Analysing organisational culture : a critical ethnography of public relations and personnel specialists in a state bureaucracy

Following an introductory chapter, I examine (i) typologies which have differentiated the literature on organisational culture and symbolism (Chapter 2), (ii) the contribution of organisation theory to organisation culture (Chapter 3), and (iii) recent literature on organisational culture and symbolism (Chapter 4). Within these chapters, I adopt Habermas' (1972) notion of knowledge-constitutive interests, assessing the contrubutions to understanding organisational culture made by literature guided by technical, practical and emancipatory cognitive interests. In doing so, I suggest that more critical studies on organisational culture and symbolism have been comparatively neglected. Lamenting this neglect, I suggest that Giddens' theory of structuration can be employed to advance the development of a critical, emancipatory conceptualisation of organisational culture. In particular, I argue that this Giddensian analysis, by penetrating the existential, poltical and material processes of cultural reproduction (Chapter 5), is able to disclose some of the more contradictory features of organisation culture. The remainder of the thesis comprises of a critical ethnography of the work cultures of public relations and personnel specialists located in a state bureaucracy. I begin the ethnography with a dicussion of my research methods (Chapter 6) and an overview of the departments studied (Chapter 7): I then examine (i) the work cultures of the specialists (Chapter 8), (ii) the specialists' management of the relationships with the hosts bureaucracy (Chapter 9); and, (iii) opportunities the specialists had for developing an emancipatory praxis (Chapter 10). Finally, in a concluding section, I offer some critical reflections on the contributions of the thesis and suggest areas for future research.

Patients' and physicians' experiences of atrial fibrillation consultations and anticoagulation decision-making:a multi-perspective IPA design

OBJECTIVE: To explore patients' and physicians' experiences of atrial fibrillation consultations and oral anticoagulation decision-making. DESIGN: Multi-perspective interpretative phenomenological analyses. METHODS: Participants included small homogeneous subgroups: AF patients who accepted (n=4), refused (n=4), or discontinued (n=3) warfarin, and four physician subgroups (n=4 each group): consultant cardiologists, consultant general physicians, general practitioners and cardiology registrars. Semi-structured interviews were conducted. Transcripts were analysed using multi-perspective IPA analyses to attend to individuals within subgroups and making comparisons within and between groups. RESULTS: Three themes represented patients' experiences: Positioning within the physician-patient dyad, Health-life balance, and Drug myths and fear of stroke. Physicians' accounts generated three themes: Mechanised metaphors and probabilities, Navigating toward the 'right' decision, and Negotiating systemic factors. CONCLUSIONS: This multi-perspective IPA design facilitated an understanding of the diagnostic consultation and treatment decision-making which foregrounded patients' and physicians' experiences. We drew on Habermas' theory of communicative action to recommend broadening the content within consultations and shifting the focus to patients' life contexts. Interventions including specialist multidisciplinary teams, flexible management in primary care, and multifaceted interventions for information provision may enable the creation of an environment that supports genuine patient involvement and participatory decision-making.