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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 July 28; 335(7612): 172.
PMCID: PMC1934453
NHS restructuring

Consider social anthropology

Annabelle L Mark, professor of healthcare organisation

Braithwaite provides a practical strategy for coping with the restructuring of the NHS.1 NHS organisations are distinguished only by their instability, and the costs of this are high.2 So why do we do it?

It is a symbolic act for politicians, so what is also of interest now is the symbolism of who is appointed to lead this—and, whatever the personal characteristics of the individual, the symbolism of a surgeon sends out specific messages about doctor led action. From a social anthropological perspective it may also represent the reaffirmation of the order of tribes in health care,3 4 which increases in importance in forming and maintaining identity for individuals as the organisational identities fail yet again.

But the continual costly and often ineffective process of merger and acquisition in private industry is predicated on similar tribalism and results in similar costs, so the lessons from any sector that can be learnt are largely about minimising the negative impact.

Further useful insight from Australia is provided in the notion of “orphan knowledge”—an evocative term for what was originally an observation about knowledge management but has wider application because there are situations where organisations forget things and repeat past mistakes.5 Do organisations really “unlearn,” or is it because knowledge is forgotten, separated, or isolated within the organisation?


Competing interests: None declared.


1. Braithwaite J. How to restructure-proof your health service. BMJ 2007;335:99 (14 July.)
2. Mark A. Trust me I'm not a doctor London: Middlesex University Business School, 2003. (HRM discussion paper series No 11.)
3. Linstead S. The social anthropology of management. Br J Manage 1997;8:85-98.
4. Maffesoli M. The time of the tribes: the decline of individualism in mass society London: Sage, 1996
5. Caddy I. Orphan knowledge: the new challenge for knowledge management. J Intellect Capital 2001;2:236-45.

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