People, Place and Innovation: How Organizational Culture and Physical Environment Shaped the Implementation of the NHS TC Programme

This chapter describes the experience of an organizational change in the English National Health Service (NHS) by focusing on the interconnections between culture and place in shaping that change. We use the term ‘place’ to mean space in the sense of the physical environment, architecture and lay-out, rather than location or setting. The idea that culture structures change is familiar, but perhaps the influence of physical environments, architecture and spatial configuration is less well examined. Organizational culture and negotiated order theories have been successfully employed to understand organizational change, and while these perspectives sometimes acknowledge the importance of physical context, few empirical studies have examined the interplay of culture and place in the change process. This chapter therefore focuses on the interaction between people and place in shaping organizational change. It looks at the intersection of culture and place in the context of an ethnography of the development of an innovative form of health care delivery, namely NHS Treatment Centres. Of particular interest are the stories participants in this study told us about the physical environment and the ways in which place influenced their sense-making and decisions around the implementation of this change programme. The chapter considers the possibilities and limitations to organizational change that arise from the powerful structuring effects and interplay of culture, physical and geographical environment, by exploring how Treatment Centres were adapted to the particular local configurations of people and place and then by reflecting on the impact of place on understanding organizational change.