The charity hospice: a theory of governance processes

The study considers the processes by which a charity hospice reconciles internal, external and governmental tensions in the provision of public healthcare services. Thus the focus is on change, decision-making and relationships with public sector partners. The study is practice-based utilising a grounded theory methodology and a case study strategy based in two empirical phases. Phase 1 comprises a single organisation case study at a charitable hospice for the purposes of theory production. Data collection was primarily via participant observations from a close insider perspective as recognised by Adler & Adler (1987). Emerging theory from phase 1 was later tested and developed via Phase 2 empirics, comprising a cluster of four organisational case studies. Data collection during phase 2 was based in semi-structured interviews and, in part, critical incident technique. Around thirty interviews were held, evenly spread across participating organisations and between trustees and managers. The original contribution is a theoretical model of governance processes that identifies the ‘individual contribution’ of trustees and the ‘collective will’ of the board of trustees as key concepts. It is recognised that both are subject to ‘leakage’ from their maximum potential. Component elements of the three concepts are identified and discussed. A three-tier model is presented using these key concepts as linkages between governance, culture and change management. The theory is used to form a framework for practice, aimed at facilitating improved control and effectiveness of a charity hospice board of trustees. The theory is placed in a critical realist perspective for discussion. The study contributes to the debate on issues around public and voluntary sector commissioning and funding relationships. There is also a methodological discussion in the context of researching from the perspective of a close-insider addressing issues of access, ethics and the dual role of researcher/practitioner. There is a contention that production of emergent grounded theory for testing and development and the Scapens (1990) differentiation between positive/normative perspectives may be too simplistic for the purposes of this study.