The nature of internal mediator and moderator influences in a healthcare system in transition a thesis submitted for the degree of Doctor of Philosophy thesis

摘要

This study explores the nature of internal mediator and moderator influences through the perspectives of two major activity domains in the Mid-Western Health Board as a healthcare system in transition. The general context of this case study relates to reform in the public service and in healthcare systems with particular reference to the Irish experience. Theoretical perspectives clarify the nature of management and the professions and the tensions between them. Models and approaches in the literature on organisational change and leadership are also examined.udAn inductive grounded research method, in this study, avoids a priori assumptions of leadership in a context of ambiguity and uncertainty. This provides opportunity to discover alternative explanations of internal change influence. The analytic framework is based upon category/paradigm analysis which relies on multiple data streams generated through two major activity domains (managerial and professional).udThe findings are presented as an emergent model which accounts for the various components, categories and the inter-linkages arising from the analysis of the respondents’ data. These components are external and internal contexts, antecedent and actual experience from the perspectives of two major domains, emerging as three activity strands: mediator influence, mediating through people and the operational system. The model’s holistic framework is therefore grounded in the domains’ interpretation of their experience of internal mediators and moderators of change.udThe relevant extant literature demonstrates the relevance of the emergent model as an explanatory and developmental framework. It elucidates aspects of the internal logic of the organisation’s influencing capacity as mediators and moderators of change rather than imposing an external reductionist logic on participants’ experience. Some recommendations for future research are indicated.