How general medical practitioners make sense of their commissioning role in the English National Health Service and why it matters: theorizing field change through the interrelationship of rules, networks, and cognitive frames

Cresswell, Adele (2016) How general medical practitioners make sense of their commissioning role in the English National Health Service and why it matters: theorizing field change through the interrelationship of rules, networks, and cognitive frames. PhD thesis, University of Nottingham.

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Abstract

This thesis includes theoretical contributions to organisational studies and medical sociology, drawn from a three levelled ethnographic case study of commissioning by General Medical Practitioners in the setting of the English National Health service. In order to locate these levels as interrelated structures, the concept of “field” (Bourdieu, 2005, Fligstein, 2001, Fligstein and McAdam, 2012, Lewin, 1997 [1951]) is used. Jens Beckert (2010) has developed a framework in which cognitive frames, networks, and rules are in a relationship of irreducible interdependency. The definitions of analytic categories in the extant framework are under-developed. In this thesis, the framework is empirically applied to add definition to the analytic category “cognitive frame”. Beckert’s Framework and Weick’s (Weick, 1995, Weick, 2000, Weick et al., 2005) Sensemaking Perspective are intersected to develop a reciprocal relationship between the two theories. By conceptualising cognitive frame as a sensemaking process, insight is gained in three different but overlapping facets: wider contexts, temporality, and distributed sensemaking. At the level of an industry a cognitive frame can be described as a sensemaking type, which will have constituent sensemaking styles associated with that industries internal networks. When rules require organisations from separate industries or sectors to form partnerships then actors with different sensemaking types will be required to interact within one network. Organisational development techniques can be used to support and align sensemaking in both of these circumstances. Sensegivers may have an important role in pacing, including suspending, sensemaking. The thesis also contains insights for medical sociology in respect of how and why GPs commission as they do. These relate to the impact of belonging to the NHS family; differing permutations of changes to the profession (hybridisation, restratification, and the delimitation of autonomy) in GP networks; GP compliance with rules; and the characteristics of an inner-city GP workforce.

Item Type: Thesis (University of Nottingham only) (PhD)
Supervisors: Starkey, Ken
McDonald, Ruth
Keywords: Jens Beckert, networks, rules, sensemaking, sensegiving, general practice, primary care, commissioning, organisational development,
Subjects: R Medicine > RA Public aspects of medicine
Faculties/Schools: UK Campuses > Faculty of Social Sciences, Law and Education > Nottingham University Business School
Item ID: 33667
Depositing User: Cresswell, Adele
Date Deposited: 18 Jul 2016 06:40
Last Modified: 18 Sep 2016 07:37
URI: http://eprints.nottingham.ac.uk/id/eprint/33667

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