Markets, Moral Economy and Healthcare Provision in England
Lead Research Organisation:
University of Birmingham
Department Name: Institute of Applied Social Sciences
Abstract
The NHS in England is current embarking on large scale structural change due to budgetary pressures, shifting patient needs and changes in technology (NHS England 2014, 2017). This research is examining the impact of such change on the normative (or moral) dimension of the culture of NHS organisations.
To do this, the research is drawing on a moral economy theoretical framework. A moral economy approach states that all organised economic activities rely on shared moral understandings regarding issues such as what is good and bad, right and wrong, and appropriate and inappropriate. It also acknowledges that these understandings are adaptable and can change in response to changes in the economic environment (Sayer, 2007). The research is therefore exploring issues such as: the extent to which there are shared moral understandings (relating to questions such as duty, fairness, respect etc.) within organisations or groups (such as professional groups); how such understandings are affected by the process of service reconfiguration; and how the moral understandings of different groups within an organisation influence the implementation of national or local policy. The research is drawing on an in-depth, intensive study of the implementation of one service change in order generate these insights. The research will also seek to use the findings from the study to further develop a moral economy perspective into a theoretical tool that can be applied by other researchers to similar contexts (i.e. organisations undergoing a significant level of change) to understand how organisational culture is affected by economic and structural change.
To do this, the research is drawing on a moral economy theoretical framework. A moral economy approach states that all organised economic activities rely on shared moral understandings regarding issues such as what is good and bad, right and wrong, and appropriate and inappropriate. It also acknowledges that these understandings are adaptable and can change in response to changes in the economic environment (Sayer, 2007). The research is therefore exploring issues such as: the extent to which there are shared moral understandings (relating to questions such as duty, fairness, respect etc.) within organisations or groups (such as professional groups); how such understandings are affected by the process of service reconfiguration; and how the moral understandings of different groups within an organisation influence the implementation of national or local policy. The research is drawing on an in-depth, intensive study of the implementation of one service change in order generate these insights. The research will also seek to use the findings from the study to further develop a moral economy perspective into a theoretical tool that can be applied by other researchers to similar contexts (i.e. organisations undergoing a significant level of change) to understand how organisational culture is affected by economic and structural change.
Organisations
People |
ORCID iD |
| Christopher Smith (Student) |
Studentship Projects
| Project Reference | Relationship | Related To | Start | End | Student Name |
|---|---|---|---|---|---|
| ES/P000711/1 | 01/10/2017 | 30/09/2027 | |||
| 1925667 | Studentship | ES/P000711/1 | 01/10/2017 | 30/09/2019 | Christopher Smith |
| Description | This completed doctoral research project has refined and applied the concept of moral economy to understand a large-scale service reconfiguration in the NHS. It drew on a qualitative case study informed by a critical realist approach to social research, enabling an enhanced understanding of the way structural/ regulatory forces interact with the moral dimension of NHS organisations. The project has provided a new sociological perspective on the role of moral beliefs in NHS service change, while developing a distinct moral economy framework which can be applied more widely. The doctoral research explored how to conceptualise moral economy with greater precision than existing accounts; how to operationalise the concept into an empirical study; and how to understand the dynamics underpinning moral beliefs and decision making under conditions of organisational change. It argues that moral economy should be conceived as the study of how moral phenomena are entwined with structural relations of political and economic power. Within this, the 'moral' side of moral economy needs to be seen as consisting of a range of multi-level phenomena. This distinguishes between morality as a property of social context and as a property of individual subjectivity. With this understanding established, critical realist metatheory was deployed to further develop moral economy for the purpose of studying organisations. Here multiple types of moral and economic phenomena were identified and integrated into a single theoretical framework using a modified version of Abend's (2014) moral background. This has enabled analytical distinctions to be made between the different aspects of morality and structural relations of power, as well as specifying how they interact via reflexive human agents. The research has applied this theoretical framework to an empirical case study of a large-scale, inter-organisation service change in the NHS, drawing primarily on interviews with those involved in planning and implementation. It revealed that a range of moral phenomena - on both contextual and individual levels - interacted to create a strong consensus about what is right within the service change. The project analysed this multi-level morality in terms of a particularly subtle mode of entwinement of the moral and economic: epistemic governance. The refined moral economy framework developed has illuminated how moral beliefs within institutions are underpinned by complex, interdependent webs of meanings, ethical commitments, regulations and power structures. As such, the project has developed an original approach to moral economy which is particularly well suited to understanding how moral and economic phenomena interact as part of the process of service reconfiguration in the NHS. Through exploring the influence of structure, culture, agency, and social power on individual beliefs and judgements, this project has also provided a novel sociological perspective on the normative dimension of organisational change. |
| Exploitation Route | Now the PhD project has been completed I am working on two papers - one theoretical and one empirical - to further communicate to an academic and policy audience how this understanding of moral economy I developed can be used to understand NHS service change and the study of organisations more generally. Now that the COVID-19 pandemic restrictions have eased I will also seek to re-engage with participants of the research to explore ways in which this theoretical framework can be put to use in understanding, and possibly improving, the service change process for those involved and affected. |
| Sectors | Healthcare |