MANAGERS, DOCTORS AND CULTURE - CHANGING AN ENGLISH HEALTH DISTRICT

Much contemporary writing on organizational culture overstresses conse nsus. Using a case study of a UK National Health Service district, it is suggested that there can be distinct frames of meaning within one o rganization. Managers' ideas about creating a unified culture were ref lective of an attempt to move from medical dominance to a managerialis t orientation, but this change was the subject of considerable dispute . There was debate about whether management was appropriate to an orga nization that had traditionally relied on administration and the conse quent medical autonomy that this implied. Conflicts over the proper ro le of doctors, managers, and the health service itself meant that this culture was best conceptualized ar divided not shared Ideas about uni ty, as theory or management prescription, neglect the many ways in whi ch formulations of us and them shape organizations.