An examination of the negotiated order of NHS commissioning: a case study of a Clinical Commissioning Group. "Decisions in the absence of objectivity"

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Cox, S.N., 2018. An examination of the negotiated order of NHS commissioning: a case study of a Clinical Commissioning Group. "Decisions in the absence of objectivity". PhD, Nottingham Trent University.

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Abstract

Decision-making is a significant part of the business of board level activity in NHS organizations, including the recently created Clinical Commissioning Groups (CCGs). This research explores the behaviour of decision-makers within a CCG as part of a detailed case study focussing on a major strategic decision and looking at the various influences present. The aim being not merely to describe the decision and its outcomes, but to investigate the social interactions of those charged with making the decision and how the influences shape the eventual outcome.

The analysis used the concept of the negotiated order, analysing the texts produced in a series of decision-making meetings and qualitative interviews with the decisionmaking participants. Data was analysed through critical discourse analysis within a case study research methodology. Thus, the textual data and generated narratives provided the evidence for how the social relationships and interactions emerged in the case study. The decision-making process demonstrated the negotiated order being created through the power relations of the participants with formed coalitions using and re-shaping cognitive frames. The interpretation of the research findings produced a social power model for organizational decision-making, shaped by the use and exchange of frames within the discourse.

This is considered an original contribution to knowledge and supports the further development of the concept of the negotiated order and the use of cognitive frames within organizations. There are a number of implications for management practice that may improve decision-making and help further explorations into upper-echelon behaviour. The research is one of the first to explore the clinically led NHS CCGs and is and a rare example of detailed scrutiny into NHS decisionmaking. Furthermore, the research has a relatively unique position of the researcher as a participant observer already established as a senior position within the organization being studied. This provides a significant contribution to the body of knowledge and research practice of ethnography.

Item Type:	Thesis
Creators:	Cox, S.N.
Date:	July 2018
Rights:	This work is the intellectual property of the author. You may copy up to 5% of this work for private study, or personal, non-commercial research. Any re-use of the information contained within this document should be fully referenced, quoting the author, title, university, degree level and pagination. Queries or requests for any other use, or if a more substantial copy is required, should be directed in the owner(s) of the Intellectual Property Rights.
Divisions:	Schools > Nottingham Business School
Record created by:	Linda Sullivan
Date Added:	17 Sep 2019 10:47
Last Modified:	17 Sep 2019 10:48
URI:	https://irep.ntu.ac.uk/id/eprint/37680