Cutting the Cord: Mutual Respect, Organizational Autonomy, and Independence in Organizational Separation Processes
Abstract
Organizational Autonomy and Independence
Methods
Research Setting
Date | Key event |
---|---|
1991 | Hospital and mental health care services separated from MgmtAgency |
2007 | Divestment decision; executive team hired to manage implementation and lead the new organizational entity (“CommunityProvider”) |
2008 | CommunityProvider becomes an arm’s-length provider |
2010 | CommunityProvider becomes a separate legal entity |
2013 | MgmtAgency puts the majority of CommunityProvider services out to bid |
2015 | MgmtAgency assumes responsibility for providing the majority of CommunityProvider’s services |
Data Collection
Semi-structured interviews
Observation
Archival data
Data Analysis
Practices that the organizations (initially) cannot perform competently | Responsible entity | Successful transition toward autonomy (after 5 years) |
---|---|---|
Evaluating pediatric services | MgmtAgency | Yes: MA acquired information and skills to monitor and evaluate |
Developing and implementing a long-term, holistic healthcare strategy for region | MgmtAgency | No: MA focused on internal reorganization and did not adjust the majority of local services to changing demands |
Evaluating general community care services | MgmtAgency | No: MA lacked detailed information about many services |
Specifying contractual terms and conditions | MgmtAgency | No: MA continued to rely largely on specifications produced by CP |
Addressing unexpected service issues (incl. complaint procedure and remedial action) | Both | Yes: New procedures agreed and generally adhered to |
Closing, changing, or temporarily withdrawing services without causing disruptions to patients and/or other organizations (incl. notification and implementation) | Both | Partial: Success apparent in only one region |
Managing sexual health services | CommunityProvider | Yes: CP acquired information and skills to provide services that were nominated for national awards |
Managing community nursing services | CommunityProvider | No: Continued reliance on, and interference from, MgmtAgency |
Managing property rights | CommunityProvider | No: Majority of property rights not transferred |
Upgrading infrastructure | CommunityProvider | No: Continued reliance on financial support from MgmtAgency |
Findings
Organization | Name or Title | Role |
---|---|---|
CommunityProvider | Amanda | Contract manager |
CommunityProvider | Angela | Manager (specialist services) |
CommunityProvider | Catherine | Chief nursing officer |
CommunityProvider | CEO | Chief executive officer |
CommunityProvider | CFO | Chief financial officer |
CommunityProvider | Ella | Contract manager |
CommunityProvider | Fred | New chief financial officer |
CommunityProvider | Helen | Contract manager |
CommunityProvider | Jonathan | Regional manager |
CommunityProvider | Lucy | Regional manager |
CommunityProvider | Margaret | Manager (sexual health) |
CommunityProvider | Mark | Clinical director |
CommunityProvider | Richard | Manager (pediatrics) |
CommunityProvider | Nathan | Operations manager |
CommunityProvider | Robert | Clinical director |
MgmtAgency | Allison | GP rep/commissioner |
MgmtAgency | CEO | GP rep/chief executive officer |
MgmtAgency | Dale | GP rep/commissioner |
MgmtAgency | Felicity | GP rep/commissioner |
MgmtAgency | George | GP rep/commissioner |
MgmtAgency | Jennifer | GP rep/commissioner |
MgmtAgency | Joe | Director of contracting |
MgmtAgency | Kevin | Community contract manager |
MgmtAgency | Martin | GP rep/commissioner |
MgmtAgency | Melanie | Public health manager (sexual health) |
MgmtAgency | Paul | Finance manager |
MgmtAgency | Sharon | Children’s services contract manager |
MgmtAgency | Theodore | Communications manager |
MgmtAgency | Tim | Director of contracting |
Communication Facilitates Appraisal Respect
Communicating across organizational boundaries facilitates developing and demonstrating competence
So, in the end, Mark just . . . plonked himself in the surgery and said, “I want to see you.” And she had no choice basically. Interesting point: one of the comments that [Jennifer] made [was], “Oh, do we commission [all of these] children’s services? I didn’t think we did.” (Richard, CP, interview)
When we had the commissioning–provider split it was very much: the provider floated off; we didn’t really know much about the provider or their performance. And there was a lot of conflict in the meetings and mainly that was due to our lack of understanding of the provider, and you know, we were working with a sort of bottom-line contract sum and we didn’t actually have a detailed understanding of the services and what they were delivering. (Kevin, MA, interview)
Developing and demonstrating competence generates appraisal respect
There still does seem to be a view that [MgmtAgency members] can change contract definitions willy-nilly. As if I can just turn the tap and change the service focus or give it up, or I don’t know, just because they think it might be done differently. . . . That is the immaturity that I spoke of. (CEO, CP, interview)
Appraisal respect facilitates continued interorganizational communication
Communication Facilitates Recognition Respect
Communicating across organizational boundaries facilitates developing and demonstrating recognition
It is still very illuminating when you have discussions with GPs [affiliated with MgmtAgency] who talk about “Well, you must’ve got money for this” or “You must’ve got money for that.” And my answer is, “I got absolutely zilch.” QIPP [quality, innovation, productivity, and prevention] money? Zilch in district nursing, etc. And they are shocked when you lay the truth of the funding arrangements out. So, we should have [clarified that we were not] cutting posts out for the sake of it [but instead] trying to live within very meager means. (CEO, CP, interview)
Recognizing others’ concerns promotes feeling respected
When Tim attended [a performance review meeting], we talked about community matron personal health plans [and we] said, “Look, you have given us a 100% target and it is just not doable; there is a waiting list; so, let’s reduce it.” And he went, “Yeah, okay.” . . . And for me that was a valuable conversation. (Margaret, CP, interview)
Recognition respect facilitates continued interorganizational communication
It got so frustrating, and there was such negativity towards CommunityProvider by that stage. . . . And it was just getting beyond a joke. So, everybody was moaning about them . . . and it was becoming, I thought, untenable. I mean in public meetings, MgmtAgency would be badmouthing them and I felt it was unfair. . . . And it was sort of kicking the dog. (Felicity, MA, interview)
Mutual Respect Facilitates Autonomy
Appraisal and recognition respect enable granting and claiming autonomy
Claiming and granting autonomy reinforce appraisal and recognition respect
Autonomy Enables Increased Independence
Autonomy enables substituting organizational dependencies over time
Autonomy reduces the need to communicate extensively over time
Jennifer (MA): The importance of transparency of information is what this is bringing out. We didn’t have it in the past. We should be much more mature—rather than relying on anecdotes.Nathan (CP) notes that nursing staff would like more information about what will happen now that community services are being put out to bid.Tim (MA): I think we have held back on communication because certain things have not yet been agreed.Nathan (CP): But any communication is better than nothing. . . . What GPs are saying is that it is worse hearing nothing rather than that things are in progress.Jennifer (MA): It’s about managing expectations.Tim (MA): Should we commit to some kind of communication by the end of next week, regardless of any agreements? . . .Jennifer (MA): We should be doing this regularly; I hope we move to a much more collaborative way of working rather than being confrontational, which is the direction we have been going.Fred (CP) laughs, stands up, walks over to Tim, smiles, and hugs him. Several meeting participants also laugh.
Dealing with a Lack of Autonomy during Organizational Separation: Approaching and Distancing
Discussion
Contributions to Our Understanding of Respect
Subtractive Change and Identity Formation
Scope Conditions and Future Research
Acknowledgments
ORCID iDs
Footnotes
References
Biographies
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
- ds_10.1177_0001839218779806.pdf
- 252.54 KB
Cite article
Cite article
Cite article
Download to reference manager
If you have citation software installed, you can download article citation data to the citation manager of your choice
Information, rights and permissions
Information
Published In
Keywords
Authors
Metrics and citations
Metrics
Journals metrics
This article was published in Administrative Science Quarterly.
VIEW ALL JOURNAL METRICSArticle usage*
Total views and downloads: 8706
*Article usage tracking started in December 2016
Altmetric
See the impact this article is making through the number of times it’s been read, and the Altmetric Score.
Learn more about the Altmetric Scores
Articles citing this one
Receive email alerts when this article is cited
Web of Science: 20 view articles Opens in new tab
Crossref: 0
-
Rethinking de facto autonomy? A multi‐policy area approach and the reg...
-
The Impact of Partner Organizational Structure on Innovation
-
From corporate social responsibility (CSR) to corporate humanistic res...
-
Strategic change in the health sector: a literature review and future ...
-
Room for space in agencification reforms: A tale of three Italian muse...
-
Acquisitions of divested business units: A typology and strategies for...
-
Organizational Autonomy: A Review and Agenda for Future Research
-
From a dyadic to a triadic perspective: Divestiture research implicati...
-
Loss associated with subtractive health service change: The case of sp...
-
The Dynamics of Organizational Autonomy: Oscillations at Automobili La...
-
Why Multibusiness Corporations Split: CEO Strategizing as the Ecosyste...
-
A Multi-Perspective Framework for Research on (Sustainable) Autonomous...
-
Dealing with Mistakes
-
Two sides to every coin: Assessing the effects of moving physicians to...
-
In Search of Autonomy: Dancing With Rules
-
What if Marie Kondo Wrote an Organizational Change Book? Making Space ...
-
Stakeholder Orientation and Divestiture Activity
-
Health Care Research and Organization Theory
-
The costs of refocusing: Evidence from hedge fund closures during the ...
-
Family firms and the stock market performance of acquisitions and dive...
Figures and tables
Figures & Media
Tables
View Options
View options
PDF/ePub
View PDF/ePubGet access
Access options
If you have access to journal content via a personal subscription, university, library, employer or society, select from the options below:
loading institutional access options
Alternatively, view purchase options below:
Purchase 24 hour online access to view and download content.
Access journal content via a DeepDyve subscription or find out more about this option.