essential-guide-to-qualitative-in-organizational-research

40 –––––––––– QUALITATIVE METHODS IN ORGANIZATION STUDIES ––––––––––––––––––into the practice – I’m like a square peg in a round hole.’ The scale of these difficulties canbe demonstrated through describing a relatively minor, but significant, incident about whetherher office door should be left open or closed. Since her arrival, the practice manager had leftthe door between her office and the reception area, which housed the rest of the office staff,open throughout the day. The reception staff, for whom she was responsible, interpreted thisaction as ‘spying on us’, and resented what they perceived as her interference in the way theycarried out their work. She, on the other hand, felt that she was ‘only doing my job by makingsure everything’s running smoothly and that I’m available if needed – I see that as myresponsibility.’ At first glance these can seem like very superficial disagreements, easilyexplained as interpersonal difficulties. But they actually embodied the different, andcompeting, assumptions deeply held by the various members of the practice, and which madeup the network of typifications that served to structure their realities. Some of thesetypifications are discussed below.Prior to the arrival of the practice manager, this three doctor, seven staff practice had prideditself on its very flat structure and its ‘caring family’ ethos. This family structure reflected thedesire held by all the doctors, but particularly Dr B, to create a caring, cohesive, collectiveloyalty within, and to, the practice, which ‘also includes the patients – we wouldn’t have apractice without the patients.’ This family orientation was reflected in the stories which stafftold about the practice’s past. For example, ‘Dr B has been like a father to me’ was how onereceptionist described her relationship with the founder, whilst another told stories about ‘allthe support I received from here when I was going through my divorce – support that you’dexpect from your family.’The structure worked in the sense that relations based on the personal rather than thehierarchical evolved, together with the view that nobody was much higher or much lowerin importance than anybody else. This was uncommon in general practice and these relationswere manifested and reinforced in a variety of ways. For example, the use of first name termsfor doctors, staff and patients conveyed friendship, and therefore reinforced the notion ofrelationships of equality. Similarly, many practice discussions were organized around issuesunconnected with the usual functions of general practice. One such discussion took placeabout the political implications of the Gulf War, for example, reflecting the commonly sharedpolitical views held in the practice, and reinforcing the notion of the practice as a liberal,egalitarian organization. However, in reality the doctors held the locus of control, and anunspoken rule had evolved over many years which embodied the implicit knowledge that thedoctors’ views and therefore their authority were never really to be questioned. Thiscontradiction was managed through a high level of trust and mutual respect which existed inthe ‘family’ prior to the new legislation and the employment of the practice manager.This family orientation and related structure were accompanied by a high value on clinicalexpertise and autonomy, but a very low value on management principles and techniques. Thelatter were seen as secular activities, potentially damaging to the sacred clinical orientation ofthe practice (Laughlin, 1991). Despite this, the doctors hired a management consultant tocontrol and direct the appointment of a practice manager in response to the new reforms,again reflecting the value placed on expertise. The person appointed came from a highlybureaucratic background with a lot of experience in the wider NHS system. She was chargedwith implementing the reforms, which required the reorganization of much practice activity,but she was largely denied the power to do so, and struggles over the modification oforganizational realities and practices ensued. These struggles became evident in organizational