Exploring health work: a critical-action perspective

Purpose: The purpose of this paper is to describe a hybrid approach to the research developed during a multi-researcher, ethnographic study of NHS management in the UK. Design/methodology/approach: This methodological paper elaborates a hybrid approach to the sociological analysis – the critical-action theory – and indicates how it can contribute to the critical health management studies. Findings: After exploring the various theoretical, methodological and philosophical options available, the paper discusses the main research issues that influenced the development of this perspective and the process by which the critical-action perspective was applied to the studies of managerial work in four health service sectors – acute hospitals, ambulance services, community services and mental healthcare. Research limitations/implications: This methodological perspective enabled a critical analysis of health service organisation that considered macro, meso and micro effects, in particular and in this case, how new public management drained power from clinicians through managerialist discourses and practices. Practical implications: Healthcare organisations are often responding to the decisions that lie outside of their control and may have to enact changes that make little sense locally. In order to make sense of these effects, micro-, meso- and macro-level analyses are necessary. Originality/value: The critical-action perspective is presented as an adjunct to traditional approaches that have been taken to the study of health service organisation and delivery.