Contested Affordance of a Corporate Change Programme Dr

Introduction This paper addresses three phenomena of interest to organizational scholars and practitioners: corporate change programmes; new forms of organising; and knowledge processes in and around organisations. It does so using a case study of the Leicester Royal Infirmary, a large UK NHS teaching hospital, that gained the status of innovator in its sector through the introduction of a reengineering change programme. Business process reengineering (BPR) was involved within senior managers' action designed to meet intensifying demands upon the hospital related to the volume, quality, and efficiency of patient care. As a national pilot site, reengineering was subject to in-depth, empirical analysis between 1995 and 1998. Fuller accounts of the study are provided elsewhere (McNulty and Ferlie, 2002; Bowns and McNulty, 1999) but this account is distinctive as it utilises recent developments within the knowledge-based view of organisations to understand the implementation and impact of reengineering. Attention to the processes and effects of reengineering uses perspectives that regard knowledge as resource and social process (Eisenhardt and Santos, 2002). From a 'knowledge as resource' perspective reengineering is seen as so-called best-practice knowledge imported into the hospital by senior management to enable superior corporate performance. On the other hand the implementation and impact of reengineering is understood more from the perspective of knowing as a social process in local settings. The distinction between knowledge and knowing and the concept of dynamic affordance (Cook and Brown, 1999) are used within the paper to reveal how the adoption of reengineering was problematic in practice. The reengineering change programme was characterised by plural meanings and contested interpretations of process redesign. Indeterminate core organisational processes, as well as highly contentious patient process redesign interventions suggest the explicit knowledge and prescription of reengineering (Hammer and Champy, 1993) to have been of limited value as an aid to redesign organizational and healthcare processes in this context. Over time, knowing, analysed though redesign interventions and interactions, was more guided by tacit knowledge informed by structural and relational dynamics within the hospital – notably the organisational structure of clinical directorates and clinical specialties and the inability of mangers to direct change in organisation and practice within clinical domains. In effect, reengineering was mediated by powerful actors receiving and negotiating reengineering interventions in view of managerial and professional jurisdictions. The associated impact of reengineering was found to be less decisive and more locally variable across the many clinical settings within the …