Analysing structural and cultural change in acute settings using a Giddens-Weick paradigmatic approach.

An examination of the salient literature on hospital clinical directorates (CDs) is presented. A critique of the largely managerialist, instrumental, hortatory and normative extant literature about CDs is offered. In analysing the literature this way the earlier promotional and critical literature is eschewed in favour of an evaluative approach. CDs are then reconceptualised by locating them within two overarching accounts of social structure--formalised, prescribed frameworks, and enacted, patterned interactions--following the kinds of distinctions made by Giddens, Weick, social action and institutional theorists. Social structure as it relates to culture is also considered, following Martin. Such an approach facilitates an understanding of the general weaknesses of health service perspectives and methods of analysis, and exposes the strengths of Giddens-Weick type paradigms.