Background

Against the wider background of debates over the positive and negative effects of work on employee wellbeing, there has been a specific interest in organisational change. It is most often suggested that change has a negative effect on employee wellbeing (Ferrie et al, 1998; Tehrani et al, 2007), with concerns expressed over the nature of changes, how they are managed and the rate of change. In particular, a widely held notion that the contemporary employment experience is one of constant change has given legitimacy to focusing on change in its own right. One sector strongly associated with constant change is that of healthcare services, both in the UK (for example, Bach, 2004) and beyond (for example, Schoolfield and Orduna, 1994). Despite this, and despite a growing evidence base that health service employees experience higher levels of mental distress than other working populations (Tennant, 2001; Loretto et al, 2010), remarkably little attention has been paid to managing health service employees through times of change. Existing studies have tended to use quantitative methods (such as Bourbonnais et al, 2005; Hansson et al, 2008). While useful in establishing the nature and extent of stressors associated with organisational change, such research provides limited insight into the ways in which organisational change may affect employee health and how employees adapt and respond to change.

Situated within a multimethod research project in the UK National Health Service (NHS), this chapter reports findings from a qualitative longitudinal study. It aims to explore the dynamic nature of the relationships between organisational change and staff health over the period of a three-year change programme that encompassed the relocation of a key UK hospital trust and major restructuring of service provision. It draws on the demand-control-support (DCS) model (Karasek, 1979; Karasek and Theorell, 1990) to explore how organisational change affected employees’ health and investigates how individuals’ health trajectories developed over the course of the study.

Change and health

Theorell (1974) was one of the first to suggest that changed work circumstances, such as new responsibilities, work schedules or working relationships, may influence health. Karasek (1979) and Karasek and Theorell (1990) later developed a model that focused on the interactions between ‘demands’, ‘control’ and ‘support’ at work and their role in determining levels of stress-related illnesses (‘job strain’).