Emergent Change and its Implications for Professional Autonomy and Managerial Control: A Case Study from Midwifery

摘要

Change can be seen as inevitable and constant, unpredictable and sometimes alarming and yet to stand still risks decay and stagnation. All organizations therefore need to be able to change and adapt to internal and external forces. The ability of the individual to embrace such change is in part due to the way change is managed, with this management approach often a reflection of the institution's culture whether it is in the private or public sector. Using a case study from midwifery, this article explores the tensions found between professional autonomy and managerial control during the application of a Scottish practice change initiative by NHS QIS Scotland in the repair of perineal trauma following childbirth. The study found a number of inter-related factors that drive the effectiveness of clinical change implementation namely; the emphasis placed on evidence-based practice, the role played by communities of practice within the hospital culture, the level of management commitment, and the personal and positional characteristics of the 'change agents'. Two different stories of the change process emerged: one planned, staged and linear; the other continuous, dynamic and unpredictable.