). Intertextuality, antenarrative and deconstruction are useful tools to expose the evolved meanings, layered stories and silenced voices which create accepted cultural practices, behaviours, and narratives. The lens presented in the literature review will provide a basis for critically evaluating the NHS.

This critical evaluation will appreciate the phenomenon of culture within the NHS. To align with philosophical foundations in linguistic ontology, cultural practices and behaviours will be analysed through text and discourse (Hatch, 2018; Derrida, 1976). NHS culture has been widely discussed by the media, academics, and the government, which presents an opportunity to investigate the dominant narrative and bring to the fore alternative voices and power dynamics (Matthews, 2009). To unearth multiple layers of culture, this evaluation will begin with the dominant narrative held by the NHS themselves, before delving into alternative voices and power dynamics within the Government’s narrative.

The NHS claim a culture shift will improve organisational outcomes, which is an attempt to use culture to control employee behaviours for financial gain (Kings Fund, 2020; Hancock & Tyler, 2001). In the 1980s, the NHS experienced an organisational shift towards modernist ideals of efficiency and control (Matthews, 2009). This can be seen in recent NHS public discourse, which is laced with words such as rules, behaviour, results, and outcomes (NHS Improvement, 2017; Stevenson, 2019; HCSA, 2019). This approach hides the realities of their culture and silences voices (Stevenson, 2019; HCSA, 2019).

Alternative narratives and voices hold the NHS narrative of culture to be true, whilst also contradicting it. Voices reported through the media were the basis of NHS improvement plans, however, they also showcase alternative experiences which the NHS does not acknowledge (NHS Improvement, 2017). Media reports of toxic NHS culture reveal unheard voices, for example, a GP felt NHS culture endorsed secrecy, and a paediatrician was offered compensation to not report complaints to the media (Triggle, 2013; BBC, 2015). However, this is the first discovered layer and not the ultimate truth (Martin, 1992; Martin, 2002).

Intertextuality reveals the evolution of meaning in the media narrative (Hatch, 2018). Quotes are contextualised around the writer’s opinion which distorts the original meaning (Martin, 2011). This could raise issues of authenticity, as news outlets can be used as a tool to push agendas (Gehlbach & Sonin, 2014). Building a negative perspective of the NHS creates a sense of inadequacy, which can increase acceptance of government policies and frame a sense of reality which increases governmental power (Walker, Hanna, & Raisborough, 2020; Hatch, 2018; Foucault et al., 1982).

Antenarrative can expose the many layers of NHS culture (Clegg & Kornberger, 2003). A book written by a former NHS worker brought to the surface many distressing, hidden accounts yet was publicly disputed by the NHS (Dyer, 2019; Williams, 2020). The NHS created an antenarrative, reinforcing the inadequacies of the individual rather than addressing the claims, which silenced the author’s voice and created a new accepted narrative (Clegg & Kornberger, 2003).

Some employees experience a cover up culture where consultants change written accounts of experiences to avoid penalties and fines (NAME ertyupersonal communication, February 2016). The consensus of employees is that these behaviours protect the team and create a culture where mistakes are forgiven (A. Irving-Carr, personal communication, April 2016). Whilst these innocent intentions could hold true, these behaviours could indicate a culture of manipulation which leads to a rise in power, legitimacy and status for consultants (Foucault et al., 1982; Martin, 2002). It could be that culture does not exist at all, and that these stories are another way to control employee behaviours (Hatch, 2018). Alternatively, employees could be reacting against the power imbalance imposed by the penalties and fines (Clegg & Kornberger, 2003). This experience can represent the illusion of culture which differs depending on position, privilege, and power (Hatch, 2018; Foucault et al., 1982).

Deconstruction of media and NHS texts reveal that culture may be used as a scapegoat for organisational shortcomings (Scott et al., 2003; Clegg & Kornberger, 2003; Wise, 2018). Reports push a culture of bullying, silencing and blame, but this projection of a single culture ignores the nuances of coexisting cultures and subcultures (Scott et al., 2003). This is reinforced by the NHS in their use of language, always referring to the NHS as a singular entity (NHs, 2020a; NHS 2020b). This one-dimensional, fixed culture creates a set of measures to overhaul their system, which serves only the performance outcomes (Scott et al., 2003). This approach ignores the multiple roles, departments, locations, and people under the NHS umbrella, and offers simplistic solutions with little depth (Wise, 2018). Furthermore, framing culture as a one-size-fits-all phenomenon, with a singular remedy, marginalises key contributors to culture such as knowledge, macrostructural factors and governmental influence (Scott et al., 2003; Wise, 2018; Anderson-Wallace & Shale, 2013).

It is important to evaluate the political dimension of NHS culture, as the government and politics underpin dominant narratives and influence reporting, compliance, and targets (Jencks, 1993; Anderson-Wallace, & Shale, 2013; Hatch, 2018; Lacobucci, 2017). A centralised administration allows the government to exercise power using top-down approaches to instil behaviours in the organisation (Scott et al., 2003; Foucault, et al., 1982). This can be seen in a report released by the Department of Health (2015) which details a plan for culture change. This is a modernist outlook, as they focus on prescribing methods for improvement to reduce defects and increase productivity, showing they believe culture can be designed and controlled from the top (Matthew, 2009; Hatch, 2018).

The government introduced ‘clap for the NHS’ to unite the public, show appreciation and improve organisational culture (Bowman, 2020; Binding, 2020). However, this hides the governments reluctancy to improve working conditions and budgets (Darlow, 2020; King & Lawley, 2016). Their public support of the NHS is an illusion, hiding the fact that parliament blocked an NHS pay rise, resources have been cut (Peat, 2020; Savage, 2019; Darlow, 2020). These are all causal factors of a toxic corporate culture (Wise, 2018).

The Government respond to cultural problems in the NHS by describing leadership as the only solution, as demonstrated in a speech by Matt Hancock and a Government Brief (Stevenson, 2019; Department of Health and Social Care, 2018; Sturrock, 2019). However, this modernist approach suggests leadership can control workers, which diminishes agency and ignores organisation members as a creator of change (Scott et al., 2003; Matthew, 2009; Martin, 2002; Hatch, 2018). Wise (2018) argues that using cultural leadership as a remedy is politicised bureaucracy, which hides the negative impacts of government strategy, budgets, and policies.

This critical evaluation of practices and behaviours in the NHS exposes and navigates many layers and illusions of culture. The NHS describe a collective and kind culture throughout their organisational texts, but through intertextuality, antenarrative, and deconstruction we can understand the abundance of alternative voices which describe workplace bullying, marginalisation and silencing (Scott et al., 2003; Clegg & Kornberger, 2003). This evaluation argues that the government create an unbalanced power dynamic to benefit their own agenda, with leadership as a method of control (Matthew, 2009; Martin, 2002; Wise 2018).

Through the postmodern lens, this essay has appreciated the many layers of organisational culture at the NHS. It has been argued that both hidden and visible layers silence voices to create an illusionary narrative intertwined with power imbalances (Matthew, 2009). Whilst the NHS create a positive narrative for their organisation, other voices expose a culture of bullying (Scott et al., 2003). Furthermore, it has been found that the government frame a sense of reality to create a source of power and control (Wise, 2018). It is important to accept that these narratives and voices can coexist, even if conflicting, to appreciate the fluid and fragmented meaning of culture (Schultz & Risberg, 1992; Sanger, 1995; Hancock & Tyler, 2001).

With the assertion of control and the silencing of voices through culture, there is a great deal of change needed within the NHS. However, moving forward with action could be difficult given the ambiguity of postmodernism (Martin, 1992). Offering a set of recommendations would be asserting power in itself. Instead, we can encourage awareness of the ethical implications that the NHS culture can bring (Hatch, 2018). We can inspire individuals and organisations to critically question themselves, their cultural experiences and the power asserted on them to come together to overturn corporate control (Schultz & Risberg, 1992; Hancock & Tyler, 2001).

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