Continuity and change in a hospital ward : an open systems analysis

Abstract

Using a voluntaristic theory of action and Buckley’s (1967) paradigm of complex adaptive systems, explanation of the process of change in organisations is attempted. The specific question addressed is why some changes, rather than others, are incorporated into organisational arrangements. This thesis has three parts. The first is a theoretical statement of Buckley’s model and an argument for the extension of this scheme in two important respects. The second is an extended case study of a psychiatric ward of a general hospital to which the model is applied. The third is a theoretical re-statement of the original paradigm in the light of this application. Buckley’s model was used to identify: 1. The external and internal variety which may affect an organisation 2. The tension-producing factors within the organisational arrangement which constrain actor’s choice of response to variety 3. The processes whereby actors selectively map responses to variety 4. The processes for the transmission and perpetuation of stable accommodations to variety. Two adaptations were made initially to Buckley’s scheme. To explain more fully the process of ‘mapping’ ((3) above), two constructs are proposed, derived from the concept of the phenomenal ‘self’. These are ‘meaning system’ and ‘dramatic repertoire of self-presentation’. Inclusion of Koestlers’ (1967) concept of the open-ended hierarchy of awareness is suggested as a theoretical solution to the problem of homeostasis ((4) above) in systems of action. Argument for the use of an open systems approach in general, and Buckley’s paradigm in particular, together with the proposed amendments of Buckley’s scheme is presented in Chapters I and II. The case study is presented in Chapters III-VIII. Chapter III is a review of the historical factors which provide the context for the study, while changes occurring in the nursing, medical and non-medical sub-systems are discussed in turn, in Chapters, IV, V and VI respectively. Chapter VII identifies four scenes of social encounter in the ward and discusses the process of interaction occurring in each. Chapter VIII is an epilogue which examines briefly the outcome of events mentioned in the earlier chapters. Chapter IX is a statement of the conclusions drawn from the case study. The value of Buckley’s paradigm in the construction of an extended case study is demonstrated and the importance of the concepts of ‘mapping’ and ‘perpetuation’ is highlighted because they permit explanation of macrosocial processes which remain fully within the social context and point to the importance of identifying the dramatisation of power in social encounters. The initial harnessing of action theory and systems theory concepts was found to be too limited. A theoretical solution is, therefore, proposed in Chapter X which is capable of explaining system elaboration in the two dimensions of ‘organisation’ and ‘self’. The model takes into account the dialectic tensions existing between ‘self/organisation’ and ‘stability/change’, and differentiates between evolutionary and revolutionary change, making explicit both the constitutive processes of interaction and the interplay of forces affecting the individual and social order.