Nurses, Organisational Culture, and Innovation: Perspectives from the Frontline.

Abstract

This thesis investigates nurses' perceptions of organisational culture and examines whether this culture is supportive of innovation or whether it constrains it. These concepts are especially pertinent in the healthcare sector. The National Health Service (NHS) faces mounting challenges due to the need to meet increasing public demands within current funding, whilst at the same time improving quality. Innovation has been proposed as being central to the success of these efforts (Department of Health 2011a). Frontline workers such as nurses are key to the idea generation and dissemination necessary for successful innovation. (Knol and Van Linge, 2008) and organisational culture can support innovation or equally it can inhibit innovation and its spread (Coeling and Simms, 1993a). Therefore this study examines the organisational culture from the perspective of nurses within one hospital, and identifies cultural barriers to and drivers of innovation.
Using an ethnographic case study approach, combining methods including questionnaires, depth interviews, focus groups and observation, this study establishes the key issues facing nurses working in one Welsh NHS hospital. The findings reveal six key cultural themes and indicate that nurses are stretched to their limits by the intensification of nursing work and conflicting demands on their time. Additionally nurses expressed feeling undervalued and unrewarded. The research also reveals a disconnect between senior management and frontline
workers and a lack of inter departmental sharing and communicating. Drawing on these findings and using an amalgamated model of innovative culture, the thesis establishes that, from the perspective of the nurses, the culture within the hospital does not support innovation and indeed there are numerous cultural barriers to innovation both in terms of idea generation and dissemination. The thesis makes a number of contributions to knowledge; theoretically by the development of an amalgamated cultural model which draws on the work of Johnson (1992), Schein (1985) and Herman (1970). It makes empirical contributions by the development of a model of the relationship between key themes raised by nurses and the development of a hierarchy of nursing innovation motivation model. It also makes methodological contributions by the discussion of ethnographic methods and of what constitutes a 'proper ethnography'. Furthermore it makes practical contributions for those wishing to foster an innovative culture among nurses by recommending measures to reduce cultural barriers to innovation and increase employee engagement.

Date of Award	May 2015
Original language	English
Awarding Institution	Bangor University
Sponsors	The Knowledge Economy Skills Partnership 2 (KESS 2) programme, Bangor University, ESF, and Tenovus Cancer Care
Supervisor	Clair Doloriert (Supervisor) & Sally Sambrook (Supervisor)