Learning to listen to the organisational rhetoric of primary health and social care integration

Nurse Educ Today. 2007 Nov;27(8):947-54. doi: 10.1016/j.nedt.2007.02.005. Epub 2007 Mar 27.


The sustained modernisation of the UK primary health care service has resulted in individuals and organisations having to develop more integrated ways of working. This has resulted in changes to the structure and functioning of primary care organisations, changes to the traditional workforce, and an increase in scope of primary care practice. These changes have contributed to what for many staff has become a constantly turbulent organisational and practice environment. Data from a three-year project, commissioned by the North West Development Agency is used to explore how staff involved in these changes dealt with this turbulence. Three hundred and fifty staff working within primary care participated in the study. A multimethods approach was used which facilitated an iterative analysis and data collection process. Thematic analysis revealed a high degree of congruence between the perceptions of all staff groups with evidence of a generally well-articulated, but often rhetorical view of the organisational and professional factors involved in how these changes were experienced. This rhetoric was used by individuals as a way of containing both the good and bad elements of their experience. This paper discusses how these defense mechanisms need to be recognised and understood by managers so that a more supportive organisational culture is developed.

MeSH terms

  • Adaptation, Psychological
  • Attitude of Health Personnel*
  • Communication
  • Community Health Services / organization & administration
  • Cooperative Behavior*
  • Defense Mechanisms
  • England
  • Health Care Reform / organization & administration
  • Health Knowledge, Attitudes, Practice
  • Health Services Needs and Demand
  • Humans
  • Interinstitutional Relations
  • Interprofessional Relations*
  • Leadership
  • Nursing Methodology Research
  • Organizational Culture
  • Organizational Innovation
  • Primary Health Care / organization & administration*
  • Professional Role / psychology
  • Psychoanalytic Interpretation
  • Social Work / organization & administration*
  • State Medicine / organization & administration*
  • Surveys and Questionnaires