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Public service health care organizations are often characterized by ambiguity of roles, authorities, processes, and structures. They are the site of cultural collision, the street fighter culture of politicians who fund services, and the health providers' culture of care. The service itself suffers from unremitting, brutal, and unsuccessful change initiatives rampant with rationalizations that are hidden in euphemism and language codes such as ‘break even’ and ‘sustainability’. Given expansion of knowledge and expertise, how do we not know, or slide away from knowing, what ails us and how to remedy it? How do stakeholders, through expediency, ignorance, cowardice, or worse, bind themselves into repeating patterns of ineffective action? These are the questions this paper seeks to address.
The paper presents an analysis of a recent organizational reconfiguration through merger (in 2008) of three acute hospital trusts in a rural environment in the UK. Using conceptual lenses from organization studies, for example, Weick et al. (2005), psychodynamics, for example, Obholzer and Zagier Roberts (1994), Levine (2005), and leadership research, for example, Grojean et al. (2004), a resulting explanatory schema accounts for the covert turf warfare underlying divisions and tensions in public service health care organizations that are the symbolic and real site of a struggle between life and death.