‘If you were to have this conversation with any of the “management” guys, they’ll tell you the right gobbledygook, and tell you that we’re absolutely committed to that [modernisation]. In reality, we’re so struggling to get the work and get through it and stay afloat financially, that that’s not the agenda as I perceive it.’ (senior clinical manager, St Urban’s)
Chapter Two highlighted the paradox that, considering all eight sites were part of the same NHS and engaging with the same national innovation programme, their initial circumstances had almost nothing in common with each other. However, they all had local justifications for opening a TC that were the result of complex ‘negotiations’ between different ‘players’ at each site, each of whom interpreted the innovation differently. At each site, key players in the early phases of the development of the TCs contested their understandings and definitions of a TC and what it might mean for the organisation. The tussles, disagreements and bargaining that would shape the resulting TCs were not simple interprofessional (often referred to as “tribal”) battles between, say, doctors, managers and nurses. Rather than splitting along professional lines, they seemed rather to fall into four types of player, namely opportunists, pragmatists, idealists and sceptics, who were to be found in varying proportions in each of the sites. Each type had a role in determining the fate of the innovation, using different aspects of the local initial conditions in each site to argue the case for or against developing a TC (Pope et al, 2006).
Opportunists, pragmatists, idealists and sceptics
Opportunists saw TCs as a chance to do something (rebuild, expand, renew) that they might not otherwise have the chance to do, which was often an innovation they had already been planning or developing. In several of our sites opportunists used the TC programme as a way to get capital funding to finance projects they had long been hoping to implement. At Northendon, for example, a project group had, for a long time, been wanting to expand day surgery in their hospital. Following the announcement of TC funding and prodded by the SHA, the project group developed a bid for a TC mainly as a vehicle for the day surgery unit they had thus far been unable to realise.