NHS transformation

Following the Cooksey Review of 2006 and the establishment of nine Collaborations for Leadership in Applied Health Research and Care, a research programme followed three NHS Acute Trusts over five years. Three waves of in-depth interviews were conducted in 2009, 2011 and 2012; the analysis discussed in the book draws on twenty-seven interviews with nine managers who remained in post throughout.

Longitudinal data of this kind is unusual in a setting with high leadership turnover, and it is what makes the central finding possible: tracking how the same people emplotted the same events differently at different moments.

It produced the concept the book uses most in practice: prospective emplotment. A finance director who had been through three previous hospital moves narrated the sequence of collective feeling in advance — apathy, panic, excitement, adjustment — before the move happened. When the events departed from the template, the template was revised in real time; two years later it had been resolved again retrospectively into a tidy sequence.

It also produced meta-emplotment: a nursing director thinking not only about her own account of the change but about the accounts others would construct from what she provided or withheld. If people are told only part of the story, they will supply the rest — and typically darker than the reality.

Across all three trusts the same deep structure appeared: the organisation as a protagonist on a quest, with managers positioning themselves as agents of that larger journey. The template preceded and organised the experience it appeared merely to describe — which is why resistance is often better understood as a narrative that does not yet make sense from where someone is standing than as stubbornness.

Character · Method · Application

1. Can you pre-script the emotional sequence honestly, including the worst point?
2. What are people making up because you told them only part of the story?
3. Which template are you applying to this change, and where has the situation been bent to fit it?
4. Who is a minor character in a quest that belongs to someone else?

Chapter Two: Character — the chapter carries the evidence and the close reading this page only points at.

Status: paraphrased from the manuscript · author review required · no case facts introduced from outside the manuscript