Abstract
This study contributes to research examining how professional autonomy and hierarchy impacts upon the implementation of policy designed to improve the quality of public services delivery through the introduction of new managerial roles. It is based on an empirical examination of a new role for nurses – modern matrons – who are expected by policy‐makers to drive organizational change aimed at tackling health care acquired infections (HCAI) in the National Health Service (NHS) within England. First, we show that the changing role of nurses associated with their ongoing professionalization limits the influence of modern matrons over their own ranks in tackling HCAI. Second, the influence of modern matrons over doctors is limited. Third, government policy itself appears inconsistent in its support for the role of modern matrons. The attempts of modern matrons to tackle HCAI appear more effective where infection control activity is situated in professional practice and where modern matrons integrate aspirations for improved infection control within mainstream audit mechanisms in a health care organization.
Highlights
The empirical study shows limited prospects for modern matrons to enact their role in the face of professional hierarchy
This appears decoupled from the technical, knowledge-intensive activities of „new‟ nursing (Borthwick and Galbally, 2001; Dingwall and Allen, 2001). Whilst their visible presence in a wide range of arenas aid their attempts to tackle HCAI, overall modern matrons lack the necessary influence over other healthcare professionals, including their own ranks
As with other studies of professional change (e.g. Kirkpatrick et al, 2004), our findings regarding the role of the modern matron in tackling HCAI, reveal the limits of management change and the difficulties of securing occupational compliance towards managerial aims
Summary
The organization and management of professional work remains a significant area of analysis (Ackroyd, 1996; Freidson, 2001; Murphy, 1990; Reed, 1996).It is argued that professional autonomy and hierarchy conflict with bureaucratic and managerial methods of organizing work, especially attempts at supervision (Broadbent and Laughlin, 2002; Freidson, 2001; Larson, 1979).the extension of managerial prerogatives and organizational controls are seen to challenge the autonomy, legitimacy and power of professional groups (Clarke and Newman, 1997; Exworthy and Halford, 1999). One such policy initiative in England has been through the introduction of modern matrons charged with driving organizational change to tackle health care acquired infections [HCAI].
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