Changing cultures--determining domains in the NHS

This article explores changes in the National Health Service (NHS) as an organisation, in the context of the emerging managerial culture. This new culture is also seeking to influence the other forms of organisational culture which have co-existed until now in the NHS; its success in doing so is limited by the lack of a shared value system within the new management culture. The issue is explored with reference to domain theory as suggested by Kouze and Mico (1979), and subsequently amended by others, to fit the developments occurring in the NHS. Consideration is given to the following issues with reference to the three domains of politics, management and professions. Can we establish: the continued existence of each domain; the changing location of groups between each domain; the interrelationship between the domains: the location of issues within or between the domains. The theory is then located within the broader discipline of organizational behaviour to provide a revised model for thinking about and acting upon the cultural change in the new NHS; the organizational learning now required is shown to require the following activities by each domain; identification, interpretation and communication.