Does ownership matter? Case studies of healthcare employee-ownership and the implications for alternative organisations

Since 2014, new employee-owned Public Service Mutuals in the UK have been created by transferring £1 shares to staff. Much current research draws upon conventional approaches to evaluating policy implementation and falls short in understanding the implications of such new ownership arrangements. Utilising insights from the critical scholarship of alternative organisations, this thesis offers to redress this absence. Long standing academic, as well as policy debates testify to the importance of talking about ownership, even if there is no consensus amongst social scientists about what it means and whether it is important as a replacement for state or private models. The capacity of employee owners to control management is doubted while organisational hierarchies’ use of co-option to seduce workers to self-discipline highlighted. This thesis investigates the dynamics of implementing employee-ownership in the context of the English healthcare sector, underpinned by a critical realist theoretical framework. Employing qualitative methods including interviews, group discussions and non-participant observations to compare four case studies the thesis asks several key questions about employee-ownership and the possibilities of alternative organising. Namely, how ownership was embraced or contested by staff; whether shareholding gave staff greater control; and how resistance to managerialism was manifested. Major observations and contributions were identified: 1) Interpretations of employee-ownership amongst local actors multiplied and became uncontrolled with managerial and individualist forms challenged by democratic-collective versions; 2) The transfer of shares initiated a new debate, creating space for arguments driven by ideals of democracy, justice and equality leading to tangible differences to management prerogatives. However, new forms of staff control over the organisation and management were limited and dependent on employees valuing ownership as more than the possession of property; 3) Staff showed substantial differences in responding to management’s version of employee-ownership. While non-ownership and indifference to shareholding were common; others embraced being an owner as they sought to radicalise its conceptualisation in their efforts to resist managerialism. The study suggests that despite shortcomings, employee-ownership in the healthcare sector has tangible (but partial) merit as an alternative organisational form. Drawing on a critical realist approach, the interaction between discursive contestation over the notion of ownership as well as the importance of non-discursive changes in organisational structure and economic roles is emphasised.