• nursing;
  • subcultures;
  • ritual and ceremonial;
  • National Health Service;
  • change;
  • symbol;
  • demarcation;
  • organizational culture

The role of ritualistic ceremonial in removing barriers between subcultures in the National Health Service

Background. One of the ways in which it is possible to achieve successful organizational change is through the elimination of those ceremonies that reinforce or preserve the negative aspects of professional and work group autonomy, thus maintaining the barriers between subcultures. Conversely, the encouraging of ceremonies which reinforce positive aspects is likely to achieve more flexible, team-orientated changes.

Aim. The paper considers those ceremonies, which perpetuate barriers in a National Health Service (NHS) Trust, and explores new ceremonies which may question, weaken or eliminate current dysfunctional practices.

Design. Our research approach was mainly phenomenological, as we wished to elicit the symbolic significance of organizational routines. The primary source of data was spoken language. The findings are based on purposive sampling of informants by means of semi-structured interview and observation. Other types of information were also collected, including business plans, reports and brochures. Informants included the Chief Executive and four Board members, three consultants, the director of nursing and midwifery, 10 middle managers and eight junior, nonmedical and nonmanagerial employees.

Findings. Two broad bands of ceremonies have been identified – those which preserve the existing norms and autonomy of professional and worker groups, which we have named Ceremonies of Preservation, and those which encourage change, which we have called Ceremonies of Change. Considerable data are provided to help to `tell the story'.

Conclusion. The paper argues that attention to ceremonial in the wider change process may facilitate the desired, specific change or changes in practice. It suggests that changes which confront unnecessary demarcation, but which do not undermine professional integrity, can create real benefits for NHS hospitals.