Logics, Levels, and Voice: Recovering Human Relations in Management of Health Services

Abstract

In the context of globalisation and a dominant market ideology since the 1980's several earlier assumptions concerning Human Resource Management in both the private and public sectors have been thrown into question. The command-and-control presumptions of models of New Public Management are being challenged as embodying an outdated Fordist and Taylorist production paradigm, while recent management perspectives more consistent with the earlier Human Relations approach of Elton Mayo and stress on the need for Voice of Albert Hirschman are recovering concern with employee well-being for both competitive and mutual advantage. This paper seeks to contribute to these by distinguishing macro institutional from meso organizational and micro operational levels and to enhance the case for greater relative autonomy at such intermediate and lower levels. It draws on audio-taped semi-structured interviews with 46 doctors and 3 nurses as managers and 3 administrators through a period of change within a recently formed Hospital Trust of a major teaching hospital and two other hospitals in a southern European National Health System. In particular, to capture their perceptions over three phases from their internal reorganisation on New Public Management lines (2009), their merger (2011) and post-merger scenarios (2014-18). It then discusses the findings in relation to the case for recovering a human relations approach in the management of public services and offers suggestions for future research.