Plus ça change, plus c'est la même chose: senior NHS managers' narratives of restructuring

The UK National Health Service (NHS) is regularly restructured. Its smooth operation and organisational memory depends on the insights and capability of managers, especially those with experience of previous transitions. Narrative methods can illuminate complex change from the perspective of key actors. We used an adaptation of Wengraf's biographical narrative life interview method to explore how 20 senior NHS managers (chief executives, directors and assistant directors) had perceived and responded to major transitions since 1974. Data were analysed thematically using insights from phenomenology, neo-institutional theory and critical management studies. Findings were contextualised within a literature review of NHS policy and management 1974-2009. Managers described how experience in different NHS organisations helped build resilience and tacit knowledge, and how a strong commitment to the 'NHS brand' allowed them to weather a succession of policy changes and implement and embed such changes locally. By synthesising these personal and situated micro-narratives, we built a wider picture of macro-level institutional change in the NHS, in which the various visible restructurings in recent years appear to have masked a deeper continuity in terms of enduring values, norms and ways of working. We consider the implications of these findings for the future NHS.

Creating a standard of excellence. the history of ACHE's membership and credentialing

This year, ACHE celebrates its 75th anniversary. To commemorate this occasion, Healthcare Executive will feature a series of articles showcasing ACHE's rich history and contribution to healthcare.

Personal reflections

A hospice pioneer and veteran of 23 years reflects on the early days of the hospice movement in the United States. The political, social and economic forces, which shaped the industry, are addressed from a local state and national perspective. Current challenges are briefly referenced with a call for hospice leaders to recognize the need for and identify where hospice fits into the broad end of life discussions.

The 1970s: realignment

This year marks the American College of Healthcare Executives 60th year of service as a professional society. To celebrate the occasion, the column "In Review" will be features in Healthcare Executive throughout 1993. This issue features highlights from the 1970s.