Management of organisational changes in a case of de‐institutionalisation

Abstract

This paper seeks to explore the development of a discharge programme in one learning disability hospital in Scotland. The study aims to concentrate on organisational developmental changes in that institution. The model of the management during the discharge programme was investigated. The aim of the study is to explore how the discharge programme developed, as seen under the lens of organisational change, in order to find out what kind of model of management is more suitable in similar programmes.
A case study was employed. Data were collected by means of interviews. The interviews followed a structured format. The sample of the study had to be a purposive sample and the method of snowball sampling was used; finally, 28 interviews were conducted. A grounded approach was adopted for the data analysis. The software program QSR "NUD*IST" (version "N6") was used as a technical tool, in order to facilitate the data analysis.
The findings of this study show that various management models were adopted in the four phases of the discharge programme. These different models represent a "quest" by the institution's management regarding the most appropriate model for managing the discharge programme. This study shows that this goes on continuously in organisations under transition until they settle down to a more permanent state.
It was concluded that management models, which are composed of characteristics from the organic theory of organisational management, could apply in discharge programmes. The data gathered enabled the researcher to arrive at a model of management which is suitable for managing organisational changes in discharge programmes, the named "stakeholder management model".

Full text

Management of organisational
changes in a case of
de-institutionalisation
Stavros K. Parlalis
Department of Social Work, School of Humanities and Social Sciences,
Frederick University, Nicosia, Cyprus
Abstract
Purpose – This paper seeks to explore the development of a discharge programme in one learning
disability hospital in Scotland. The study aims to concentrate on organisational developmental
changes in that institution. The model of the management during the discharge programme was
investigated. The aim of the study is to explore how the discharge programme developed, as seen
under the lens of organisational change, in order to find out what kind of model of management is
more suitable in similar programmes.
Design/methodology/approach – A case study was employed. Data were collected by means of
interviews. The interviews followed a structured format. The sample of the study had to be a
purposive sample and the method of snowball sampling was used; finally, 28 interviews were
conducted. A grounded approach was adopted for the data analysis. The software program QSR
“NUD *IST” (version “N6”) was used as a technical tool, in order to facilitate the data analysis.
Findings – The findings of this study show that various management models were adopted in the
four phases of the discharge programme. These different models represent a “quest” by the
institution’s management regarding the most appropriate model for managing the discharge
programme. This study shows that this goes on continuously in organisations under transition until
they settle down to a more permanent state.
Originality/value – It was concluded that management models, which are composed of
characteristics from the organic theory of organisational management, could apply in discharge
programmes. The data gathered enabled the researcher to arrive at a model of management which is
suitable for managing organisational changes in discharge programmes, the named “stakeholder
management model”.
Keywords De-institutionalization, Organizational change, Stakeholder management model,
Organic theory, Organizations, Change management, Learning disabilities, Scotland
Paper type Research paper
Introduction
This study explored the development of a discharge programme in one learning
disability hospital in Scotland. Only a limited amount of work has been done on the
development and progress of a discharge programme itself, especially as seen under the
lens of organisational change. In the specific case under investigation, the institution was
a not-for-profit organization, deciding on its own dissolution, under pressure from the
wider society to provide better services for people with learning disabilities. The
management during the discharge programme was investigated, in a time framework of
about 20 years. The research question which was posed by this study was:
RQ1. How was the evolution of the process of de-institutionalisation managed in the
specific Scottish institution?
The current issue and full text archive of this journal is available at
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Organisational
changes
355
Journal of Health Organization and
Management
Vol. 25 No. 4, 2011
pp. 355-384
qEmerald Group Publishing Limited
1477-7266
DOI 10.1108/14777261111155010

The aim of the study was to explore how the discharge programme developed and
which were the difficulties faced during the organisational changes, a topic which is
not adequately covered by existing theories of organisational change; the ultimate aim
was to find out what kind of management model is more suitable in similar
programmes.
The process of change in public services and public service organisations
In the 1980s a radical change occurred in public services. This happened due to the
inability of the government to respond to the social and economic changes of those
years and its inability to deliver policy appropriate to the existing conditions (Osborne
and Brown, 2005). Osborne and Brown (2005) argued that this was the time in which
the need for greater accountability and responsiveness in public services reached its
peak point; citizens’ demands regarding the quality of services increased, and the
government was obliged to respond to this demand (Vigoda, 2003). Also, the 1980s was
the time for making the shift “from public administration to public management”
(Osborne and Brown, 2005). One of the aims of these changes was to transfer public
service operations to the private and community sector, in order to avoid the
difficulties that had emerged from ineffective public administration (Keast and Brown,
2003; cited in Osborne and Brown, 2005).
Similar changes occurred in the community care field. Scull argued (Scull, 1977) that
the adoption of a policy of “decarceration” was a reflection of changes in the social
organisation of the advanced capitalist societies. Moreover, by that time the argument
was shifted from medicine to “the adjustment of institutional practices in the light of
psychiatric considerations, the minimisation of mental pathology and the promotion of
mental health” (Miller and Rose, 1986). Around the end of the 1980s the services, which
up until then had been provided in the institutional setting, began to be transferred into
the community. These changes led to the production of a number of new policies, such
as the White Paper Caring for People – Community Care in the Next Decade and
Beyond (DoH, 1989) and then the NHS and Community Care Act 1990 (NHS and
Community Care Act (1990, Chapter 19)) – which has been described as “the most
significant reform since the Beveridge Report of 1945” (Parry-Jones et al., 1998, p. 271).
Through these documents local authorities received the responsibility for the planning
and coordination of community care services in their area (Scottish Parliament, 1999,
p. 2). From that point and under a more general process of “modernisation”,
multi-professional and inter-professional partnerships between statutory and
non-statutory sectors were developed (Meads et al., 2006, p. 166). As a result,
modern primary care organisations became responsible for commissioning secondary
care and promoting public health (Meads et al., 2006, p. 166).
These developments led to the provision of care in the community and to the
creation of an “internal market”[1] within the NHS (Peck and Spurgeon, 1993, p. 19).
This process was an interaction between “exogenous” dynamics (the market context
and institutional context) and “internal” dynamics, i.e. professionals’ interests, values,
power dependencies and capacity for action (McNulty and Ferlie, 2004). It has been
considered as an attempt to move from a bureaucratic command of service provision to
“a more regulatory mode of governance” (Hogett, 1996; cited in Hood and McGarvey,
2002), or a more democratic distribution of support compared to a more bureaucratic
and inefficient top-down approach (Dahlberg, 2005). The strategic changes involved
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can also be seen not just as changes in the organisation’s structures and processes, but
as a cognitive organisational reorientation, including changes in the organisation’s
mission and purpose (Fiss and Zajac, 2006); in the case under investigation, these
changes have actually led to the dissolution of the institution.
Under these conditions, the institutions can be thought of as being required to plan
their own closure, in order to respond to the demand for the provision of better services.
Changes of this magnitude in the nature of an organisation inevitably alter its
components and orientation. The involvement and contribution of various agencies
and authorities was required (Tichy, 1983), in order to establish powerful
constituencies for promoting change (Eilbert and Lafronza, 2005). The organisation
needs to be open to external stakeholders to achieve this target. The creation of inter-
and intra-organisational interdependence and collaboration is the foundation for
responding to the organisational changes (Graetz and Smith, 2005). A “flat” rather than
“tall” organisational structure is required (Rowe and Boyle, 2005; Gill, 2003), in order to
incorporate this cooperative, multi-disciplinary model of service delivery (Rowe and
Boyle, 2005). This structure also enables the decentralisation and devolution of the
decision-making process (Palmer and Dunford, 2002) and leads to the formation of a
bottom-up decision-making approach in public organisations, which has proved to lead
to successful implementation of changes (Sminia and Van Nistelrooij, 2006).
A bottom-up approach with the participation of the employees is also suggested in
the public sector for succeeding with the implementation of the changes (Sminia and
Van Nistelrooij, 2006) rather than a linear top-down change process (McNulty and
Ferlie, 2004), which is not popular among employees (O’Brien, 2002). This approach
which emphasises the participation of those who are affected and those who deliver the
services (Cline, 2000) in the planning and execution of the programmes (deLeon and
deLeon, 2002) rather than leaving service users marginalised and unable to act as
purchasers in the free market (May and Hughes, 1987). This development increases
employees’ ownership over the changes and also pushes decision-making downward
(Bartkus, 1997), a practice that was occasionally met in the specific case under
investigation.
The needs of participants during the transition phase (professionals[2] in this
context) were another fundamental issue that has to be considered. One of the issues
that had often emerged in organisation design is the neglect of processes and
relationships and instead focusing on the structure ( Jackson, 2000; cited in Graetz and
Smith, 2005). Since it is people who do things in organisations, it was a priority to
observe how they manage the changes through human resource management practices
(Sanchez-Runde et al., 2003). “Networks are the only alternative for collective action”
(Milward and Provan, 2000, p. 243); similarly, the development of networks between
colleagues and the relationships between them replace the formal hierarchies that are
found in bureaucratic organisations (Gill, 2003). All employees should have feelings of
ownership over the changes (Oxtoby et al., 2002) and develop organisational
commitment (Allen, 2004) for the changes to be successful. This issue had to be
considered in similar cases, even though privatisation emphasises market rather than
social and humanistic values (Rodrigues, 2006).
Taking the above arguments into account, it becomes clear that in complicated
organisations like institutions, different aspects of the change may follow different
models (Bamford and Daniel, 2005). There is no clear-cut formula for achieving
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successful organisational changes (Osborne and Brown, 2005). The various methods
and models available in the literature have been developed in order to respond to
specific cases and therefore they are unlikely to be able to find application in cases
other than those for which they were designed (Burnes, 1992). Therefore, it is too
complicated to identify the most appropriate model of change for an institution that
implements a discharge programme.
Transformational change cannot be avoided in organisations with complex and
turbulent environments (Chapman, 2002), and similar conditions exist in institutions
that provide long-stay care. For a number of reasons, the institutions had to close
down, something that can be considered as a total transformation for the organisation.
This was a strategic change, which also required changes in the way that the
institution was governed (Goodstein and Boeker, 1991, as cited in Worley et al., 2000).
The organisation had to plan its own closure, in order to respond to the demand for the
provision of better services.
Regardless of the above factors, de-institutionalisation constitutes an exceptional
case in organisational change for a different reason: its uniqueness lies in its intentional
move to a state of dissolution. Provision in the community is the way in which the
continuation of the services will be achieved; but the dissolution of the institution is
integral to that new provision. Although the literature on organisational change has
some relevance and application to such an organisation, ultimate closure is not a
feature covered by existing theories of organisational change. For this reason,
de-institutionalisation represents a unique case to put under the lens of theories of
organisational change; moreover, it consists an opportunity to observe and report on
how managers respond to the new conditions and proceed to the changes.
Specific aims
The current study has aimed to investigate the model of the management during the
discharge programme in a time framework of about 20 years.
The research question that was posed by this study was on: How was the evolution
of the process of de-institutionalisation managed in the specific Scottish institution?
As was described earlier, the process of de-institutionalisation in the UK and in
Scotland has a long history, involving the publication of a large number of Reports,
White Papers and Acts during the last 30 years. However, there are still institutions
that have not closed down, especially in Scotland, where the development of
de-institutionalisation has been much slower than in the rest of the UK. There are a
number of reasons that can be identified as being responsible for this delay. These
include financial difficulties (Stalker and Hunter, 1999; Watts et al., 2000, p. 180;
Baldwin, 1993, p. 10; Rees et al., 2004, p. 534), the lack of adequate preparation (Watts
et al., 2000; Todd et al., 2000), inadequate provision of community services (Tyrer and
Creed, 1995), the re-organisation of local government (Stalker and Hunter, 1999;
Dalrymple, 1999, p. 15), and the need to maintain continuity of care (Dukkers van
Emden et al., 1999, p. 1187). The realisation that these difficulties are common to
different programmes led the researcher to investigate the extent to which these or
similar factors affected the development of the specific discharge programme. Through
this approach, the researcher was aiming to develop a view of how things were
developed and also to identify any lessons that might arise regarding the function and
the progress of the discharge programme in the Scottish setting.
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This research question had also another purpose. The researcher wanted to explore
the degree to which the structure of the organisation might be affected and the
management might change. Moreover, it was also designed to identify which theory of
organisational development fits better for the purpose of an organisation which
implements a discharge programme.
Bringing together these issues for investigation, the focus of this research question
was placed on understanding how professionals perceived the process through which
the institution changed its functions and how it came to its closure. The underlying aim
was to make the findings available for countries with less developed welfare systems,
in which future attempts of de-institutionalisation could be implemented with fewer
barriers and in a smoother way. However, it has to be noticed that the policies and
practices suggested by this paper are not necessarily comparable (neither compatible)
with less developed welfare systems. Special care has to be given in cases of
comparison or application of the current findings, since each welfare system has its
own characteristics.
Methodology employed in this study
The decision to employ a case study was based on a number of practical reasons. A
case study has a holistic approach: it allows the researcher to understand the
wholeness of a case and to explore it in depth, recognising both its complexity and its
context (Punch, 1998, p. 150). Also, case studies are often employed in organisational
research, when a detailed understanding of processes is required (Hartley; cited in
Cassell and Symon, 2004, p. 323). Similarly, the use of a case study enabled the
researcher to capture how organisational changes occurred in the institution and how
the discharge programme developed.
Also, as case studies are well placed to uncover the causal processes linking inputs
and outputs within a system (Gomm et al., 2000, p. 234), the adoption of a case study
was deemed necessary in order to meet this study’s aim of understanding the
complexity of the discharge programme.
This case study examined organisational changes in a specific institution during the
implementation of a discharge programme. The choice of investigating this specific
type of organisation was based on the fact that most institutions are closed and there
will soon be no more chance to undertake research in this kind of institution. The start
of this study was excellent in terms of timing, as it coincided with the launching of the
last discharge phase (phase 4) (Table I), enabling the researcher to be involved in such
When (duration) Main characteristics
Phase 1 1988-1991 Initiative of three key persons, lack of clear strategy
Phase 2 1991-1995 Lack of funding – discharge programme delayed
Participation of different disciplines in the work of
the discharge team
Phase 3 1995-2000 “Bridging Finance”, joint plan between local
authority and health board
Phase 4 2000-2006 Appointment of a Joint Project Manager
Table I.
The four phases of the
discharge programme
and their characteristics
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an organisation at such a time. The researcher was enabled to investigate closely this
last discharge phase and also to identify potential interviewees.
Data were collected by means of interviews. Interviews were chosen as they allow
the researcher to elicit participants’ perceptions and experiences of the issues under
investigation and understand how and why the participants come to have this
particular perspective (King; cited in Cassell and Symon, 2004).
The interviews followed a structured format. Open-ended questions were used, in
order to get richness and depth. Owing to the fact that interviewees were coming from
different backgrounds, the use of a structured format could be lead to the collection of
comparable data and complexity could be avoided. The interview schedules were
composed of eight groups of questions (Table II), which covered different aspects of
de-institutionalisation.
The interview schedules were piloted with the appropriate professionals before
being finalized, and embarking on the main data collection.
The sample of the study had to be a purposive sample. Because of how specialised
the subject under investigation was, only professionals with the specific knowledge
and experience on the subject were invited to participate. The rationale behind the
adoption of a purposive sample was the identification of a specific group of
professionals that would have the appropriate knowledge around the issues
investigated. Following this method, 28 interviews were finally conducted (Table III).
In the light of these arguments, some specific criteria were set up, criteria that would
distinguish this sample from the “general specification type” samples (Wengraf, 2001).
The first criterion set up for the recruitment process was the representation of most of
the professional groups based in the institution. The participation and representation
of the views of professionals coming from different disciplines would enrich the data,
as the issues under investigation could be seen and explored from different angles. The
next criterion was the interviewee’s professional status. Only qualified professionals
were chosen for interview; other social care staff, including staff who were employed as
support workers, support assistants, and nursing assistants or indeed people with
learning disabilities, were excluded. The participation of people outside of this criterion
would have given the study a completely different character.
Another criterion was that professionals were only included if they had already
participated in previous phases (Tables I and III) of the discharge programme rather
than only in the last one. The purpose of this choice was double. In first place, it was
Interviewees’ personal information Interviewees’ professional title, their current
employer and their working experience during the
discharge process
Professionals’ expectations and attitudes
towards the changes
Exploring professionals’ expectations
Management of change Exploring organisational change
Interagency working Exploring joint endeavour between stakeholders
Cooperation between managers and colleagues Exploring cooperation between professionals
Changes andimpact on professionals’ roles Exploring changes in professionals’ roles
Support provided to staff Exploring the support provided to professionals
Lessons to be learned Exploring the lessons which could be learned from
the interviewees
Table II.
Interview schedules:
eight groups of questions
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Gender Title(s) Employer Years in post
Phases
involved
Manager1 F Social worker
Project manager
Local authority’s social work
department
20 1, 2, 3
Manager2 M Joint project manager Social work and health 1 4
Manager3 M NHS Adviser with the Scottish Executive
Health Department
Performance manager for the specific health
board
Scottish Executive Health Department 22 3, 4
Social worker1 F Home leader Local authority 10 2, 3, 4
Social worker2 M Team leader Local authority More than 10 1, 2, 3
Social worker3 F Team leader Local authority More than 10 1, 2
Social worker4 F Worked in community care teams Local authority Almost 20
years
1, 2
Social worker5 F Team leader Local authority Almost 20
years
2, 3, 4
Social worker6 F Worked in community care teams Local authority Almost 20
years
2, 3, 4
Social worker7 F Mental Health Officer Local authority 40 1, 2, 3, 4
Social worker8 F Team leader Joint appointed post 5 3, 4
Social worker9 F SW in hospital Community care teams Local authority 18 1, 2, 3
Social worker10 F SW in hospital Local authority
Voluntary organization
10 years 1, 2
Nurse1 F Clinical nurse manager
Team leader
NHS
Local authority
22 years 1, 2, 3, 4
Nurse2 F Charge nurse
Team leader
NHS
Local authority
10 years 1, 2
Nurse3 F Clinical support nurse (in both settings) NHS 30 1, 2, 3, 4
Nurse4 F Charge nurse
Community nurse
NHS 14 2, 3
(continued)
Table III.
The 28 professionals who
were interviewed and
their characteristics
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Gender Title(s) Employer Years in post
Phases
involved
Nurse5 F Charge nurse
Community nurse
5
6
3
Nurse6 M Nurse NHS
Voluntary organization
62,3
Psychologist1 F Clinical psychologist in community LD team NHS 5 3, 4
Psychologist2 M Clinical psychologist NHS More than 10 1, 2, 3
Psychologist3 F Clinical psychologist NHS 9 1, 2, 3
Psychologist4 M Clinical psychologist NHS 12 1, 2
Psychiatrist1 M Psychiatrist 2 4
Psychiatrist2 M Psychiatrist 7
Psychiatrist3 F Psychiatrist 20 1, 2, 3
Occup. Th.1 M Senior OT 10 3, 4
Physioth.1 F Senior physiotherapist 11 3, 4
Note: Characteristics ¼Professional status, their employer, years in their post, phases of the discharge programme in which they were involved
Table III.
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decided in order to include in the sample professionals with a longstanding experience
and knowledge of the programme, so that information referring to every aspect of the
process could be elicited: the drawbacks of the whole programme, the difficulties faced
in the past, how organisational changes could be enhanced, and the type of
management which should be adopted. Secondly, data regarding the four phases of the
discharge programme were sought, a criterion which could not be fulfilled if the
researcher was selecting professionals who were involved only in the last phase.
The final criterion was that interviewees should have experience of working both in
the hospital setting and in the community, in order to form a sample with the
appropriate knowledge and experience for the purposes of this study.
Three key persons helped researcher to identify potential interviewees. Through
their professional networks, in local authority social work services and in health board,
they contacted professionals who fulfilled the criteria that had drawn up. An initial list
of eight interviewees was created. Once no more professionals could be identified by
this mechanism, the method of snowball sampling was used.
The interviews were conducted in professionals’ working setting. The current
author conducted the interviews; the fact that he was an external observer worked
positively, as enabled interviews to speak freely. At the beginning of each interview,
the researcher described the purpose of the study. The first attempt to explain the aims
of the study had been made through a letter that had sent to potential participants
during the search for the appropriate sample. The interview started once participants
had been assured about the confidentiality of the collected data and gave their consent
for the recording of the interview. Most of the interviews lasted from 40 minutes to 60
minutes. All interviews were audio-recorded with the interviewee’s prior permission;
notes and memos were not taken during the interviews.
Subject consent and ethical issues
The research proposal was accepted by the Local Authority and the Health Board and
permission was received. At that time, no further requirements were made by the
institution in relation to proceeding with conducting the research. In addition, the
university had a three-level approach for checking research ethics. The research
proposal went through the investigation process required by the University Research
Ethics Policy and Procedures. It was evident that no ethical risks would emerge
through this study; therefore, no further action was required.
Methods of data analysis – the choice of grounded theory approach
A grounded theory approach was adopted for the data analysis. In this study there was
an attempt to move from the professionals’ description of the process of
de-institutionalisation to the conceptual level of how de-institutionalisation
developed through the history of the specific institution.
In the first stage of the analysis process the transcribed interviews were entered into
the software programme N6. The next step was to work with each individual interview
separately. The sentence was the unit of analysis, so each sentence was focused on
separately (Kelle, 2007; cited in Bryant and Charmaz, 2007). Every single piece of data
was coded. Working with this method, the researcher could stay close to the data
collected and also the reliability and the validity of the exported findings could be
ensured. This was the first step in the process of coding, the so-called “opencoding”,
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which is “the basic grounding approach to the data and leads to emergent discoveries”
(Glaser, 1992) rather than to test theory (Dey, 1999).
In the next step, nodes of the same or quite similar concepts were identified (Glaser,
1992) and they were put together into groups, in order to form categories of nodes with
the same content. This led to the creation of 30 categories (Table IV), divided according
to their content and based on the “properties and dimensions” of each node.
Through analysis of these categories, there were links and connections between
some of them. The application of this process led to the emergence of 9 broad themes
(Table V). Subsequently, coding occurred around the axis of a category, in each of the
categories (axial coding). The last level of the analysis was the selective coding; the
categories were integrated in order to form a theoretical scheme that can lead to the
formation of a substantive theory about the field of study (Wester and Peters, 2004;
cited in Richardson and Kramer, 2006). Strauss and Corbin (1998) stressed that “if
theory building is indeed the goal of a research project, findings should be presented as
a set of interrelated concepts, not just a listing of themes”. Since a simple listing of the
themes (as shown in Table V) could not fulfill this aim, this aim was attained through
the use of the network model (Table VI).
The software program QSR “NUD *IST”[3] (version “N6”) was used as a technical
tool, in order to facilitate the data analysis. The main benefit of using this computer
software was that it allowed the huge mass of data to be manipulated in a more
controlled way (Webb, 1999; Eilbert and Lafronza, 2005). It also made the
categorisation of the data much easier and faster than doing it manually.
Professionals’ titles, experience, involvement in
the discharge programme (1)
Organization’s structure (16)
Community Services (2) Relations and cooperation between
professionals (17)
Policies/practices to support professionals during
transition (3)
Pros and contras of working in community (18)
Aims of the discharge programme (4) Professionals’ concerns and resistance (19)
Differences between institution and
community (5)
Positives and negatives during the discharge
programme (20)
Belief on the success of the programme (6) Joint working (21)
Discharge process (7) What the whole programme needs in order to
work
better (22)
Phase 1 (8) Skills needed for professionals participating in
similar projects (23)
Phase 2 (9) SWs relations and cooperation with other
professionals (24)
Phase 3 (10) Professionals’ performance (25)
Phase 4 (11) Professionals’ perceptions for SWs (26)
Success of the discharge programme (12) Arrangements to make professionals familiar
with changes/training (27)
Professionals’ roles in both settings (13) Personal strengths and weaknesses (28)
Professionals’ participation in
decision making (14)
Future planning/suggestions (29)
Manager’s support (15) Policies during the discharge programme (30)
Table IV.
The 30 categories, based
on the “properties and
dimensions” of nodes
with the same content
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Themes
Professionals’
expectations and attitude
towards the changes
Belief in the success of the
programme (6)
Professionals’ concerns
and resistance (19)
Aims of the
discharge
programme (4)
Success of the
discharge programme
(12)
History of institution Phase 1 (8) Phase 2 (9) Phase 3 (10) Phase 4 (11)
Management of change Organization’s structure
(16)
Discharge process (7) Community
services (2)
Policies during the
discharge programme
(30)
Interagency working Joint working (21) Differences between
institution and
community (5)
Relations between
professionals/
participation in decision
making
Professionals’
participation in decision
making (14)
Relations and cooperation
between professionals
(17)
Manager’s support
(15)
Changes and impact on
professionals
Professionals’ roles in
both settings (13)
Skills needed for
professionals
participating in similar
projects (23)
Professionals’
performance (25)
Personal strengths
and weaknesses (28)
Pros and contras of
working in community
(18)
Support provided to
professionals
Policies/practices to
support professionals
during transition (3)
Arrangements to make
professionals familiar
with changes/training
(27)
Perceptions about social
workers
SWs relations and
cooperation with other
professionals (24)
Professionals’ perceptions
for SWs (26)
Lessons to be learned Positives and negatives
during the discharge
programme (20)
What the whole
programme needs in
order to
work better (22)
Future planning/
suggestions (29)
Table V.
The nine emerging
broad themes
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Managerial
tool Mission and strategy Tasks Prescribed network People Processes
Managerial
areas
Technical
system
2.1 Organization’s mission
and resources for its
achievement
2.1.1 Environmental
opportunities
2.1.2 Environmental
threats
2.1.3 Organizational
strengths
2.1.4 Organizational
weaknesses
2.1.5 Resources
2.1.5a Human resources
2.1.5b Funding
2.2 Strategic planning
activities
2.2.1 Strategic level
2.2.2 Operational level:
strategies for people’s
discharge from institution
2.3 Re-definition of
professionals’ roles under
the new organizational
structure
2.3.1 Differentiation of
roles between
professionals in the new
organizational structure
2.3.1a Social Workers,
Nurses,
Psychologist,Psychiatrists,
Occupational Therapists,
Physiotherapists
2.3.2 Integration:
recombining
professionals’ roles in
community
2.3.2a Social Workers,
Nurses, Psychologists,
Psychiatrists, Occupational
Therapists,
Physiotherapists
2.3.2 g Align structure to
strategy
2.4 Matching
management style with
technical tasks
Organizational structure
throughout the discharge
programme
2.5 Developing
information to fit people
to roles
a. Limited formal
information
b. Meetings to be kept
informed
c. Development days
d. Sharing of information
between professionals
e. Tools to make
professionals familiar
with the changes
f. Staff should be updated
g. Staff were unprepared
2.5.1 Specifying
performance criteria for
roles
2.5.2 Measuring
performance
2.5.2a Monitoring of the
whole project
2.5.2b Supervision
2.5.2c Appraisals
(continued)
Table VI.
The network model
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Managerial
tool Mission and strategy Tasks Prescribed network People Processes
Political
system
3.1 Balance of power
between the main
organizations
3.1.1 Managing coalitional
behaviour around
strategic decisions (Joint
Working between Social
Work and Health)
3.2 Internal function of the
organization (decision-
making process/relations
between professionals)
3.2.1 Lobbying and
influencing external
constituencies
3.2.2 Internal governance
structure
3.2.2a Social Workers,
Nurses,Psychologists,
Psychiatrists, Occupational
Therapists,Physiotherapists
3.2.3 Coalitional activities
to influence decisions
3.2.3a Professionals’
relations and cooperation
with colleagues
3.2.3b Professionals’
relations and cooperation
with higher staff
3.2.3c Manager’s support
(Relations with managers)
3.3 Distribution of power
across the role structure
3.4 Utilizing political
skills
3.4.1 Matching political
needs and operating with
organizational
opportunities
3.5 Managing succession
politics
3.5.1 How Joint Working
can be enhanced?
3.5.2 How decision-
making process could
improve
3.5.3 How cooperation
between professionals
could improve
3.5.4 How management
could work better (How
manager’s attitude could
enhance professionals)
(continued)
Table VI.
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367

Managerial
tool Mission and strategy Tasks Prescribed network People Processes
Cultural
system
4.1 Developing culture
aligned with mission and
strategy
4.1.2a Managing influence
of values and philosophy
on mission and strategy
(How professionals were
supported to become
familiar with the changes)
4.1.2b Training offered to
professionals
4.2 Use of symbolic events
to reinforce culture
4.2.1 Role modeling by key
people
4.2.2 Clarifying and
defining values
4.3 Organic managerial
style
4.4 Utilizing cultural
leadership skills
4.4.1 Matching values of
people with organization
culture
4.5. Selection of people to
build or reinforce culture
4.5.1 Development to
mould organization
culture
4.5.2 Management of
rewards to shape and
reinforce the culture
4.5.3 Management of
information and planning
systems to shape and
reinforce the culture
Table VI.
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Strengths and limitations of the research
The employment of a qualitative method was considered as strength, as it was the only
way to explore professionals’ personal perceptions in depth. It gave interviewees the
chance to express their beliefs and ideas around the issues investigated without
limiting their responses to preconceived answers. The use of a semi-structured
questionnaire, using open-ended questions, was a method that encouraged this. This
method worked well and led to the collection of useful data.
Also, individual interviews were the best method that could have been used in this
particular study. The direct communication with the interviewees enabled researcher
to gain a clear understanding of what they were saying, rather than, for example, using
a questionnaire. The construction of a focus group would have been advantageous for
gaining a better understanding of professionals’ accounts; however, this was quite a
difficult method to implement due to many practical reasons.
Finally, the N6 software was considered as a limitation. Although it saved
researcher a lot of time in proceeding with the analysis of the gathered data, the time
spent on transcribing the interviews and preparing them to be entered into N6 was
excessive.
Findings
In this section, the findings of the study are presented. The data are presented under
the following three sections, according to the network model: Technical System,
Political System and Cultural System. Special focus is given on the forms which the
structure of the organisation structure took.
In the specific discharge programme there were four different phases in its progress
(Table I). The strategy for closing the institution had its roots in the mid-1980s and the
strong commitment of three key persons who were behind the first moves towards that
aim (Phase 1). However, there was no clear overall strategy and small steps were made
towards that aim. During Phase 2 (1991 to 1995), there was such a lack of funding that
the programme was discontinued for that four year period [“...there was a period of
four years that there was no money and nothing happened.”]. The programme only
resumed as a result of “Bridging Finance” (Phase 3, 1995 to 2000), which provided £2.5
million to support the movement of service users into the community. It was a joint
plan between local authority and health board, with a legal agreement in place, which
identified the people who were to leave and the funding to support them. In the next,
fourth phase (2000 to 2006), the appointment of a Joint Manager between the two
organisations reflected the intention of the stakeholders to cooperate towards the
common goals [“This is a more powerful management, which definitely didn’t have in
the past.”].
Technical system
One of the most important issues that emerged was the conceptualisation of the
discharge programme. It was stressed that the whole process should be seen as a
developmental process rather than “closing down” of services. In the wider context in
which such a conceptualisation can be developed, a number of factors were identified.
Support should be provided from the government from the outset and throughout
along with the formation of a clear strategy, the publication of policy documents and a
clear agreement between the main stakeholders.
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369

The changes that the discharge programme made to professionals’ roles also
stressed in the study. Social workers and nurses were shown to be the professional
groups that experienced the greatest changes in their roles by their movement from the
institution to the community. The other professional groups – psychologists,
occupational therapists and physiotherapists – did not report any major differences in
their role; their adaptation was much easier compared with other professional groups.
In the same context, a number of practices that could enhance professionals’
adaptation to the community setting were identified. The provision of the adequate
training was possibly the major issue that professionals stressed. The measures they
recommended included secondments, the creation of long and detailed sessions to
introduce them to their new role, shadowing more experienced colleagues during their
introduction, and participation in conferences in order to enhance their understanding
of care in the community.
The different management models that were formed as the discharge programme
progressed were also described. The structure of the organisation was in a continuous
process of change throughout the implementation of the discharge programme.
Different structures were formed and various management models were adopted
during the four discharge phases. This section presents the forms that the structure of
the organisation structure took.
Setting up a social work team in the grounds of the institution was the first attempt
to boost the discharge programme (late 1980s; Appendix 1). A small team of social
workers in the institution took the first steps to begin the discharge. There were a small
group of activists, who acted in an opportunistic way and within the framework that
existed at the time. The development of community teams at the same time was a
positive factor in reinforcing the first discharges from the institution. At that time, each
discipline had a separate head in the hospital and each of the disciplines worked under
independent management. Also, the changes were made without having very strong
connections with external organisations or other participants. It was an embryonic
attempt to begin discharges and did not have the strength to find wider application or
change society’s view of de-institutionalisation.
In the second phase (Appendix 2), the so-called discharge team, which was based in
the institution, became responsible for promoting discharges. The management of the
programme were controlled by this discharge team. The main difference was the actual
participation of different disciplines in the discharge team. The social work team
expanded with the addition of new members due to the increased interest in the whole
programme shown by the NHS Trust and the general management principles, which
came into force in the institution. Cooperation with community teams was also
enhanced, reflecting the need to include external players in the discharge process.
During the next third-phase of organisational change (Appendix 3), the structure of
the institution was further affected. A more organisation-led approach towards the
implementation of discharge policies was developed. A joint approach between the
local authority and the health board was initiated; a discharge team was set up jointly
by the social work services of the local authority and health board, based outside of the
institution, in order to take the discharge programme forward. That was the first time
that the main stakeholders shared the same vision of the need to promote
deinstitutionalisation.
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This change led to what were described as remarkable changes in the higher posts,
with many managerial posts being eliminated: a whole tier of management was
eliminated. It was also reported that the team of professionals gradually became
smaller [“... one of the things that I was always remembered is that hospital was
becoming smaller and smaller and suddenly the team that you came in ... where was
it?”]; moreover, a more managerial orientation in the organisation’s functions was
observed. At this time, the conflict started over power in the discharge programme.
New medical leaders wanted to retain medical power; on the other hand, social work
wanted to gain more power over peoples’ discharges.
Also, financial pressures coming from the existence of two operational settings in
parallel – services in the institution and services in the community – was an
additional factor which pressed both stakeholders towards a closer cooperation.
However, although a joint partnership was the foundation on which the discharge
programme was promoted, this approach was less successful than expected. The
stakeholders did not share the same kind of commitment to the changes due to their
different professional background[4] and as a consequence, even though the project
was supposed to have been managed by both organisations, it was only promoted by
the local authority social work services. Senior managers never came to the point of
establishing a joint management.
The structure under which discharges were boosted consisted of the joint working
team and the community social work teams. The discharge team developed and
functioned under a project management approach, through the establishment of
working groups, which undertook specific tasks and responsibilities. The joint
working team received funding from both the local authority and the health board,
regardless of any financial support from other resources (e.g. Bridging Finance). Apart
from the funding, limited joint activity between the two organisations was developed.
At that time, there was also a separation of two functions in the discharge programme:
while the commissioning and purchasing of services was organised by the local
authority social work services, the actual power to make the decision to discharge a
person lay with the health side, mainly with psychiatrists. Also, even though it was
intended to be a joint attempt, there were no clear lines of accountability. Health
professionals, for example, were not accountable to the discharge team, a fact that
made the implementation of policies more difficult.
In the last phase the institution was nearing complete closure (Appendix 4). Scottish
legislation had now led to the creation of a formal joint partnership between local
authority social work services and the health board, in which the leadership was
allocated to a joint leader, i.e. a leader appointed jointly by both, who had the authority
to supervise the complete discharge programme and manage the priorities and
activities between various stakeholders. A Joint Project Manager was appointed to take
responsibility for the overall programme, so that the management of the services
included the one service manager and all the professionals under him/her. This
structure offered a more powerful management over the whole programme, as it
followed a straight top-down approach. Also, succeeded in marrying the two main
functions of the making decisions about a person’s discharge and commissioning the
care package so that both were undertaken by the single, joint, multi-disciplinary team
[“And now there is really one service manager and just all the professions”]. Having in
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place this structure, decisions regarding each individual could be taken faster, which in
principle could have led to the acceleration of the last part of the discharge programme.
Political system
Data regarding the relationships between the two main organisations during
de-institutionalisation were also collected. Professionals, from both the health side and
the local authority social work services had to overcome their differences arising from
their fundamentally different approaches to the model of care provision, in order to
provide joint services. The shift of power from the health side to local authority was
seen as one of the major changes during the implementation of this programme.
A number of suggestions were developed by professionals in order to enhance joint
working. First, on the strategic level, the publication of joint policy documents would
enhance joint approach, as it would bind both agencies to follow a common path. In
this way, the lines of accountability could be made clearer and duplication could be
diminished. The key ingredients for developing joint initiatives included the
development of mutual respect, a commitment to working on the disagreements, and
flexibility. The involvement of all appropriate personnel from the beginning of the
programme and also the formation of a clear vision of the programme were all
characteristics that should be sought after in a discharge programme.
Cultural system
Professionals made a number of recommendations in order to develop an environment
in which the organisation’s missions could be achieved. It was explained that
managers should have the ability to identify and then teach their staff the new skills,
values and attitudes that they would have to adopt in their working practice. In
addition, they must be able to mirror their practice to their inferiors, in order that they
too would adopt a similar working attitude and proceed with the changes.
Professionals’ willingness to work to these standards was the main factor that could
enhance the overall programme, and it was also stated that they should be encouraged
rather than coerced into adopting their working practice to the new standards.
It was also suggested that training was a significant tool for enhancing
professionals’ skills and ability to adapt into the community setting. Training should
be arranged according to each individual professional’s needs and in correlation with
the group of service users who they expected to work with in the community. It was
also necessary to put in place a managerial style that could introduce new cultural
behaviors in the organisation. The development of a managerial model with organic
characteristics was described as most appropriate for disseminating the values and the
principles that govern the provision of services in the community.
Discussion
The findings of this study showed that various management models were adopted in
the four phases of the discharge programme. The models presented here were formed
and developed under different conditions and circumstances. The application of these
models represents a “quest” by the institution’s management regarding the most
appropriate model for managing the discharge programme. That was a subconscious
process, during which managers were trying to progress the discharge programme.
This study showed that this goes on continuously in organisations under transition
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until they settle down to a more permanent state. Although this could be seen as a
valuable practice, if changes in the models were based on lessons that had been learnt
through the years, this was not the case for the institution under investigation. Rather,
the adoption of different models was a response to the lack of cooperation in higher
levels of authority for the promotion of the changes, and the use of different models
was actually a hindrance to the discharge programme, as it interrupted its continuity
and coherence.
Although the literature on organisational change has some relevance and
application to such an organisation, ultimate closure is not a feature covered by
existing theories of organisational change. In this framework, the data gathered
enabled researchers to arrive at a model of management which he believes is suitable
for managing similar programmes. For the purpose of this study this model was called
the “stakeholder management model” (Appendix 5), which is consisted by two main
components.
First, it was made clear that strong foundations should be established from the
outset of the programme in order to manage a change of the extent of a discharge
programme. More specifically, a consortium between the main stakeholders should be
established. In the case of de-institutionalisation, a merger between local authority
social work services and health board should be promoted. Such a practice would
enable one single authority to be responsible for all the policy-making,
decision-making, legislating and finally proceeding with the implementation process.
This proposal is a step forward from what was suggested in Community Care: A Joint
Future (Scottish Executive, Joint Future Group, 2000), which was looking to promote
local joint services between social workers and health professionals. Moreover, such an
endeavour should be surrounded by the appropriate policies, practices and culture for
change. The establishment of a formal process should be promoted from the early
steps of the changes, in order to drag most of the employees, if possibly all of them.
Members of the organisation must first accept the new task that has to be achieved,
which is one of the difficulties in every new initiative (Poole et al., 2006). This means
that the culture of the provision of the changes has to change, which is defined as the
lens through which members of the organisation have to perceive the programme
(Fraser, 1998). An organisational culture affects the organisation’s behavior at all levels
(DiBella, 1996), and mainly the interactions between stakeholders. Collaboration
between stakeholders is essential (Atkins and Walsh, 1997), as integration leads to the
provision of better services and increases cost-effectiveness (Rees et al., 2004). In the
case of a discharge programme this practice could attract different providers, aiming to
be involved in the programme. An advanced competition can then be developed
between them, which would lead to better services.
Second, this model favours the suggestion that a small dedicated and specialised
team should be formed, in order to undertake the management of the programme. The
existence of a common manager was identified as one of the most significant issues to
be considered. This suggestion is in accordance with references found in the literature
regarding professionals’ accountability in the wider frame of public policies (Hill and
Hupe, 2006, p. 558), according to which professionals’ accountability to different
organisations often led to problems (Cline, 2000). It has also been pointed out that the
right leadership can make all the difference for the introduction of changes in an
organisation (Gill, 2003; Karp, 2006; Cline, 2000). In the case under investigation, the
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existence of a joint manager, to whom personnel from social work services and health
side will be accountable, can be considered as the way for moving the changes forward.
This is in accordance with the aims of the twenty-first century Social Work Review,
focusing on the formation of services that have fewer line managers and more people
taking on leadership roles (Scottish Executive, 2006, p. 66). Middle managers made
limited input into the implementation of strategic changes (Graeme, 2006, p. 5);
therefore, it was suggested that middle layers of management should be removed
(Scottish Office, 1998, paragraph 2.11), which was a common practice during 1990s
(Herzig and Jimmieson, 2006, p. 628). Finally, a joint manager post would add more
flexibility to the function of the whole programme (Scottish Executive Health
Department, Directorate of Health Policy, 2001), as both purchasing and
commissioning would be managed jointly by both main stakeholders.
Moreover, the study suggested that the development of the services required skilled
and trained professionals. The claim that better educated employees learn more
quickly and in turn contribute more to the organisation’s learning activities (Hatch and
Dyer, 2004, p. 1159) applies perfectly in programmes like de-institutionalisation.
According to this view, specialist professionals are expected to respond to the needs of
the community roles faster. This proposal is in accordance with one of Taylor’s
proposals regarding the selection of workers, according to which “maximum
specialisation” was required (Barnes et al., 1970, p. 31). Moreover, he had proposed that
training should be offered to employees, as it could be beneficial for the organisation’s
function (Taylor, 1911, p. 36; Rose, 1975, p. 37).
Having presented the main components of the so-called “stakeholder management
model”, there is a discussion over its theoretical background, in order to understand the
significance of the model itself and its applicability in a case of a discharge programme.
The “stakeholder management model” employs many characteristics from a
specific theory of organisational management, namely the organic one. According to
the organic model, the management of change can be best achieved through a strategy
that emphasises individuals’ active participation in the organisation. Individual parties
within an organisation might have conflicting interests, but the behavior theory
recognises that through interaction parties form coalitions (Roome and Wijen, 2005),
and also create open cooperation between individuals, develop interpersonal support,
advance their interpersonal cooperation and thus proceed with the solution of any
problems which might arise. In this way, changes in an organisation could be enhanced
or blocked depending on individuals’ participation and involvement in the
organisation’s functions.
Under a management style with characteristics of an organic function, professionals
are released from the old-fashioned hierarchical model, which is characterised by a
top-down approach (deLeon and deLeon, 2002). The adoption of a bottom-up
mechanism leaves more space for professionals to participate in the decision-making
process and to affect the policies (Brigden, 2006). Also, professionals gain more power
in the decision-making process and have more say than in other models, as this is
deemed necessary for strategic changes to proceed (Quinn, 1980) and it works as
intrinsic motivation (Srivastava et al., 2006). Furthermore, a management model with
organic characteristics enhances the interactions between professionals, promoting
more collaborative relations and the formation of joint activities. Also, participative
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management methods can also reduce conflicts and disagreements between the
involved parties (La
¨msa
¨and Puc
ˇe˛taite˛, 2006).
This model of management also emphasises the achievement of the goals and
targets that have been set, rather than following organisational processes. The values
of this model are opposite to those of the bureaucratic model of authority, which
reflects the loyalty of all employees for a set of rules, roles or procedures (Gouldner,
1954, p. 222) and finds application in organisations that have close relations with the
state (Ho
¨pfl, 2006, p. 11). In the case of the institution under investigation, professionals
could gain more freedom to work in a way that promoted individuals’ aims, rather than
being stuck in procedural activities that had been put in place by the organisation.
Under such a management model, professionals have an empowered position in the
decision-making process and the ability to act more autonomously in the community
field. This contrasts with the mechanistic model of management, which is
characterised by bureaucratic, centralised, formalised procedures and lower
employee participation (Campbell et al., 2004). It also contrasts with the values of
the Bureaucracy School according to which each person has a specific area of work
with strict limits on their power (Weber, 1947, p. 58). Through a participative model
possible disagreements can be diminished, common principles and norms can be
promoted by the management, and work morale can be enhanced (La
¨msa
¨and
Puc
ˇe˛taite˛, 2006).
Implications for policy and practice
Having discussed the theoretical background of the “stakeholder management model”,
its relevance and potential applicability in the British and international context are
considered.
The adoption of the structure suggested by the “stakeholder management model”
would establish a single point of access between the organisations, which restrict
duplications and delays, enhance contact between stakeholders, develop joint
initiatives, and possibly make better use of resources (Newbigging, 2004). However,
Scotland, it was suggested, lacked an explicit structure for considering independent
living and lacked leadership and a strategic approach (Disability Rights Commission,
2004); the same document stressed the need to create a political and organisational
structure in Scotland which recognises and promotes independent living and equality
for disabled people (Disability Rights Commission, 2004). In the case of Czech Republic,
for example, it has been recognised that the current legal and political structures
stands as a major barrier to the development of de-institutionalisation (Vann and Siska,
2006).
Moreover, in the international environment, the suggestion regarding the creation
of a consortium with centralised authority is supported to a certain extent by some
organisations through the creation of joint services. Joint working between health
and local authority services has been promoted by legislation, with the establishment
of numerous strategic and policy commitments (Disability Rights Commission, 2004).
At local and national level, it is recognised that central government should
emphasise the need for “jointly agreed hospital discharge procedures, promoting
good practice and encouraging agencies to develop flexible responses at a local level”
(NHS, National Library for Health, 2007). Also, at European level, the available
literature underlines the importance of empowering stakeholders in order for
Organisational
changes
375

partnerships to be formed between public, non-governmental and private sectors
(European Coalition for Community Living, 2007). The Commissioning Framework
for Health and Wellbeing (DoH, 2007) aimed to bring health and social services closer
in respect to commissioning services. These policies reflect the need for “integration”
at all levels, from strategic planning through to practice. Already, incentives are
available to some European countries to enhance coordination between health and
social care sectors, especially the integrated coordination of these organisations
(Commission of the European Communities, 2007). Such structures could allow
coordination between all different policy fields in the process of deinstitutionalisation
(European Commission, Unit of Integration of People with Disabilities, 2003). Also,
this approach could lead to control the provided services between the two
organisations and also embodies a holistic approach to policy development, in which
the needs of all stakeholders are met (European Coalition for Community Living,
2007). The Disability Rights Commission (2006) focuses on the promotion of
independent living and concluded that there is a need to establish mechanisms for
cross-governmental and interdepartmental work and make links between key
stakeholders and relevant bodies, and it also supported the establishment of an
Independent Living Task Force.
Conclusion
For de-institutionalisation to be successful, new habits and values need to govern the
relations between professionals, and a change is required in “fundamental thinking”
(Hubbard and Themessl-Huber, 2005, p.382) about how the joint approach should be
developed. Learning a new role is very different from more general organisational
learning (Morrison, 2002, p. 1156). This requires a culture in which collaboration is the
norm, especially in terms of the relations between professionals in an inter-disciplinary
team (Sandars and Heller, 2006, p. 345).
The current study has aimed to investigate the model of the management during the
discharge programme in a time framework of about 20 years. Through this
investigation, the main inquiries that were raised in this research focused on
identifying how the discharge programme progressed through the years, which were
the difficulties faced during the organisational changes and what kind of management
model is more suitable in similar programmes.
The overall conclusion was that the creation of a joint venture between local
authority social work services and the health board should be encouraged, in order to
promote the discharge programme more effectively. Professionals favoured the
creation of a small joint team under the authority of a single joint manager, who would
be responsible for all the staff, as they believed that this model would lead the changes
positively in such a complex programme.
The findings brought up the so-called “stakeholder management model”. The
theoretical background of this model was discussed, and its applicability in the
international scene was searched. Through this scrutiny, it can be concluded that
management models, which are composed by characteristics from the organic theory of
organisational management, could apply in discharge programmes. In this framework,
the adoption of the “stakeholder management model” could possibly find application in
similar programmes.
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Notes
1. Within the National Health Service and Local Social Services and along with voluntary and
private organisations, the government tried to create a market but with the basic services
remaining in public ownership and control. The arrangements within the NHS were known
as the “internal market”.
2. Professionals based on the institution like managers, social workers, nurses, psychologists,
psychiatrists, occupational therapists physiotherapists and others.
3. Available at: www.qsrinternational.com/
4. Nurses and psychiatrists were more reluctant to proceed with changes during the discharge
programme.
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Appendix 1.
Appendix 2.
Figure 1.
Organisational structure
during the first phase of
the discharge programme
Figure 2.
Organisational structure
during the second phase of
the discharge programme
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Appendix 3.
Appendix 4.
Figure 3.
Organisational structure
during the third phase of
the discharge programme
Figure 4.
Organisational structure
during the forth phase of
the discharge programme
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changes
383

Appendix 5.
About the authors
Dr Stavros K. Parlalis obtained his Master’s in Policy Studies (2003) and PhD in Social Work
(2008), from the University of Edinburgh in Scotland. He obtained a first degree in Social Work
(TEI of Crete) in 2002. His most recent job was at the Office of Preventive Mental Health of the
Greek Navy. In the past he has worked for five years as a social worker for Enable Scotland, in
Edinburgh. He has given a number of talks at conferences or as invited speaker in mental health
hospitals. He has seven publications in international and Greek peer reviewed journals and he
has also published two book chapters. Dr Parlalis has been awarded two scholarships as an
undergraduate and as a postgraduate and research student, from the Greek State Foundation of
Scholarships (IKY). His main research interests include organisational changes, organisational
development, de-institutionalisation, integration of community services and health professionals’
job satisfaction. He has been member of the British Association of Social Workers and member of
the IASSID. Dr Parlalis can be contacted at: stavros.parlalis@gmail.com
Figure 5.
Stakeholder management
model
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