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The purpose of this paper is to describe a hybrid approach to the research developed during a multi-researcher, ethnographic study of NHS management in the UK.

This methodological paper elaborates a hybrid approach to the sociological analysis – the critical-action theory – and indicates how it can contribute to the critical health management studies.

After exploring the various theoretical, methodological and philosophical options available, the paper discusses the main research issues that influenced the development of this perspective and the process by which the critical-action perspective was applied to the studies of managerial work in four health service sectors – acute hospitals, ambulance services, community services and mental healthcare.

This methodological perspective enabled a critical analysis of health service organisation that considered macro, meso and micro effects, in particular and in this case, how new public management drained power from clinicians through managerialist discourses and practices.

Healthcare organisations are often responding to the decisions that lie outside of their control and may have to enact changes that make little sense locally. In order to make sense of these effects, micro-, meso- and macro-level analyses are necessary.

The critical-action perspective is presented as an adjunct to traditional approaches that have been taken to the study of health service organisation and delivery.

The purpose of this paper is to explore the use of stories in a mental health environment. It includes an account of learning to read and recognise stories as a particular form of organizational narrative in the National Health Service (NHS).

The study involved a retrospective search for stories contained within ethnographic data collected from a mental health organization. A small number of stories were analysed in an attempt to discover how stories were used in one particular organizational setting.

The stories told by staff ranged from heroic action on behalf of a patient and in spite of the organization, to tragic stories of staff coming to harm. Stories told by patients concerned their experiences of meaningful relationships with the staff. Alongside this small collection of stories, two particular phenomena associated with storytelling are described; the first involves counter‐stories, which involved either discrediting accounts of patient as storytellers or offered different stories to suggest competing interpretations. The second involved collapsed story forms exchanged between staff as a means of convergent sense‐making.

The paper works with stories as a particular narrative form in one particular mental health setting. These stories have the potential to draw attention to aspects of organisational life such as fears about harming patients or coming to harm and possibilities for relationships between patients and staff. Two forms of exchange related to storytelling are detailed and are described as counter‐ and collapsed stories.

The purpose of this paper is to compare the evidence from a range of reviews concerned with the links between human resource management (HRM) and performance. The aim of the paper is to review this diverse literature, and to derive human resource (HR) implications for healthcare researchers, policy makers and managers.

Recent reviews of the human resource management and performance literature are examined, in addition to the inclusion of a previously unpublished review. Their methods, HRM focus, findings and recommendations are contrasted in order to produce this review.

The paper finds that relationships have been found between a range of HRM practices, policies systems and performance. Despite being an important concern for HR professionals, there is little research exploring the link between HRM and performance in the health sector.

The paper sees that recent studies have found HRM practices to be associated with patient outcomes such as mortality, yet they yield little information regarding the processes through which HRM affects individual performance and its consequent impact on patient care. The use of approaches that seek to gain an understanding of workers' interpretations of their experience, i.e. the psychological process through which HRM can affect individual performance, may shed some light on how these processes work in practice.

The paper shows that increasing autonomy for healthcare organisations in the UK, i.e. Foundation Trusts, may offer increased opportunity for locally tailored HR systems and practices.

The paper presents findings drawn from a review of previous research on a subject of increasing relevance to HR researchers and practitioners in healthcare organisations. The paper indicates alternative approaches to research and practice in light of extant research.

The purpose of this paper is to review themes emerging in articles published in QROM over the previous ten years.

Retrospective review article.

Over the previous ten years of QROM, the content of articles has been extremely diverse as the journal has been able to sustain a valuable “dissensus”. This has meant that the journal provides a forum for rigorous, poly-vocal accounts about qualitative method and organisational life such that multiple, contrasting accounts might be held together for examination.

A research agenda is proposed that argues for further examination of what happens to different voices in organisations and management and in associated research practice.

The purpose of this paper is to examine National Health Service (NHS) employee perspectives of how high performance human resource (HR) practices contribute to their performance.

The paper draws on an extensive qualitative study of the NHS. A novel two‐part method was used; the first part used focus group data from managers to identify high‐performance HR practices specific to the NHS. Employees then conducted a card‐sort exercise where they were asked how or whether the practices related to each other and how each practice affected their work.

In total, 11 high performance HR practices relevant to the NHS were identified. Also identified were four reactions to a range of HR practices, which the authors developed into a typology according to anticipated beneficiaries (personal gain, organisation gain, both gain and no‐one gains). Employees were able to form their own patterns (mental models) of performance contribution for a range of HR practices (60 interviewees produced 91 groupings). These groupings indicated three bundles particular to the NHS (professional development, employee contribution and NHS deal).

These mental models indicate employee perceptions about how health services are organised and delivered in the NHS and illustrate the extant mental models of health care workers. As health services are rearranged and financial pressures begin to bite, these mental models will affect employee reactions to changes both positively and negatively.

The novel method allows for identification of mental models that explain how NHS workers understand service delivery. It also delineates the complex and varied relationships between HR practices and individual performance.

To examine the introduction of role‐redesign in the NHS and highlight implications for employment relations.

A 12‐month independent evaluation (2003‐2004) of a role redesign initiative in the NHS is reported. The study followed a developmental, case‐study design and included secondary data analysis, semi‐structured interviews and observations at five case‐study sites.

The role redesign process involved four types of change to job content: skill‐mix changes; job widening; job deepening; and development of new roles. Each of these changes had implications for employment relations in terms of remuneration, management and accountability, and education and training.

The research involves one initiative in the NHS and was evaluating a developing programme. Whilst implications are suggested for efforts at role redesign generally the research specifically relates to NHS organisations.

Three aspects of employment relations are identified as important when attempting role redesign: remuneration, management and accountability, and education and training.

This paper offers the first account of this national NHS role redesign initiative.

It has been suggested that localised attempts at change may fail because of organisational defences that are sustained through bureaucratic systems. Mental health workers face specific threats arising from the nature and context of their work. The resulting anxieties lead to defensiveness in the workers that may be supported by organisational structures and procedures. Attempts at changing existing patterns of work can increase anxiety and lead to more (rather than less) entrenched resistance in the form of organisational defences. As a result, the service received by patients may barely change. Four health service contexts are introduced here and psychodynamic processes operating therein are explored and contrasted.

The purpose of this paper is to propose five organisational factors associated with abuse, neglect and/or loss of dignity of older people resident in care homes. It derives from one set of findings from the ResPECT Study of Organisational Dynamics of Elder Care commissioned by Comic Relief and Department of Health through the Prevention of Abuse and Neglect In the Care of Older Adults programme.

A knowledge synthesis method was selected to identify organisational aspects of elder mistreatment in residential care settings. The method was selected for its suitability in examining ill-defined and contested concepts such as; elder mistreatment – where the available evidence is dispersed and produced in varied forms. A rapid review comprising a search of three academic databases and a detailed examination of selected investigation reports into institutional mistreatment was followed by panel meetings with subject matter experts to complete the knowledge synthesis.

This paper identifies and elaborates five organisational factors associated with elder mistreatment; infrastructure, management and procedures, staffing, resident population characteristics and culture. It also indicates macro-structural factors affecting care quality.

Further research is needed to elaborate the influence of these organisational factors on mistreatment and to understand any interactions.

As an adjunct to personal factors, the knowledge synthesis indicates common organisational factors contributing to institutional abuse. This suggests that care quality is produced systemically and that it can collapse as a result of seemingly minor and unrelated organisational changes.

Care home safety and quality is an ongoing concern, with popular analysis frequently stopping at the point of describing individual errant behaviour. However, as “problem” organisations are closed down, “problem” organisational factors continue to recur elsewhere.

The paper identifies and elaborates organisational aspects of elder mistreatment in residential care settings. The findings are original, valuable and grounded in relevant experience by the method of analysis and synthesis of the findings from inquiry reports as well as research and the contribution to the development of findings by those central to the issue, residents, relatives and care providers.