Theorising culture and culture in context: institutional excellence and control.

In this paper an attempt is made to focus on the ideological and practical implications of the new cultural forms of healthcare sector management variously described as institutional excellence, empowerment, total quality and human resource management. Thus, I look in detail at the managerial and academic claims concerning the mobilisation of corporate culture and go on to emphasise the impact which the literature of culture management has had on nursing employees and healthcare organisations. I also highlight the restrictions of the applied research approaches and argue that the managerial and poststructural literature is limited in that its conceptualisation of culture and change is incomplete. The focus switches then to a range of literature which has been used to study change with a labour process perspective and explains why an approach based upon the study of the disparity between the cultural rhetoric and the day-to-day practice, as well as how people experience and respond to that disparity, is to be preferred. Furthermore, I gain substance from a variety of viewpoints in order to discover a suitable way of putting the matter of interest into context. Drawing on the analytical framework of the sector model, which differentiates in the economy between private and state production sectors, it is possible to distinguish between the different modes of rationality governing each sector. As a basis for further contextualisation, the powerful and privileged positions of nursing as well as other healthcare professionals and the distinctive character of their employment relationships are considered. The paper concludes that an extended labour process analysis is necessary to challenge the way in which the concept of culture is applied by nursing academics and practitioners.