Choose one organisation with which you are familiar through personal experience: this may

be a school, the university, a sports or social club, a previous/current employer, the NHS or
another health-related organisation.
Summarise and set the context for your chosen organisation and introduce the key arguments
you will make in the rest of your essay in approximately 150 words.
On the basis of your personal experience and your reading of the Mingers (2000) article, try
to identify the following within the organisation you have chosen (500 words):
(i)
(ii)
(iii)
(iv)

Key sources or examples of rhetoric (language used; forms of argument;

premises and assumptions)
Key sources or examples of tradition (taken-for-granted, traditional ways of
doing things)
Key sources, examples, or taken-for-granted beliefs about authority (dominant or
privileged positions e.g., who has the power to set the agenda and make
decisions?)
Key sources, examples, or taken-for-granted beliefs about objective knowledge,
truth claims, or facts (whats taken for granted as the truth; the way things
are; reality)

How do ideas and perspectives from modernist organisation theory (especially

bureaucracy) help you to better understand this particular organisation, including aspects
and features of it that you might previously have taken for granted?
You are encouraged to critique aspects of this OT perspective as appropriate in the
development of your argument.

Bureaucratic organisations usually show two main characteristics. Firstly, a hierarchal

structure in which there is more power given to the managers than the workers, and secondly,
a rational system in which rules and regulations govern the organisations decisions instead of
emotion or favouritism. I would argue that the NHS fits both of these criteria, and would like
to question whether bureaucracy in this case has lead to higher standards of healthcare, with
consistent and fairer standards. The organisation has a large number of porters and nurses at
the face of the organisation, who tend to have much less decision making power than the
small number of consultants/managers at the top of the organisation. Red tape rules and
regulations have been brought in to ensure fair and consistent healthcare and discourage risk
taking and subjective behaviour.
Throughout this essay I will critically evaluate the structure and nature of our NHS and then
assess whether bureaucracy is the most beneficial and efficient organisation structure and
how it can be used to promote equality, fairness and a better quality of healthcare.
With the current Conservative government attempting to control its government debt, we
have to think critically about areas of public spending. Mingers (2000, p226) states that we
should be sceptical of conventional wisdom, this is particularly important when our
government is slowly moving towards privatisation and competitive tendering of healthcare
contracts. There are plenty of people opposing this motion, but we should question whether
this is because it is a change from the norm, or whether there is genuine fear of a worse
healthcare system. Although the NHS has always been seen as a public service, it has been
argued that the competitive tendering of contracts can be a source of cost and efficiency
savings, leaving more funds free for further patient care (Milne & McGee, 1992).
With a top-down approach to NHS reforms, it is important to critique the people with
authority, namely Jeremy Hunt with his new junior doctor contracts which have lead to the
first doctors strike in 40 years. Hunt argues that a patient is far more likely to die if admitted
to hospital at a weekend, and we have to question whether the statistics have been skewed in
favour of politicians whom could have ulterior motives. We should question if it is logical for
us to systematically agree with every new policy put forward by someone in a position of
authority.
We can also think critically about the use of rhetoric in healthcare, especially when it comes
to communication skills between the doctor and patient and the use of jargon. If a doctor uses

the same language as he/she has been taught at medical school, it would be very easy to
confuse the patient and this could lead to the doctor misleading the patient.
Max Weber, a German sociologist, developed a concept of bureaucratic management (a
reaction to the subjugation at the time from monarchies and dictators at the time) which was
meant to give authority and control on the basis of skills and knowledge. This can be seen
through the division of labour in our NHS. After medical students graduate, they begin to
specialise in a narrow sub-discipline of medicine. This leads to a more efficient healthcare
organisation in which patients go to different doctors depending on the necessary treatment.
However, we have found in recent years that this system has lead to severe shortages of
specialists in some areas of the country (for example GPs in Wales) due to the fact doctors
now do not have interchangeable roles.
Modernist organisation theory emphasises the importance of rational thinking and
functionality. Red tape rules and regulations often go hand in hand with bureaucracy, this is
commonplace in the NHS and can often be beneficial. For example, every new medicine has
to undergo a long process of trials and experiments before it can be passed on to humans, and
the regulations are there to protect us. Doctors and nurses are given algorithms or procedures
to follow, which should lead to consistent, better healthcare with less room for risk taking and
subjective behaviour. However, in practice, Ruston (2006) argues that even though these rules
are designed to control the environment, doctors and nurses were still able to exercise
judgement which can still lead to subjective decision-making, the consequence of which was
the continuance of the variation in practice that scientific-bureaucratic medicine aims to
eradicate.
Bureaucracy can have a positive impact on the NHS, as it encourages all patients to be treated
equally and impersonally, and discourages favouritism and nepotism. This is very important
because the very idea of a health service provided by the government is that everyone has
equal opportunity to a basic level of care and factors of race, gender or sexuality do not
impact this. It could be argued that even though this leaves no room for discrimination, it also
may not allow for empathy in special cases.
Being a government provided service it is imperative that waste is minimised because the
NHS is funded by the taxpayer. One of the limiting characteristics of bureaucracy and
organisations with a tall structure (many levels of management) is that there is a use it or
lose it mentality towards expenditure. Managers are given a budget for the year, and

sometimes they are afraid that if the budget is not spent by the end of the year the budget may
be reduced. The NHS in particular has no profit motivation, and can therefore be very prone
to wasted expenditure.
Modernist organisation theory is based on the fact form fits function. When applied to a
firm, this dictates that the highly skilled and most technically qualified employees should
reach the positions with most control. We see this in the NHS, in which it takes around 15
years of education, training and experience to reach consultant level and this is a rational
way do thinking because highly skilled workers should reach more important positions in the
hierarchy. Unfortunately, in practice this top-down control can lead to a higher overall cost
due to extra layers of management, and ultimately slower decision making which is of
importance in healthcare.
To conclude, I think modernist organisation theory can build a rational, well thought out
organisation structure which is suited to large government and private organisations. Weber
gave us a prescriptive system which in theory should maximise efficiency and eliminate
subjective behaviour. Whilst evaluating this theory when applied to the NHS, I believe that it
could be argued that subjective behaviour should be encouraged and that it is a necessity in
healthcare. Bureaucracy deters favouritism, but it could make healthcare completely
impersonal and cause a lack of empathy which is important in this industry.
Bibliography
Campbell, D. (2016) Who has come out on top after the first junior doctors strike in 40
years?. Available at: http://www.theguardian.com/society/2016/jan/12/who-has-come-out-ontop-after-the-first-junior-doctors-strike-in-40-years (Accessed: 2 March 2016).
MILNE, R. and McGEE, M. (1992) Compulsory competitive tendering in the NHS: A new
look at some old estimates, Fiscal Studies, 13(3), pp. 96111. doi: 10.1111/j.14755890.1992.tb00185.x.
Mingers, J. (2000) What is it to be critical? Teaching a critical approach to management
undergraduates, Management Learning, 31(2), pp. 219237. doi:
10.1177/1350507600312005.
Ruston, A. (2006) Interpreting and managing risk in a machine bureaucracy: Professional
decision-making in NHS direct, Health, Risk & Society, 8(3), pp. 257271. doi:
10.1080/13698570600871729.
Final word count: 1,119.