An evidence-based model of job rotation

A project submitted to Middlesex University in partial fulfilment of the requirements

for the degree of Doctor of Professional Studies

Candidate’s name: Patrick F. Coyne

School of Health and Social Sciences

Middlesex University

28th February 2011.

Module Code: IPH 5180

Student Number 2045281 

Copyright: Patrick Coyne.

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Table of contents:

(i) Doctorate of Professional Studies: Summary............................................................12

(ii) Summary/Abstract...................................................................................................14

(iii) Acknowledgements..................................................................................................16

Chapter One: Introduction...................................................................................................18

1.1 Emergence of this study from an on-going emancipatory action research study......18

1.2 Ethical aspirations in the health care arena................................................................18

1.3 Contributing to my record of developing professional knowledge for practice........19

1.4 Developing nursing practice theory...........................................................................19

1.5 Meeting the Doctorate of Professional Studies requirements....................................20

1.6 The general context of nursing and health care in the UK at the time of setting up and running this study................................................................................................20

1.7 The context of nurses’ participation in research........................................................21

1.8 My investment and influence over the project, its findings and utilisation...............21

1.8.1 Developing collaborative and useful understandings to promote change 22

1.8.2 Contributing to advanced nursing clinical practice as nurse consultant..22

1.9 The major objectives of the research study................................................................23

Chapter Two: Terms of reference/objectives and literature review.................................24

2.1 Introduction................................................................................................................24

2.1.1 Aim of the literature review.......................................................................24

2.1.2 Nature and parameters of the literature review........................................24

2.1.2.1 Developing the literature review..........................................................................25

2.1.2.2 Expanding the context and terms of the literature review....................................25

2.1.2.3 Diverse sources of comment and knowledge about job rotation..........................26

2.1.2.4 Structural, process, outcome and evaluation issues related to job rotation........26

2.1.3 Exclusions from the literature search and review.....................................26

2.2. Knowledge from different stakeholder groups:.........................................................27

2.2.1 Internet sources.........................................................................................27

2.2.1.1 Access and empowerment.....................................................................................27

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2.3 Research and reviews of job rotation.........................................................................28

2.3.1 Prevalence of job rotation.........................................................................28

2.3.2 Characteristics of those organisations that adopt job rotation.................28

2.3.3 International and national policy and job rotation...................................30

2.4. Definitions of job rotation..........................................................................................30

2.4.1 Discovering the synonyms.........................................................................32

2.4.2 Confusion of terms.....................................................................................33

2.5 Outcomes of the use of job rotation...........................................................................33

2.5.1 Summary of outcomes................................................................................38

2.6 Leadership and management issues for the use and implementation of job rotation 39

2.6.1 Factors influencing the managerial decision to use job rotation..............39

2.6.2 Managerialism...........................................................................................39

2.6.3 Time and support.......................................................................................39

2.6.4 Structures and processes...........................................................................40

2.6.5 Stress and satisfaction – the employees’ point of view..............................41

2.6.6. Cost and benefits.......................................................................................41

2.6.7 Specialist employees vs generalists...........................................................42

2.6.8 Promoting learning in organisations........................................................42

2.6.9. Productivity...............................................................................................43

2.6.10 Absence or insufficient job rotation opportunities....................................43

2.7 Job rotation for nurses................................................................................................44

2.7.1 Job rotation as an inducement and/or reward..........................................44

2.7.2 The diverse use by nurses of job rotation..................................................45

2.7.3 Prospective action research studies on job rotation.................................45

2.7.4 Inclusion in national policy.......................................................................46

2.7.5 Improving organizations and communities...............................................47

2.7.6 Getting into work and returning to work...................................................48

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2.7.7 Negative effects on service delivery..........................................................48

2.8 Critical reflections of reports and research on job rotation........................................48

2.8.1 Difficulties accessing relevant literature.......................................................

2.8.2 Reflections on the substantive and methodological nature and quality of the literature.....................................................................................................................

2.8.3 Shortcomings and collateral effects of job rotation..................................53

2.8.4 Misrepresenting the evidence base............................................................54

2.8.5 Developing the evidence base...................................................................54

2.8.6 A research paradigm for evidence generation and research....................55

2.8.7 Unanswered and ‘unthought of ‘questions................................................56

2.9 Conclusions................................................................................................................56

2.10 Knowledge gaps in the job rotation theory and knowledge base...............................58

2.11 Research question......................................................................................................58

2.14 Lessons learnt from writing this chapter....................................................................58

Chapter Three: Methodology................................................................................................60

3.1 One of a series of studies as part of an action research project on job rotation.........60

3.2 The emergence of the research question....................................................................62

3.2.1 The research question................................................................................64

3.3 My philosophical approach to this research project: ontology, epistemology and ethics..........................................................................................................................65

3.3.1 Ontology....................................................................................................65

3.3.2 Epistemology.............................................................................................65

3.3.3 Ethics.........................................................................................................66

3.3.4 Overall approach to research: Critical realism........................................67

3.3.4.1 Developing knowledge – concepts, theories, models, ideas..............................68

3.3.5 Summary of key factors that I bring to this study as pre-judgements.......68

3.4 The approach and methods used in the overall action research study on job rotation.......................................................................................................................69

3.4.1 Context of uncertainty, ambiguity and opportunity...................................69

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3.4.2 Useful research and learning....................................................................70

3.4.3 Emancipatory action research..................................................................71

3.5 The design and methods used this study....................................................................72

3.5.1 4th generation evaluation – ‘responsive evaluation’................................72

3.5.2 Formative merit evaluation.......................................................................73

3.5.3 Nominal group technique..........................................................................74

3.5.4 Nominal group technique process.............................................................75

3.5.4.1 Preparing to access and contact key stakeholders...............................................75

3.5.4.2 Ethical permission................................................................................................75

3.5.4.3 Purposive sample - Setting up the expert panels..................................................76

3.5.4.4 Distributing data for analysis to participants......................................................76

3.5.4.5 Time line for the data collection...........................................................................77

3.5.4.6 Collecting the data................................................................................................77

3.5.5 Analysis of data.........................................................................................81

3.6 The intent and nature of the research report..............................................................84

3.7 Dissemination............................................................................................................85

3.8 The criteria to judge the value of the research report................................................85

3.9 Learning from writing this chapter............................................................................86

Chapter Four: Project activity and findings.......................................................................88

4.1 Introduction to the project activity and findings chapter...........................................88

4.2 My interpretations of the findings from the two expert panels – using template analysis.......................................................................................................................89

4.2.0.1 Limitations due to the word count........................................................................90

4.2.0.2 Audit trail...............................................................................................................91

4.2.1 Overall approach to reporting the project activities and findings............91

4.3 Key outcomes for the use and successful implementation of job rotation.................92

4.3.1 Cohort 4 (plus Cohort 1-3) research studies.............................................92

4.3.2 Experienced nurse job rotation study........................................................92

4.3.2.1 How to present the complexity of the findings – produce a useful report and model....................................................................................................................93

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4.3.3 Supervisors’ research report.....................................................................93

4.3.4 Sabotaging and undermining factors........................................................94

4.3.5 Links within the model...............................................................................95

4.4 Key structures required for successful job rotation...................................................95

4.4.1 Cohort 4 and Cohort 1-3 research reports................................................95

4.4.2 Experienced nurse job rotation research study........................................98

4.4.3 Supervisors’ research report....................................................................99

4.4.4 Sabotaging or undermining factors.........................................................100

4.5 Key processes necessary to implement job rotation successfully............................102

4.5.1 Cohort 4 (cohort 1-3) research reports...................................................102

4.5.2 Experienced nurse research report.........................................................103

4.5.3 Supervisors’ research report...................................................................103

4.5.4 Sabotaging and undermining factors......................................................104

4.6 Overall conclusions – Job Rotation Model April 2009..........................................107

4.6.1. Extending the 'community of interest' and increasing the abstraction of the model...

4.7 Critical reflection upon the emancipatory elements of the study.............................115

4.7.1 Expectations of participation in the expert panel and nominal group process.....................................................................................................116

4.7.2 Benefits from participation......................................................................116

4.7.3 What was new about participation in the research project?...................117

4.7.4 What was useful about participation in the research project?................117

4.7.5 What could be taken back to work by the participants from their participation in the research project?.....................................................117

4.7.6 Summary of reflection upon the expectations and benefits of participation in the research project.......................................................117

4.8 Learning from writing this chapter..........................................................................118

Chapter Five: Discussion.....................................................................................................120

5.1 Introduction...............................................................................................................120

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5.2 What has been undertaken in this study?.................................................................120

5.2.1 Research process to produce a model.....................................................120

5.2.2 Emancipatory component........................................................................121

5.2.3 Ethical issues – equality of opportunity..................................................121

5.3 Limitations of this study..........................................................................................122

5.3.1 Limited theory and literature sources.....................................................122

5.3.2 Limited time for the formative evaluation and feedback........................122

5.3.3 Fear and/or apathy amongst stakeholders could limit their potential contribution.............................................................................................123

5.3.4 The limits of my assumptions or ‘map of the world’..............................123

5.3.5 Limits of my developing capabilities to construct a persuasive ...................argument..................................................................................................124

5.3.6 Limits associated with the absence of numerical data............................124

5.3.7 Limits of embodying the perspectives of insider/outsider researcher.....125

5.3.8 Hermeneutical dialect interpretation – limits of negotiation and interpretation...........................................................................................125

5.3.9 The limits of the visual model..................................................................126

5.3.10 Limited consultation with original rotatees............................................126

5.3.11 Limited opportunity for the expert panel to comment upon the emerging model.......................................................................................................127

5.3.12 The limits of a changing action research community of practice...........127

5.3.13 The limits of my interest, values, persuasiveness and endurance...........127

5.4 Learning from this study – what I would do differently..........................................128

5.4.1 Greater involvement of rotatees as an expert panel................................128

5.4.2 Key local partners as an expert panel.....................................................128

5.4.3 Expert panels and co-facilitation............................................................129

5.4.4 Time.........................................................................................................129

5.4.5 Critical realism and action research.......................................................129

5.5 Yet…What findings are of worth and merit?...........................................................129

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5.5.1 An important research question..............................................................129

5.5.2 Whole system and action approach to develop useful practice theory. . .130

5.5.3 Drawing together a number of methodological techniques....................130

5.5.4 Views of those actually experiencing job rotation as managers, supervisors, and rotatees.........................................................................130

5.5.5 Work-based learning approach and personal circumstances.................130

5.5.6 Contributing to sustainable change.........................................................131

5.6 Findings that could have been anticipated from the literature.................................131

5.6.1 Useful for recruitment and retention.......................................................131

5.6.2 Diverse use of job rotation......................................................................131

5.6.3 Developing a body of useful evidence on job rotation............................132

5.7 That which is novel from the findings/study..........................................................132

5.7.1 Comprehensive literature review..................................................................133

5.7.2 Specific data and interpretations about structures.................................134

5.7.3 Specific data and interpretations about processes..................................135

5.7.4 Specific data and interpretations about outcomes..................................136

5.7.5 A model of job rotation............................................................................137

5.7.6 Emancipatory component........................................................................138

5.7.7 Role of personal and professional reflection and support with critical friends......................................................................................................139

5.7.8 Reflections upon the criteria to judge the value of this research report and its products..............................................................................................140

5.8 What I have learnt from writing this chapter...........................................................141

Chapter Six: Conclusions and recommendations.............................................................144

6.1 Conclusions.................................................................................................................144

6.2 The products................................................................................................................144

6.3 Recommendations for future action............................................................................145

6.3.1 Information for local decision making....................................................145

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6.3.2 Incorporating work-based learning partnerships...................................145

6.3.3 Involving all stakeholders in the change process....................................145

6.3.4 Inclusion in health policy........................................................................145

6.3.5 Use for nursing professional practice development................................146

6.3.6 Sustained leadership and management...................................................146

6.3.7 Enhance evidence-based practice, audit and research...........................146

References:............................................................................................................................148

Bibliography:........................................................................................................................165

Appendices -...............................................................................................................................171

Appendix 1: Summary of Programme Plan - Authorised...............................................172

Appendix 2: Essential Characteristics of Job Rotation Scheme 2002...................................173

Appendix 3: Interpretation of Experienced Nurses Two research study by expert panel - West London...................................................................................................................................175

Appendix 4: Participants in the expert panels.......................................................................178

Appendix 5: Nature of data recorded on postit notes produced by Nominal Group Technique................................................................................................................................................179

Appendix 6: First template analysis – Cohort four, West London Expert Panel...................180

Appendix 7: Email from colleague in Wales about setting up job rotation schemes............182

Diagrams and illustrations:

Figure 1 – Organisational Framework Job Rotation...............................................................40

Figure 2 - My model of action research...................................................................................61

Figure 3 - The methodological process....................................................................................72

Figure 4 - Nominal Group Technique Process (repeated four times for each document being evaluated)................................................................................................................83

Figure 5 - Summary model of fourth generation evaluation (central) and nominal group technique method (outer).........................................................................................84

Figure 6 - A visual representation of key outcomes for successful job rotation......................96

Figure 7 - A visual representation of the key structural factors for successful job rotation..101

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Figure 8 - A visual representation of the key process associated with a successful model of job rotation............................................................................................................106

Figure 9 - Job rotation model – April 2009..........................................................................108

Figure 9a- Job rotation model - February 2011....

Figure 10 – Reflections by the Expert Panels on their participation in the research process...................................................................................................................109

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(i) Doctorate of Professional Studies: Summary

Doctorate of Professional Studies in Health.

Title: Leadership of innovation and change in mental health services

Module

code

Title Credit/level RAL

Claim

IPH 4013 Review of learning 20/4

IPH 4014 Programme planning and rationale 40/4

IPH 4015 Research and development in professional

practice

20/4 Yes

IPH 4040 Project: Leadership via consultancy support for

the development of relapse prevention services

40/4 Yes

IPH 4060 Project: Leadership via. strategic development

and clinical leadership of dual diagnosis services

60/4 Yes

IPH 5001 Expert seminar series 40/5

IPH 5140 Project module: Leading and developing a job

rotation scheme: experienced nurse rotation

scheme (phase one).

140/5 Yes

IPH 5180 Project module: The leadership and development

of an evidence-based model of good practice in job

rotation to improve recruitment and retention in

mental health services

180/5

(see Appendix 1)

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(ii) Summary/Abstract

This submission is the major project for Doctor of Professional Studies. It describes

increases in my professional capabilities as a leader and researcher by innovative use and

development of job rotation as a means to enhance nurse recruitment, retention and

development in north west London. It includes an up-to-date and unique critical review of

the broad literature on job rotation.

As part of an ongoing emancipatory action research study, it is a formative evaluation of five

previous local studies. The formative evaluation was undertaken by two expert panels and

myself, using nominal group technique, with a view to identifying key factors from the

literature and our own experience to develop an evidence-based model of job rotation. By the

use of template analysis and hermeneutic dialectic process an evidence based model of job

rotation has been produced.

In addition to the model that has been produced around an a priori template of structure,

process and outcome, the research process, using a critical realism and emancipatory

approach, has also led to increased learning amongst the many participants plus a variety of

other benefits identified by them.

Our research reports and this model will contribute to the local action research community or

community of practice. They are currently contributing to a feasibility study sponsored by

the local Primary Care Trust to explore the use of job rotation to enable Incapacity Benefit

Claimants to return to work. Further dissemination of the work will be targeted at sharing the

knowledge widely amongst my own profession of nursing and my own area of health care

work. It will also be disseminated beyond these fields to include general business and other

professions.

It is expected that the work will continue to influence human resources policy, as it has in the

past, to promote the appropriate, effective and efficient use of job rotation, and the ongoing

systematic development of an evidence-base in this area of knowledge.

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(iii) Acknowledgements

I have been very fortunate to work with many great colleagues and friends throughout this

doctorate and this study, and want to thank them all.

In particular I want to thank Dr. Ricky Lucock for her ongoing and expert support of my

research endeavours over many years. I would also like to thank her for her supervision and

support with this study. I have been privileged by Dr. Kay Caldwell’s kind and enduring

supervision of my doctorate and this study.

I want to thank Peter Walsh, Director of Nursing and Luella Dixon, Deputy Director of

Human Resources in CNWL Mental Health NHS Trust, for their initial concept paper on

Rotation Schemes, and their support for the development of the projects. Additionally I want

to thank Raj Boyjoonauth, Robyn Doran, Jose Wood, Lynis Lewis, Ursula Gallagher, Carol

Scott, Dana Murphy-Parker, Rami Jumnoodoo, Patricia Leung, David Brettle, Lynne Hunt,

Claire Murdoch, Dr. Peter Carter and Graham Nash for their support with this work.

I am grateful to the participants of the five cohorts of the Nurse Rotation Scheme, and the

whole action research community – in particular the two Trusts which set up the pilot

(CNWL and WL Mental Health NHS Trusts); the Workforce and Education Confederation;

Dr. Katherine Rounce, Alan Beadsmoore and their colleagues of the Work Based Learning

Unit of Middlesex University; as well as local managers who are supporting the scheme. I

want also to thank the other researchers involved with the overall rotation scheme and the

action research – Professor James Buchan and Jane Ball. Dr. David Etherington has also

been of great support exploring job rotation beyond the health care arena.

In the light of the regular organisational changes for both West London Mental Health NHS

Trust, and the now called Central and North West London NHS Foundation Trust, I want to

thank all of the new stakeholders who provide us with support.

On a personal note I want to thank Hannah Jacksley, and my partner Aidan Coyle, for their

enormous support over the years. I am fortunate to have found and received immense

personal support and facilitation from Tina Boyden over the past several years.

Finally I want to thank my family who are a joy to know.

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Chapter One: Introduction

1.1 Emergence of this study from an on-going emancipatory action research study

This formative evaluation emerged from an action research study that I have led since 1999,

on the use of job rotation as a means of recruiting and retaining mental health nurses to ‘hard

to staff’ clinical areas, within two large organisations in west London. The studies (Buchan

and Ball 2003; Lucock and Coyne 2004, 2006a, 2006b, 2006c) were used, as they emerged,

to inform the growing project, and to support the four successful annual funding bids that

were made to the local Workforce and Education Confederation (formerly consortium). They

include descriptions of the contexts of the work, the various influences upon nurse

employment, career development, and impact.

Following the previous studies in this series colleagues and I, as a community involved with

job rotation and nursing leadership, believed that there was a need to evaluate and summarise

our findings. As part of the process I believed that we needed to provide other nurses, who

were thinking of or using job rotation, with some of our conclusions from the various studies

to help them with their decision making.

1.2 Ethical aspirations in the health care arena

On a personal note and as part of my own Doctorate in Professional Studies, ethically we can

‘do some good’ by sharing the learning, and avoid ‘doing harm’ by wasting the learning, in a

context of scarce resources. Additionally to promote justice, autonomy and integrity I

believe that I should endeavour to maximise the quality and potential use of the findings of

this study, within nursing and healthcare, and to encourage others to continue to develop

knowledge in this area of work.

This study will tell my story, including the many inputs of others, of the local efforts to use

and develop job rotation in a reflective way. It will include a local case study as part of an

action research study, one that has already been cited by a number of policy documents, and

has been used to inform decisions about recruitment and retention. This story will not only

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provide a critical review of what we intended to do and eventually found, but will also reflect

upon how nurses and others could develop the evidence base on job rotation further. 1

1.3 Contributing to my record of developing professional knowledge for practice

On a professional level this study will contribute to a body of knowledge that I have

developed, with colleagues, during my career. During the course of my degree in nursing

studies at the Royal College of Nursing/Manchester University, one of the key issues that

struck me was the publishing of ‘nursing ideas’ by the leading nurse theorists (Marriner

1986). Their aspiration to develop nursing knowledge has stayed with me, and energised my

contribution to the ‘knowledge bank’ of nursing and health promotion. Whilst I fully

understand that knowledge, useful to the highly diverse nursing profession, needs to be

rigorous, I also acknowledge that knowledge has to be built, and has to start somewhere. I

was struck by the leading nurse theorists and the publication of their ideas and studies in

small journals, of one form or another, demonstrating to me the need to draw my ideas

together and make them available to others. Consequently I have published in a number of

fields including mental health, substance misuse, public health and HIV fields.

1.4 Developing nursing practice theory

It is also the case that nursing, because of its diversity of application, is heavily dependent

upon knowledge from other fields e.g. biology, law, psychology, leadership and management,

yet there is also a specific field of nursing knowledge, which needs to be explored, many

elements of ‘care’ having never even been named (Dickoff, James and Wiedenback 1968).

Consequently this study will contribute to the field of nursing, in particular nursing

administration, management and leadership. It will also contribute, as a nursing based piece

of research, to the field of human resources management, general management, work based

learning, and organisational research; a somewhat different direction of knowledge sharing

than is normally the case.

It is also salutary to consider the notion of tacit knowledge developed by Polanyi (1966)

summed up by the idea that ‘we know more than we can tell’, and the limitations that face

1 Emancipatory action research, to paraphrase Grundy (1982), is a form of action research which seeks to improve performance through group reflection and action as well as to promote changes in restrictive structures. P.28

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researchers who have experience but for whom the use of research and language to describe,

explain and share is limited. However this view of knowledge also opens up a discourse

about the development of the use of reason to make interpretations and develop a persuasive

argument for a model of job rotation rather than search for absolute truths. This required me

to empathise with the potentially diverse readers of this study and their different experiences

and understandings of the subject matter and related fields [see 3.5.4.3].

1.5 Meeting the Doctorate of Professional Studies requirements

This report will identify how my capabilities at doctoral level, as specified by the assessment

criteria for the doctorate, have been explored and developed. . In the companion volume I

include copies of the other research reports from this action research study, which I have led

and researched over the past eight years. This body of evidence will substantiate my claim for

level 5 doctoral capabilities as a leader of my profession who is able to innovate and generate

new knowledge of value to my organisation and profession and indeed beyond.

Using in-depth tables of contents for each chapter (see Lucock and Coyne 2003, 2006a,

2006b and 2006c), bullet pointing, the use of mind maps and tables, this report, in the spirit

of work-based learning, will be constructed to make the ideas within it accessible to readers,

many of whom are busy professionals, as highlighted, for example, in Appendix 4. This

highly structured approach could create a sense of narrative fragmentation, however I have

had to balance this against the need for very busy professionals to quickly access the text and

its findings.

To maximise the leadership impact of the study, I have followed Handy’s (1996) suggestion

by undertaking a small project, but to do it as well as I can with the resources available to me.

1.6 The general context of nursing and health care in the UK at the time of setting up and running this study

The development of the health service workforce, as with other public sector workforces, and

indeed the workforce in general, continues to be a focus for governments internationally

(Imison, Buchan and Xavier 2009). As Morton (2003) describes, critical to organisational

success in the light of prevailing trends, is the development of the knowledge economy and

the privatisation of public services. The work based education of individual employees will

be the foundation for the future success of organisations. Consequently the education of the

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workforce is not only a costly enterprise, but one that needs to be both effective and efficient.

There is a potential for work-based learning and job rotation contributing to individual

learning and the ‘organisational learning’ as described by Senge (1990) and others.

This study will explore the value of job rotation, and consider its potential use to enhance the

value of employees and their own employability and its contribution to the success of both

public and private enterprises. From the perspective of nursing, the use of job rotation could

well enhance the contribution of the profession in standard health care environments, and also

in the allied services such as health informatics, ergonomics and preventative health in

‘joined up’ neighbourhoods or enterprises.

1.7 The context of nurses’ participation in research

The involvement of nurses in knowledge generation of one form or another has increased

over time, despite many barriers including funding, legitimacy and places to publish

(Rafferty, Traynor and Lewison 2000). Yet there are still many barriers for nurses to

overcome in order to lead and participate in research and make an impact on the

improvement of health care for individuals and communities by the development of useful

practice knowledge.

Bellman (2003) following a substantial review of research, health care and nursing suggested

that nurses needed to undertake more useful research, and recommended action research as an

approach that generated innovation, improvements, and the development of knowledge, and

involvement of users, staff and other key stakeholders. This view is one that I have held for

some time, and have used action research in this study.

1.8 My investment and influence over the project, its findings and utilisation

My reflection on myself and my career over many years, not least during the course of this

doctoral study, the review of learning and the Recognition and Accreditation of Learning

(RAL), and the construction of the programme plan have led me to realise that I view

nursing as an endeavour to promote justice. Much of this view has been influenced by my

learning from family and friends, from experiences in formal education, personal therapy,

nursing supervision, and from an increased understanding of social influences – not least

associated with my own personal characteristics – a man working in a ‘women’s’ world’ of

nursing, a gay man, a member of an immigrant community and marginal faith group. These

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views of the world have helped me to understand the influences upon equality that not only

affect me, but also those with health, mental health, substance misuse and HIV concerns, and

indeed with other additional ‘labels’ – e.g. ‘hopeless’, ‘terminal’, ‘criminal’, ‘disabled’.

1.8.1 Developing collaborative and useful understandings to promote change

This study has been influenced by my experiences and understandings of the world. These

will be highlighted in various ways throughout the study, to both contribute to the findings of

the study, and to frankly share with readers. Key influences on the project and findings are

my own ‘optimism’, despite the many challenges I face; my own choice of career and my

success in being able to practice and lead it; together with my good fortune in working

closely with many colleagues and service users as a practice network of innumerable

conversations and attempts to lead changes (Wenger 1998; Murphy-Parker and Boyjoonauth

2002; Wheatley 2002). Intriguingly, in my view, nursing is an adventure, something of a

Sherlock Holmes exploration, or perhaps an adventure in a battle zone of competing factors:

life and death, hope and hopelessness, possibility and despair, and for me, personal ‘horizons’

(Gadamer 1975), often ‘out of sight’ and or ‘out of mind’. This feature of the nursing and

health context has been a source of fascination for me, leading me to explore it some years

ago in the context of nursing, substance misuse and HIV (Coyne and Clancy 1996) and

currently in this study of job rotation.

1.8.2 Contributing to advanced nursing clinical practice as nurse consultant

This study contributes to a professional vision that colleagues and I had some long time ago,

of the development of a Nurse Consultant role, with the opportunities for nurses to have

senior leadership posts, that were focussed on direct clinical care, knowledge generation, and

the enhancement of clinical environments as active learning organisations, deeply and

respectfully within the practice field rather than on the margins (Coyne 1996). This study, in

its own limited way, is another contribution to the improvement of care for service users and

communities, by suggesting improvements, and which will hopefully encourage other nurses

to participate in similar processes. Clearly this is another in a long line of learning

opportunities for me many of them associated with my mistakes and those of others, and will

contribute to my endeavours in the future as a Nurse Consultant, with greater understanding,

skill and effectiveness.

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1.9 IThe major objectives of the research study

In summary, the three major objectives of this research study are to:

1. Contribute to innovation in nursing and mental health services by formatively

evaluating the research studies previously generated from this action research study in

order to develop an evidence-based model of job rotation.

2. Maximise the impact of the research studies and methods to promote sustained change

via emancipatory action through increased learning amongst participants and

stakeholders.

3. Use the knowledge generated from this local organisational study and previous

studies to both sustain change and take forward the use, development and evaluation

of job rotation in the local context and beyond.

The following section will critically explore the literature on job rotation and identify gaps

which could be significant for the use of job rotation in the west London context, within the

nursing profession and amongst organisations in general.

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Chapter Two: Terms of reference/objectives and literature review

2.1 Introduction

This critical literature review is designed to identify, describe and critique published ideas

about job rotation that exist in current literature, in as clear a way as possible in order to assist

busy colleagues to make professional, strategic and/or managerial decisions about using or

modifying their use of job rotation.

These critical reflections about the research studies and the commentaries has led to the

identification of gaps in the current knowledge base about what job rotation is, and how best

to use it, not only in my local situation in London, but also in the broader sense of both

organisations and communities. This provides the basis for the identification of a research

question that will be of use to the organisation that I work for, my profession and those that

use health services. The literature review provides a context for the development of the

methodology of the study, the interpretation of the findings and finally the discussion of the

results of the research study and their implications.

There are a large number of management tools that claim to promote change and

organisational improvement including a variety of career development interventions e.g.

career paths, job enlargement, job enrichment and job rotation (Kirk, Downey, Ducket and

Woody 2000; Iles and Sutherland 2001; Peck 2005). This review will focus on the literature

addressing job rotation in particular, and its use as a human resource management tool.

2.1.1 Aim of the literature review

The aim of this critical literature review is to explore the main themes in labour market

policy, leadership and research that describe, explain and predict the nature and models of job

rotation, and its use as a tool, with nurses and other professions, for organisational change

and improvement.

2.1.2 Nature and parameters of the literature review

This critical literature review has developed over the ten years of the north west London

action research study on job rotation for nurses. Whilst I conducted most of the literature

search for this critical review for this study, I am grateful to colleagues over the years who

have pointed out relevant literature. The international and diverse literature that supports this

formative evaluation of our research to date has been collected by a variety of means, and

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refers to literature produced from the 1950s to March 2010, and builds on the review

undertaken by Lucock and Coyne (2006c). The search engines and sources were:

HILO (NHS Dialog Datastar search engine) – last search March 2010

Full text articles except for those occasions when I have relied upon abstracts

Policy documents

Job Advertisements

Conference presentations

‘grey literature’ i.e. literature that exists outside of standardised journals (Benzies,

Premji, Hayden and Serritt 2006)

World wide web e.g. Google searches and Emerald

Anecdotal evidence from others who have run or are thinking of running job rotation

schemes, or those who have been part of such schemes.

Evidence generated by our action research community and published or presented at

conferences, or as evaluation reports for business meetings (Coyne et al 2001; Coyne

and Beadsmoore 2001; Coyne 2002; Buchan and Ball 2003, Lucock and Coyne 2003;

Lucock and Coyne 2006a, 2006b, 2006c).

2.1.2.1 Developing the literature reviewI am presenting to readers my current awareness and critique of literature on job rotation.

During the search I have also become aware of many difficulties associated with finding

literature and being able to access the literature e.g. having to pay hundreds of dollars for

reports (www.forrester.com), finding information about job rotation in obscure journals or

newspapers e.g. Vietnam News, or parallel literature e.g. leadership literature (Bennis and

Thomas 2007). It has become clear to me that there is a pressing need for a comprehensive

review of job rotation at this time to prevent wasted effort and failed schemes, and to

empower others by having it available, and in an accessible manner e.g. via my website

www.nurserotation.com.

2.1.2.2 Expanding the context and terms of the literature reviewOne problem that has emerged for me over time has been the identification of many related

terms for the term ‘job rotation’. At the commencement of the project in 1999, colleagues

and I undertook a small literature review, where we searched only for ‘nurse rotation’, having

no awareness of other synonyms. However as time has progressed I have become aware of

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many other terms e.g. cross-training, and transfer learning. I have also become aware that

‘job rotation’ is a label that is used for different purposes e.g. employment opportunities for

the unemployed. Furthermore, whilst it may represent similar schemes, there can be great

differences in its use. I have in general searched literature that includes the term ‘rotation’. I

will explore some of the different uses of ‘job rotation’ as part of the critical review of the

literature.

2.1.2.3 Diverse sources of comment and knowledge about job rotationIt would have been convenient to restrict the literature review to randomised controlled

studies and to produce a Cochrane systematic review, but there are few studies that could be

said to be controlled. There are however a wide variety of other sources of knowledge about

job rotation – from personal opinions, job adverts, newspaper articles, personal testimonies,

local reports, and local evaluations. In my opinion and supported by Sheldon (2005) these

diverse reports are highly informative, and represent diverse experiences and understandings

of job rotation in personal and local settings, and thus enhance the potential of a

comprehensive and ‘realist’ [see Chapter 4] understanding of job rotation to be taken

forward.

2.1.2.4 Structural, process, outcome and evaluation issues related to job rotationIn particular I intend to identify key factors of job rotation in the literature – including key

structures2, processes3 and outcomes, as well as stated enablers and barriers, in line with the

objective of this research study to develop an evidence-based model of job rotation.

2.1.3 Exclusions from the literature search and review

I have focussed the literature review very specifically on job rotation; with exceptions only to

illustrate to readers alternative bodies of knowledge that may assist their explorations and

understanding of job rotation e.g. nurse internship.

The important exclusions from the review are:

2 Structures have been defined in Bendall-Lyon and Powers (2004) as referring to ‘the physical environment and physical facilities’. In this study these include stakeholders, values, norms, contracts, policies and procedures as well as budgets, rooms and furniture.

3 Processes have been defined in Bendall-Lyon and Powers (2004) as the interaction with service personnel. I include within this definition the interaction of all of the structures to produce the expected outcomes.

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Excluding job rotation used purely for education processes e.g. in pre-registration

medical and nursing care, where the focus is purely on learning.

Job rotation for ergonomic reasons e.g. reduce the potential for musculo-skeletal

problems.

Job rotation as ‘shift rotation’.

Job rotation used as a tool to enable the unemployed to return to work.

The manipulation of musculo-skeletal joints as part of physiotherapy practice.

Non-English language texts, though English language abstracts have been included.

2.2. Knowledge from different stakeholder groups:

2.2.1 Internet sources

Sources on the internet have increased enormously over the ten year duration of this action

research project. I have undertaken a number of searches using HILO (Health Information

Library Online) over the past few years, with the most recent yielding a much larger number

of articles than previously. This suggests an increasing interest in job rotation over the course

of this action research study, with more commentaries and studies. There are also more

journals available for internet searching.

2.2.1.1 Access and empowermentIt has now become clear to me that Google searches, Google Scholar and HILO are now of

great importance for literature acquisition but they did not exist to the same extent at the start

of the action research project. From an empowerment perspective they allow busy nurses,

managers and policy makers readily to access both traditional academic sources e.g.

academic journals, and the ‘grey’ literature. However with the increased availability of

knowledge, the quality of the work and its applicability require readers to be highly critical of

the reports. It is assumed that traditional journal articles have been thoroughly peer reviewed

for quality at the ethical committee level and/or the editorial level, albeit that the assumption

is often incorrect (Fraelich Phillips 1986). However I have found that there is a democratic

and emancipatory element to the ‘free information’ that is available through the net, allowing

both authors and readers rapid access that would have been very difficult to have achieved

before. From the ethical perspective, easy access allows nurses to access knowledge that they

can use to ‘do some good’ and ‘do no harm’, whilst bearing in mind the crucial need to

critically evaluate the quality of these diverse sources.

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2.3 Research and reviews of job rotationA key source for any researcher undertaking a literature review is to search for review

articles; I have not been able to find any that attempt a comprehensive review. A number of

limited reviews including Jarvi and Uusitalo in 2004 searched for research on job rotation and

found little theoretical or empirical work. Holle (2005) undertook a brief review of job

rotation in relation to the public sector and fire services yet found few research studies and

few policy documents. Adomi (2006), in a survey of the use of job rotation in library

services, found a similar absence. This supports my own explorations of the knowledge that

exists about job rotation, and also supports my discovery of the multiple synonyms for job

rotation (Lucock and Coyne 2006c), and the different definitions of job rotation, which

makes literature searching, and drawing conclusions about job rotation complex.

2.3.1 Prevalence of job rotation

The Canadian Policy Research Networks have undertaken a number of reviews to do with

quality indicators for work, with job rotation being one of them (Canadian Policy Research

Networks 2008). Their review shows that approximately 13% of Canadian businesses use

job rotation, to making work more interesting and challenging, to boost innovation, and to

help organisations adapt to changing markets. They view job rotation as synonymous with

‘cross-training’ [see 2.4.1.] which no doubt helped with their survey by increasing the

number of articles to review. However by not including more synonyms for job rotation,

they may well have underestimated the formal and informal job rotation schemes being used.

They also suggest that job rotation is most commonly used in manufacturing industry, and

least used in the education and health care sectors. This is a finding which seems surprising

to me, as from my experience health care staff rotate frequently in one form or another.

Eriksson and Ortega (2006) undertook a review of a number of job rotation related studies as

part of their testing of three theories of job rotation using data from the business sector in

Denmark. Their findings support the Canadian survey with up to 20% of firms claiming to

use job rotation. They also suggested that the share of ‘adopter’ organisations i.e. those

organisations that choose to use job rotation, increased with the size of the organisation.

2.3.2 Characteristics of those organisations that adopt job rotation

One of the key themes to emerge from the literature is the notion of the ‘adopter

organisation’, which attempts to identify the characteristics of those organisations that either

use or do not use job rotation. Cosgel and Miceli (1999) in their review suggest that adopter

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organisations are more likely to have the following characteristics, which Morton (1998)

suggests might be ‘eastern’ business values:

Egalitarian sharing

Lifetime tenure

Participation in decision making.

Eriksson and Ortega (2006) list from their review a number of positive job rotation adopter

characteristics, which include:

Greater size of the organisation

Younger age of the firm

High speed of growth and success

Manufacturing sectors

Local wage agreements with trade unions

New work practices

Performance related pay systems

Higher relative training costs

Recruiting outside local or internal labour markets.

These characteristics seem to me to be those of ‘hungry and ambitious’ organisations, rather

than highly bureaucratic or specialist organisations. Differences between public and private

sector organisations in their use of job rotation were identified by Jaturanonda and

Nanthavanij (2006) in Taiwan e.g. issues of seniority, age and years of tenure. Another

difference between adopter organisations identified amongst American organisations was

Kalleberg, Marsden, Reynolds and Knoke’s (2006) review of organisations which used job

rotation to enhance the capacity of staff to participate. They found that non-profit and public

organizations were less likely to use multi-skilling practice rather than for-profit

organisations. I do wonder why this appears to be the case, in particular whether larger

organisations have the internal capacity for staff to move within them, with perhaps smaller

non-profit organisations requiring people to leave and seek employment elsewhere, or

whether staff are rotating but ‘informally’. The theme of ‘adopter organisation’ is one that

could be the subject of further research and assist with the appropriate matching of job

rotation to the settings which will benefit from it.

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2.3.3 International and national policy and job rotation

There is a variety of national and international initiatives to consider which promote job

rotation. This review includes literature from Nigeria, US, Finland, Australia, UK, South

Africa, Denmark, turkey, Taiwan, New Zealand, Japan, Thailand, Israel, Sweden, Greece,

Canada and Vietnam, illustrating the breath of interest in and research on this management

tool. The Canadian government in association with Canadian Policy Research Network

(2008) has developed a body of evidence on the quality of jobs in Canada. Its aim is to help

employers improve recruitment, retention and productivity by identifying the careers and

work characteristics of rewarding jobs, and to support policy makers by informing them of

new conceptual and analytic tools to analyse market developments, with job rotation being

one of the tools. In Japan Ouchi (1981) identified that job rotation was a popular form of

staff and organisational development, and Hsieh and Chao (2004) highlight a similar picture

in Taiwan. However Mourdoukoutas and Roy (1994) questioned the popularity of job

rotation in these countries, wondering whether the comparatively higher rates of job rotation

are a result of risk-averse workers, with little access to public or private income insurance,

thus making these high rates of staff mobility potentially counterproductive.

Friedrick, Kabst, Webber and Rodehurth (1998) speculated about the use of ‘functional

flexibility’, seemingly a synonym for job rotation, amongst European companies, primarily to

address short-term changes in their environment, and suggested that the use of job rotation

would be more effective if it were part of strategic human resource management plans. This

is a point picked up in Weinstein’s (2009) article describing the use of job rotation by a

number of large international organisations and emphasising the structures and processes

needed to run job rotation schemes. However taking into account the scarcity of evidence to

describe, explain and predict job rotation-related matters, it is hard to see how comprehensive

strategic plans could be developed for its use. This factor is one of the reasons behind the

establishment of this action research project and this particular study. Although not the focus

of this study, a model of job rotation has been used across the European Union as a means of

ethically supporting the freedom of movement of EU citizens, and also the employment of

workless people, in a 12 country project (Kankaanpää-Lehtinen and Lahtinen 2001).

2.4. Definitions of job rotation

I am struck by how many of the Internet sources of knowledge about job rotation appear very

authoritative, with scant clear knowledge to support the claims. One such internet source is

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the website of ‘Dr. John Sullivan’ (Sullivan 2008) which provides extensive guidance on

‘developing world class job rotation’. It does however have a very flexible and

comprehensive definition of job rotation:

‘A job rotation is the systematic movement of employees from job to job or

project to project within an organisation, as a way to achieve many different

human resources objectives…’.

This definition does not mention learning, job rotations across organisations, or along the

‘supply chain’, which might enable both the development of a successful community of

organisations and enhance success (Morton 2003).

Richardson, Douglas, Shutter and Hagland (2003) define job rotation as:

‘a reciprocal exchange of staff between two or more clinical areas for a

predetermined period of time’

This definition is in line with Sullivan’s but introduced the notion of reciprocity – as in ‘job

swopping’, guaranteeing that posts are filled. It also introduces a key issue of time, in this

instance the length of the rotation, a matter which is a key factor to the operational planning

of job rotation, and the amount of time needed to benefit from the rotation (Lucock and

Coyne 2006c).

Creager (2007) in the abstract from a recent review views job rotation as:

‘A means of accelerating the development of high potential employees in order to

build a strong management bench’

This definition focussed on the educative element of job rotation and its potential to

accelerate career success and influence, particularly by the education of a small sub-set of an

organisation’s employees, that is, those that are likely to take senior board positions in a

national financial services organisation.

Malinski (2002), in a review of job rotation particularly within library services, saw job

rotation as:

‘The systematic movement of employees from one job to another’.

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This definition focuses solely on job changing, but does bring into play the ideas of

management and organisations creating a system whereby job rotation is organised, and

indeed later in the paper it is clearly stated that it can be used as a tool for many purposes or

outcomes.

Kuijer, de Vries, van der Beek, van Dien and Frings-Dresen (2004) defined job rotation as:

‘regularly alternating between different jobs within an organization on the basis

of a scheme or spontaneously alternating on the basis of the workers' personal

needs’.

This definition focuses on two important elements barely addressed above: the notion that job

rotation per se is organised as a specific scheme in an organisation, and the notion that

individual needs of employees could be the reason for the use of job rotation, in this instance

preventing health challenges or assisting employees with them.

In summary a number of different definitions of job rotation exist, which illuminates the need

to be cautious and critical of the evaluation of literature. At times, reading research reports or

commentaries, I am not always sure of what is being studied in the papers e.g. different

synonyms in the same articles (Nalbathan and Guzzo 2009) e.g. ‘mobility’ and ‘cross

segment initiatives’. However, that said, there are similarities amongst the definitions,

summed up for me from my own previous studies and this literature review in the following

personal definition of job rotation:

Job rotation is the purposeful and organised movement and education of staff within and across organisations to enhance both the success of the organisation and the employability of staff.

2.4.1 Discovering the synonymsExploring the literature on job rotation has led to the discovery of a variety of synonyms (or

highly similar initiatives) for job rotation that includes the following:

Cross training

Jobrotation

Nurse rotation

Functional flexibility

Inter-functional job rotation

Intra-functional job rotation

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Internship

Transition programme

Graduate transition programme

Inter-functional mobility

‘Tour of duty’

This list is not exhaustive; however it does give some idea of how many terms are being used

to describe what may be similar human resource processes, and also highlights the potential

for managerial confusion when making a decision to use or not use job rotation. It also

suggests to me the need for a full conceptual analysis of the term job rotation, which will be

enhanced by this literature review and by the model that will emerge from this study (Walker

and Avant 1988).

2.4.2 Confusion of termsHowever it is important for readers to be aware that there are no doubt other terms which

incorporate key notions associated with job rotation. More importantly perhaps it is worth

noting that the use of the term job rotation may appear to be similar to other terms but may

refer to very different practices e.g. shift rotation or task rotation within a job.

2.5 Outcomes of the use of job rotationMany outcomes4 for job rotation are suggested in the literature; it is difficult to decide

whether the long list of outcomes are part of a ‘wish list’ or are tested outcomes from the use

of job rotation. It is worth noting that the term ‘outcomes’ has many synonyms in the

literature e.g. purpose or expectations. However at this stage in the development of the

evidence-base for job rotation all of these theories are worth noting. The outcomes suggested

include (Richardson, Douglas, Shuttler and Hagland 2003):

Simply staffing jobs (employing people to posts)

An attraction or retention tool

Orienting new employees

Preventing job boredom or burnout

Training employees

Involving managers in the training process

Rewarding employees

4 Outcome is defined here as the consequences of a change process. Outcomes can be desired, expected or unexpected.

33

Enhancing career development

Exposing employees to diverse/international environments.

I am surprised that job rotation, which is used to increase profitability and success for the

organisations, is rarely explicitly mentioned. I wonder if these factors are implicit in the

various definitions and research studies, but rarely made explicit. Thus a false impression

that job rotation is only for the benefit of employees may result in key stakeholders not being

enfranchised. They may be unaware of the potential key benefits for an organisation or its

customers, and thus could be unwilling to support or fund initiatives. Although their report

provides theories about “why” job rotation programmes work, there are few formal

references to support these claims, albeit that they do list seventeen different companies that

use job rotation. Overall their article does, from my experience of job rotation, provide

useful information. It usefully includes ‘warnings’ about factors that could hinder a project

e.g. a need to concentrate on ‘firm-specific skills’ – which is an approach that is in harmony

with the work based learning approach (Boud, Solomon and Symes 2001). This approach

will ensure that the rotation project and its educative element not only helps the individual

employee but the organisation as a whole.

One example of the outcomes of job rotation is the use by public services in Vietnam

(Vietnam News 2004) with a report of a two year project for 3000 employees of the Party and

the State rotating into different positions. The evaluation by staff appears to show that 79%

found the process useful to them professionally, and 35% found job rotation programme

stimulating. The use of job rotation in this context, with high state control, does remind me

of the blanket policies that used to exist in nursing for the rotation of staff, which in my

experience in the mental health services meant rotating every two or four years, regardless of

choice, but with the aim of keeping the system healthy. This report as with all reports needs

to be read critically. In this instance I wonder about the state control issues, the possibility

for dissent, and the detail of the evaluation. On the other hand, in what might be a

monotonous bureaucratic career, diversity and learning could be excellent opportunities for

staff, and could be viewed as improving their overall quality of life and the success of the

enterprise.

Cosgel and Miceli (1999) identify a number of outcomes that are likely to be more important

in some organisational cultures than others i.e. monitoring of profit sharing, an insurance

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against labour shortages, increased quality of worker contribution. Some may use job

rotation to protect the organisation e.g. from fraud (Worthington 2008). However, somewhat

more challengingly, Brunnetto (2002) suggests job rotation outcomes that could be sought by

some managers for cost cutting and increased employee accountability.

Richardson, Douglas, Shuttler and Hagland (2003) identify a number of additional benefits of

the use of job rotation:

Improving knowledge and skills

Providing development opportunities

Networking

Ability to recruit and retain staff

Improving inter-departmental relationships

Increasing motivation.

Campion, Cheraskin and Stevens’ (1994) much cited case study of a pharmaceutical

company’s use of job rotation in the US, suggested four key areas of outcome for individuals

and organisations:

Career effects

Organisational integration

Stimulating work

Personal development.

They also identified a number of potential costs or negative outcomes:

Increased workload and decreased productivity

Increased learning costs

Decreased satisfaction and motivation

Losing employees.

Amongst the many recommendations they make for further research, is that of finding out

more about the operational issues and management of a job rotation scheme, which this study

and the other studies in this action research project are seeking to do. Perhaps as a

consequence of increased knowledge, as highlighted in the previous study (Campion,

Cheraskin and Stevens 1994), Kusunok and Numagami (1998) also identified another useful

outcome for employees i.e. an increased likelihood of promotion in the future. A finding

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supported by Best (1950) was the notion of increased flexibility through job rotation, a notion

which could fit with Karaevli and Hall (2006) who suggested that ‘managerial adaptability’

develops from career variety over the span of an employee’s career. Both flexibility and

adaptability may well lead to higher job performance which is one of the most important

predictors of career advancement (Carmeli, Shalom and Weisberg 2007).

Ericksson and Ortega (2006) also suggest that inter-functional job rotation schemes could

provide an important route for the preparation for top manager posts. They also specify that

more specific rotation i.e. intra-functional job rotation, could lead to the very specific

outcome of meeting key production requirements, clearly a fundamental objective of

successful organisations. Their study compared three different overall objectives for job

rotation:

Employees learning about their work

Employers learning about their staff

Employee motivation.

They surveyed data from a large number of companies in Denmark, seeking to identify which

firms were using job rotation and why they were doing so i.e. what outcome(s) did they have

in mind. Their results suggest that job rotation is useful for employers seeking to learn about

their staff, to influence their career development, and to make the best use of their talents to

achieve the purpose of the organisation. They also found evidence to support the outcome

that employees learn about work and the organisation from participating in job rotation.

They found little evidence to support the idea that job rotation was a useful tool to improve

motivation per se. Additional important outcomes were that job rotation was positively

associated with both positive firm growth rates and nation-wide recruitment practices.

Cosgel and Miceli (1999) identified two benefits for employees from job rotation, which at

first glance might seem contradictory i.e. increased job satisfaction and reduced salary

requirements for staff. Clearly the former is good for employees, and the latter potentially

useful for organisations where competition is likely to push prices down, leaving very tight

margins, and thus job rotation, instead of salary increases, could be a valuable reward for

staff. The relationship between voluntary employee changes and salary requirements is a key

36

issue for managers (Mao 2002), and one which is key in health service organisations with

constantly restricted budgets, yet with a need to recruit, retain and develop staff.

McGillicuddy (2007) suggested that job rotation amongst Information Technology

professionals and companies could be highly useful. In this instance they explored the idea

that job rotation brought staff from business into IT companies, which helped to promote

business alignment. Yet, whilst many in the field considered that job rotation was useful,

only 22% of staff rotated within their IT organizations (Bright, Orlov and Sessions 2007).

Much of the rotation was targeted at supporting either entry-level employees or leadership

programs for director-level succession planning.

Adomi (2006) found that there was general satisfaction with job rotation amongst his sample

group of Nigerian library staff, with a major outcome of job rotation being their increased

familiarity with the operations and services of the organisation. This was supported recently

by Earney and Martins research study (2009). The learning associated with an increased

familiarisation, and indeed with the transfer of learning into and across an organisation e.g.

research evidence can also promote innovation. This feature has been identified by Weerd-

Nederhof, Pacitti, Silva Gomes and da Pearson (2002) with job rotation being considered a

tool to promote innovation. This view supports Cosgel and Miceli (1999) who suggested that

innovation was an ‘unintended consequence’ of job rotation. This suggests to me the need

for broad spectrum, multi-method, and triangulated studies that might capture the

‘unintended’ positive and negative consequences of job rotation. These could be prospective

action research studies where the intended and unintended outcomes could be evaluated for

their usefulness. Soderquist (2006) in a review of 12 global corporations emphasised the

importance of organisational development considering the use of job rotation to enable

knowledge management and the process of knowledge dissemination when developing new

products or services. He took the analysis further by considering the differences in job

rotation models that would be needed for different models of knowledge management and

dissemination.

Offstein and Dugresne (2007) in their study suggest that job rotation, used in the military and

other organisations, can be used as a tool to develop both the character of employees and

their ethical decision making capabilities. They go further to suggest that job rotation could

help organisations to both aspire to and reach higher ethical standards. Clearly this outcome

could be of enormous importance to health and social care services, where personal and

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professional ethical standards are key to the quality of services that are provided, not least

where professional decision making is needed in oppressive conditions (Amnesty

International 2006). Other literature suggests that job rotation can also have a ripple effect

upon colleagues and organisations i.e. Pierce (2001) suggests that job rotation could, in the

library context, both rejuvenate staff and consequently revitalize organisations, an issue that

is particularly important where workers are with an organisation for a long period of time.

However in my experience it could also have the negative effect of spreading poor practice

and attitudes, and as such needs to be led and managed carefully, consistently and enduringly.

The outcomes above relate to the outcomes that could be expected for organisations and for

employees. However there is an extensive literature on using job rotation to move people

into employment i.e. reduce unemployment within communities (Etherington 1998), as

recently explored across the European Union (Kankaanpää-Lehtinen and Lahtinen 2001). As

a spin-off project from this action research project I have become involved with job rotation

in west London to enable people on incapacity benefit to gain employment via job rotation.

It has been used particularly for those with long-term employment problems. Here both job

changes and learning are key factors, but also included is the notion of community or societal

benefits by reducing unemployment (Schomann, Mytzek and Gulker 1998; Parker 2001)

2.5.1 Summary of outcomesIn summary it seems to me that there are four major outcome areas identified in the literature:

Organisational success

Employee success

Increased learning for employees and the organisation

Benefits to the community.

I have enhanced my awareness and learning from this part of the review by having a greater

realisation that it is important that adopter organisations, local leaders and managers are clear

about which outcome(s) are being targeted at in order to set up evaluation programmes so

that they can measure the success of the use of a job rotation scheme. Additionally whilst

many outcomes are suggested in the literature, little research appears to have been done to

confirm, or to explore the success of those suggested outcomes. This is a clear research need

for the future. The following section will explore the structures and processes that have been

suggested in the literature that could be managed so as to deliver the outcomes aspired to.

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2.6 Leadership and management issues for the use and implementation of job rotation

2.6.1 Factors influencing the managerial decision to use job rotationOne of the key managerial issues associated with the use of job rotation is the decision to use

job rotation for a particular purpose or outcome [see section 2.3.3]. Ericksson and Ortega

(2006) highlighted in their survey that job rotation was more common in firms that were less

hierarchical and with shorter than average tenure, although different findings have been

reported by Japanese and Taiwanese firms. Other human resources and quality interventions

might produce the same sorts of outcome as job rotation e.g. work teams, quality circles, total

quality management and performance pay. Thus a clear differential rationale is needed for

choosing job rotation, and in particular a specific model of job rotation, which is a problem

for managers as most of the research is not specific about the models being described or

evaluated.

2.6.2 ManagerialismBrunnetto’s (2002) research explores the notion of ‘managerialism’ and its effect on

managerial processes and change management. It explored the potential detrimental effect of

managerialism on employees such as the top-down introduction of job rotation amongst

nurses. The study also highlighted that despite the ‘operational’ and ‘outcomes orientated’

managerial approaches, paradoxically evaluation studies were rarely recommended. The

study did highlight that the majority of nurses commented that a positive benefit for them was

an increased opportunity to learn, despite the fact that they had few choices about where they

rotated to. It also highlighted that a ‘good idea’ imposed in a top-down manner, can yield

both benefits and losses e.g. resentment by employees about ‘lack of choice’, or a feeling of

being ‘used’ or exploited. These losses highlight for me how a scheme that could be

emancipatory might also if managed inappropriately could be experienced as disempowering.

2.6.3 Time and supportRichardson, Douglas, Shuttler and Hagland (2003) identified that operational processes

needed to ensure that there was the provision of a supernumerary period to support the job

rotation, as well as continuity of supervision, a point regularly supported by participants

supervising and rotating in Lucock and Coyne’s studies’ (Lucock and Coyne 2006 b and c).

Jarvi and Uusitalo (2004) in their study of job rotation amongst nurses, where job rotation is a

requirement within the organisation, identified that whilst job rotation was considered

beneficial by one third of their participants’ motivation amongst rotatees was considered the

39

foundation of a successful job rotation experience. In my view an important element of

enduring motivation affected by the time for the support that rotatees receive, as well as the

time that they have to learn about the new job. Little is said in the literature about the costs

of job rotation, not least of which is the time required for learning [see ahead 2.6.6].

2.6.4 Structures and processesIn addition to managing staff motivation, Creager (2007) in his phenomenological study (a

method infrequently used in the literature) of the employees of a finance organisation,

suggested a number of key factors which could influence the leadership and management of a

job rotation scheme i.e.:

Structural factors – organisation arrangements and policies

Cultural factors – beliefs and ideologies

Agentive factors – individual characteristics and actions of employees and

participants.

Creager also identified a number of linking factors which go to explain matters related to

sustainability, obstructers and facilitators, and challenges to the rotatees.

Etherington and Jones (2003) describe key factors for job rotation to be used as a return to

work tool:

Figure 1 – Organisational Framework Job Rotation

The advantage of this model is that it clearly identifies a key structural requirement i.e. of

having fully involved and clearly specified stakeholder groups, in particular the workers’

representative group, as well as ‘softer issues’ such as building confidence. It also clearly

40

identified key processes i.e. planning, implementing and concluding as key to a conceptual

framework model for job rotation.

2.6.5 Stress and satisfaction – the employees’ point of viewHuang (1999) explicitly explored the employees’ perceptions of job rotation in industry in

Taiwan, and found that they were overwhelmingly supportive of job rotation. However more

educated employees were relatively more critical of the training available in the organisation,

an issue that could be related to the nature of the educational package and its relation to

improving their overall employability (Waterman, Waterman and Collard 1994). Chang and

Hancock (2003) identified two of the process issues that could hinder the taking up of new

roles in organisations i.e. role ambiguity and role stress. Interesting poorly organised or

insufficient job rotation schemes, could lead to sufficient dissatisfaction for staff to leave the

organisation. Takase, Yamashita and Oba (2008) considered nurses’ leaving intentions and

concluded that nurses’ ability to challenge current work practice, and a matching willingness

to consider change, led to reduced likelihood of leaving. Job rotation could facilitate

retention by developing a culture of change and a concomitant learning context for rotatees

which could include explicit reflection on service improvement.

2.6.6. Cost and benefits:Campion, Cheraskin and Stevens (1994) consider a number of potential costs associated with

job rotation, and recommended further research in this area. Little however appears to have

been undertaken. Cosgel and Miceli (1999), uniquely in my reading to-date, developed ideas

about economic models to consider the costs and benefits associated with job rotation.

Ortega (2001) in his study on job rotation as a mechanism for learning believed that job

rotation was more profitable for employers than job specialisation, where there was

significant uncertainty about employees and their activities. Eriksson and Ortega (2006), six

years later, following their review of the literature, still found few studies that conducted

detailed analysis of the costs and benefits of job rotation. Malinski (2002) in his review of

the literature identified a number of benefits for job rotation including reductions in work

stress, absenteeism, and increases in loyalty. He also addressed a number of the difficulties

or costs that would have to be managed for a scheme to work i.e. experienced staff not

wanting to learn or not wanting to change job, the fitting of staff skills level to available jobs

and to their skills and pay profiles; and putting untrained or inexperienced staff into

potentially hazardous situations. He concludes by implying that a whole systems approach is

likely to reduce barriers and be more cost effective. Taking a whole system approach,

41

Buchan and Ball (2003) as well as Lucock and Coyne (2003, 2006a, 2006b and 2006c)

sought to identify a wide range of factors that could be described as cost and benefit variables

e.g. stakeholder time, outcomes, possible losses such as non-completion of course. These

studies could be used to develop economic evaluations to further describe and explain the

economic benefits and losses associated with job rotation models.

Innovation in job rotation management per se is needed e.g. to facilitate the management of

job rotation and thus reduce some of the potential costs. Karadimas and Papastamatious

(2007) have developed a comprehensive software programme to support managers to manage

back to work job rotation. The programme might be adaptable to other uses of job rotation

and could make the general management and co-ordination of job rotation within and across

organisations easier.

2.6.7 Specialist employees vs. generalistsEriksson and Ortega (2006) suggest that job rotation is useful for developing generalists

rather than specialists, although it is worth noting that so called specialists themselves work

in diverse contexts and within their spheres of influence could well benefit from job rotation.

It is clear that job rotation is common in the training programmes of a number of professions

e.g. medicine, occupational therapy, library professionals; but tends to cease on or soon after

qualification. Lucock and Coyne (2003, 2006a) show that highly experienced, specialists and

long-standing professionals can be interested and can benefit from job rotation schemes, and

as such the use of job rotation for senior staff could be explored further.

2.6.8 Promoting learning in organisationsBennett (2003) considered that amongst a number of work-based approaches to

organisational learning (Boud, Solomon, Symes 2001; Buchan and Ball 2003, Lucock and

Coyne 2002 and 2006c), job rotation was one approach that was useful, yet one that did

require specific forms of support in order to be effective. Whilst job rotation is considered to

be intrinsically a learning exercise by some, and by others as requiring a formal work-based

learning educative component (Lucock and Coyne 2003 and 2006b and 2006c), what is rarely

addressed in the literature is the precise nature of the educative components, and in particular

the most effective educative approaches. Regardless of the lack of specification about what

job rotation actually is, many health staff consider it important to the ‘learning environment’

of work (Rogers and Bakas 2007). Occupational therapists have created post-qualification

job rotation schemes to enable them to develop competencies, especially management

competencies (Craik 1986; Taylor, Andriuk, Langlois and Provost 1995), something which is

42

little attended to in literature on nurses’ work-based learning. Amongst hospital

physiotherapists job rotation can be used to build upon basic training where there is an

expectation that staff do not become fully experienced until some years after qualification

(Institute for Employment Research 2001).

2.6.9. ProductivityMiller, Dhaliwal and Magas (1973) suggest that job rotation can be used by managers to

increase the productivity of engineering organisations. Ishii and Ishii (1983) highlight that

types of rotation i.e. to different jobs or rotation to similar jobs, and non-rotation can have

different effects on employees’ capabilities and careers and in effect warn managers to select

job rotation to match the needs of the organisation, for either maintenance or for performance

capabilities, as an imbalance could affect organisational or team success. One of the potential

criticisms of job rotation is its interference with lean production i.e. highly orchestrated and

interdependent practices, which would be slowed down by the ‘induction’ process associated

with rotating new staff to posts. Allwood and Lee (2004) note that whilst job rotation can

help to support lean systems and whole system learning, in particular developing problem

solving skills to maintain production or service delivery, job rotation, because of its

‘interrupting nature’, can create local service delivery problems. This however has to be

compared to the interruptions in productivity that could occur when staff cannot be recruited,

where managers cease to develop their staff or where long serving staff lose motivation.

2.6.10 Absence or insufficient job rotation opportunitiesOne of the criticisms of job rotation in organisations is the lack of job rotation or insufficient

amount of job rotation (Burke and Moore 2000; Adomi 2006; Bennis and Thomas 2007).

Olorunsola (2000), also looking at job rotation amongst library staff in Nigeria, found that

whilst staff were positive, managers needed to develop a policy for job rotation which could

clarify the managerial structures and processes that need to be undertaken to establish and run

schemes. Whilst it can be seen that job rotation is offered to health personnel post

qualification to enhance their competence and expertise – radiographers and physiotherapists

(Institute of Employment Research 2001), finance staff (Binns 1984), hospital pharmacists

(Friedman 1984), occupational therapists (Craik 1986) and medical staff (Department of

Health 1996; Little 1994), job rotation for newly registered nurses is not routine. I wonder

how this situation could undermine the potential for nurses to contribute to the effectiveness

and efficiency of health care services and service users, by reducing their potential to learn

43

and transfer knowledge and skills across specialist areas, at any one time in their career, and

indeed as they continue through their career.

2.7 Job rotation for nursesJob rotation for clinical personnel is not new (McLean 1954, Young Sheperd 1955) and is

common in the training schemes for professional clinicians. However on-going training to

retain expert practitioners is considered by McCaffrey Boyle (1997), and recently supported

by Jordan and Brauner (2008), who highlight the potential loss of clinical knowledge that

could be of help to patients by the loss of seasoned clinical nurse specialists. These factors

warrant attention, as does the development of specialist job rotation programmes which could

be of value in local and more general situations (Young Sheperd 1955; Buchan and Ball

2003; Lucock and Coyne 2003, 2006a, 2006b, 2006c.)

That nurses have researched job rotation is evident from the literature review to-date (see

above), with studies from different countries, different branches of health care, and with

different schemes. Whilst a number of outcomes have been described, and a number of

important structures and processes identified, there is still an absence of clarity about the

different models of job rotation that were investigated. In most cases, there were few clear

descriptions of the views of nurses, their managers, supervisors and colleagues, and those

stakeholders who were involved with the various models and schemes. The following section

addresses additional nursing literature and its findings to further explore its use and

implications in health services and for nurses.

2.7.1 Job rotation as an inducement and/or rewardJob advertisements are also a source of information about job rotation in that they identify the

speciality areas that use job rotation e.g. Guy’s and St. Thomas’ NHS Foundation Trust

which advertised for a general medicine and elderly care/surgical rotation. They also give

information about the model or package that makes up the job rotation programme e.g. two

nine month placements as well as the nature of the educational package. This is supported by

Yoshikawa (1986) in Japan who suggested that nursing career development benefited from

work experience that included both education and job rotation. It can also be used as a reward

to prevent the ‘flight of nurses’ at times when nurse recruitment is difficult (Bakke 1998).

Robottom (1990) briefly describes three models of job rotation used to attract and to retain

nurses who were being trained in a local area, but who mostly left the area upon qualification.

That the schemes were considered successful was the individual view of the author, a nurse

44

on the rotation scheme, in a situation that had previously ‘repelled’ rather than ‘attracted’

existing staff.

2.7.2 The diverse use by nurses of job rotationPost qualification job rotation schemes are similar to the ‘internships’ described by other

authors to attract, retain and support nursing staff in a number of specialist areas:

neurosciences (Aldrich 1988)

pediatric rehabilitation (Diehl and Dorsey 1994)

critical care (Hartshorn 1992)

ambulatory care (Swan and Moye 2009)

anaesthetic care (Jordon and Brauner (2008),

and for a variety of other purposes:

cross-training in obstetrics (Komara and Stefaniak 1998)

job satisfaction in oncology (Miller 1990)

facilitate transition –(Dufault, Bartlett, Dagrosa and Joseph 1992)

retention (Miller 1989)

career development and career planning (Almonkari-Kuikka, Miettinen, Kirveskanyas

and Porkkala 2003)

stress reduction (Berliner and Ginzberg 2002).

Clearly ‘job rotation’ per se is not used in these articles, and thus would have been missed but

for a colleague mentioning to me that the idea the nursing intern programmes might be like

job rotation schemes. These articles address job mobility, educational programs, and benefits

to the organisation, employees and service users. Job rotation has also been suggested for

health care staff in other contexts i.e. prison services (Baguley, Gallon, Alexander and

McGonagle 2006) and substance misuse and mental health services (Jackson 2001, Coyne

2002).

2.7.3 Prospective action research studies on job rotationFew studies have been part of a local prospective research programme of research on job

rotation. An exception to this has been the on-going job rotation research led by the author

and undertaken in Central and North West London NHS Trust, and the West London Mental

45

Health and Broadmoor NHS Trust from 1999 to 2006 (Buchan and Ball 2003; Lucock and

Coyne 2003, 2006a, 2006b, 2006c). The schemes were established as part of an initiative to

recruit and retain nurses in ‘hard to staff’ areas, at a time when there was a national shortage

of mental health nurses, and where some adult acute and elderly care units had more than

50% long-term vacancies (Coyne and Beadsmoore 2001; Coyne, Walsh, Dixon, Hunt and

Kelly 2001; Jackson, 2001).

These studies have explored the characteristics of the job rotation schemes by in-depth

interviews of rotatees, supervisors, and managers, and have evaluated them for their

usefulness for rotatees, colleagues, the organizations and the service users and carers. The

studies also identified a number of surprising spin offs of the job rotation schemes e.g.

experienced nurse job rotation, work-based learning as a key factor, and the need for research

to reduce waste associated with poor policy, management, and research in human resources.

Additionally the research studies identified a substantial number of factors that should be

taken into account to improve the potential success of job rotation schemes e.g. consistent

leadership and the development of comprehensive job rotation scheme manuals (Buchan and

Ball 2003; Lucock and Coyne 2003, 2006a, 2006b, 2006c). These studies provide insight not

only into the local situation, but the effect of job rotation in an organisation over several years

e.g. ceasing job rotation when recruitment problems have been resolved; or the effects of

non-sustained leadership after the establishment phase. They also show the emergence of

knowledge over time e.g. outcomes such as enhancing the capabilities of experienced nurses

who are looking for career development, as well as the use of job rotation to increase links

within local services. This local knowledge may transfer to other situations, not least of

which is its potential usefulness in developing action research schemes. Action research

studies could also track the use of job rotation over time, with ongoing evaluation, and the

sharing of the findings as recommended by the Department of Health (2002) citing the work

of this action research study.

2.7.4 Inclusion in national policyAs with the policy recommendations for the use of job rotation in different countries as

mentioned above, reviews of nursing education in Australia (Clare, White, Edwards and van

Loon 2002, Commonwealth of Australia 2002) recommended that newly registered nurses

need to be supported in their transition to the ‘community of practice’ of nursing, by the

development of ‘transition programmes’. This recommendation goes some way to support

the notion of job rotation schemes for newly registered nurses, or as it is sometimes call

46

‘internship’. However somewhat confusingly they recommended that internships are not

necessary, mainly for pragmatic reasons that not all students could be offered the new

graduate job rotation schemes and that their potential cost could be a barrier.

In England the Department of Health (2002), based on the emergence of a number of job

rotation schemes to respond to the shortage of nursing staff, recommended that job rotation

for nurses should be taken up by local workforce and education consortia and that they

should be evaluated. They reference the work of this author and colleagues and my website:

www.nurserotation.com. The King’s Fund, a UK health policy development organisation, in

two of its recent reviews recommended job rotation for nurses as an example of good practice

for recruitment, retention and nurse development (Buchan, Finlayson and Gough (2002,

2003). Additionally the Directorate of Health and Social Care (2002) refers to the East

London paediatric nurse rotation scheme as a good practice example. This work, which was

developed by Evans (2001) and colleagues, is an example of research by nurses, in this

instance on job rotation that has been included in policy documents.

Recently job rotation has been recommended for the recruitment and retention of prison

personnel, including nurses, to address the capability challenges of levels b and e of the NHS

skills escalator (Elaine Sauve Associates 2005). Baguley, Gallon, Alexander and McGonagle

(2006) have recommended to the prison service that they introduce job rotation to promote

multi-disciplinary rotation within prisons and cite the research work of the author and

colleagues to support their argument. However recent documents on the development of

nursing careers (Department of Health 2006 and 2008) focus on developing flexibility in

careers e.g. using competency passports, but say very little about the necessary structures and

processes that would be needed to facilitate how transfers or job rotations would occur within

specialities or across specialities.

One of the interesting elements to emerge from this literature review is the number of studies

and policy initiatives, and their dynamic connectivity, that are part of the emerging

understandings and policy direction on job rotation.

2.7.5 Improving organizations and communitiesJob rotation can be used by nurses to facilitate organisational change in a corporate culture

e.g. to improve the occupational health status of a company (Jorgensen 1991), in effect

operating as a clinical management intervention. As a contribution to improvements in the

health status of underprivileged communities, the job rotation of graduate and masters student

47

nurses from the USA, for two week placements in a charity health care centre in Belize, was

noted in a small charity newsletter (Hicks 2005). Clearly these employees could have a rich

learning opportunity, and also have the opportunity to transfer learning and provide clinical

interventions which may not be available to the community otherwise. Inter-community

organisational effectiveness and efficiency may also be enhanced by job rotation. Teisen

(1980,) suggested that inter-service nurse job rotation between home care and hospital could

help nurses and colleagues to problem solve and find solutions to mutual problems associated

with the care of their mutual patients. Intra-team communication could also be improved by

job rotation as recommended by nurses working in a psychiatric clinic in Germany (Ohm

1997).

2.7.6 Getting into work and returning to workWhere nurses may be in short-supply due to retirement, job rotation as a recruitment tool

and/or as a ‘back to work’ tool could be used to substitute for nursing vacancies. It could

also be used to enhance the resources available to nurses when other staff groups are scarce,

by allowing non-nurses to contribute to the care environment by undertaking specific tasks

(Schmidlechner and Nikkola 2006). Ethically the implications for operational management

and quality maintenance do however need exploration, as substation in this situation is not

like-for-like.

2.7.7 Negative effects on service deliveryWhilst there are many benefits from nurse job rotation, negative effects may occur e.g. lack

of continuity of care where rapid job rotation exists (James 1986), poor employee experience

and reduced satisfaction in the absence of consistent and experienced leadership (Lucock and

Coyne 2006a,b and c); poorly coordinated placements and communications with education

providers (Buchan and Ball 2003). However these findings do not mean that there should be

no job rotation for nurses, but they point out the need for considered and well managed

models of job rotation. They also show the need for on-going evaluation to highlight the

benefits and costs that may arise, as well as methods to overcome barriers where appropriate,

and so inform its appropriate, effective and efficient use.

2.8 Critical reflections of reports and research on job rotation2.8.1 Difficulties accessing relevant literature

One of the key criticisms of the job rotation related literature is the difficulty accessing it due

to the large number of synonyms and the use of the term to describe very different practices.

48

In my view accessibility is also a power and emancipation issue, with some of the literature

beyond the HILO search criteria for health staff, resulting in a need to seek articles through or

beyond the British Library, and requiring payment via the internet e.g. Forrester.com articles

(Bright, Orlov and Sessions 2007). The results of these barriers could be to hinder

improvements in health care. My original intention at the commencement of the action

research study, namely to develop a website (www.nurserotation.com) that could help

interested people access relevant job rotation related evidence, appears to remain valid. In

some senses its potential value has increased as the number of sources of literature has

increased, and as such, a single site that points those interested in job rotation to the sources

could be time saving, informative, and could facilitate the transfer of knowledge into practice.

2.8.2 Reflections on the substantive and methodological nature and quality of the

literature

In assessing the quality of existing literature on and relevant to job rotation, the foregoing

reflections on the specifics of the literature’s substantive concerns can be usefully

complemented by some broader ‘overview’ observations and by a focus on the

methodologies adopted, even if this overlaps with previous observations in some respects.

It is noticeable that the studies that have been reviewed hardly engage with the

fundamentally important substantive issue that job rotation may not be implemented and

engaged with voluntarily in an organisation (for example, Jarvi and Uusitalo 2004). This

situation is likely to influence the outcomes of the use of job rotation rather than reflect the

potential value of job rotation per se. With respect to understanding the benefits and costs of

job rotation, few studies sought evaluations from the ‘whole system’. This is supported by

Eriksson and Ortega’s (2006) review of the existing research literature, with case studies

being common, and few authors seeking to use large data sets from different organisations or

to use prospective studies. One exception is the study by Richardson, Douglas, Shuttler and

Hagland (2003) where not only were job rotatees surveyed but their senior colleagues and

their supervisors were also studied. This research highlighted that these key stakeholders had

views about job rotation and its benefits and costs and had ideas about possible

improvements. It is important to describe, explain and predict the details of the structures and

processes associated with the use of job rotation (Bendall-Lyon and Powers 2004; Ho,

Chang, Shih and Liang 2009) rather than just the claimed outcomes. This could enable

managers to manage rotation schemes better and also ensure that participants and those

involved as stakeholders are satisfied with the overall approach to change.

49

It is also noticeable that few of the studies reviewed have recurring authors, indicating a lot of

single studies which do not seem to be part of planned research programmes targeted at

generating on-going and useful evidence about the best use and the effective and efficient

management of job rotation. It is also clear that simply looking at nursing literature, as

opposed to a broad search of related literatures, to find out about job rotation would have

yielded few research studies for this review.

Turning to methodology, the literature on job rotation consists of experience-based

commentaries, case studies, observational pieces, reviews and policy documents as well as

articles which report original research. Together these constitute circa 120 articles, about 50

per cent of which report original qualitative, quantitative or mixed methods research. These

studies examine the use of job rotation in diverse types of organisations such as business

settings (for example, Ericksson and Ortega 2006), the pharmaceutical industry (for example,

Campion, Cheraskin and Stevens 1994) and libraries (Adomi 2006). About 50 per cent of

these research studies have been conducted in health or health-related organisations (Diehl

and Dorsey 1994; Jarvi and Uusitalo 2004; Lucock and Coyne 20006c).

Most of the research studies are quantitative, employing survey methods usually in the form

of questionnaires (for example, Hsieh and Chao 2004; Ericksson and Ortega 2006; Earney

and Martins 2009). Few use standardised questionnaires, with authors preferring to craft their

own tools for their research; one exception that was found was a study by Hsieh and Chao

(2004) which used a questionnaire on job rotation developed by Van de Ven and Ferry in

1980. Most samples were convenience samples of populations that were accessible or

relevant to the field of study. Such diversity and lack of systematicity typifies the quantitative

literature on job rotation, which makes it inappropriate to derive general conclusions about

job rotation per se from these studies. Nonetheless, this has not stopped individual

researchers from making premature general statements from their individual studies (see

review headings above). Also, it is difficult to assess individual studies in relation to validity

and reliability due to the problem with operational definitions of key terms, the lack of well

developed tools and the poor cross-referencing of studies across the field at this time. Whilst

there may well be common features across countries, industries and professions, the

embryonic status of this literature does not allow for the sort of over-confident claims that are

sometimes advanced on the basis of quantitative studies.

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Qualitative studies on job rotation are rare: for example, see Creager (2007) in management

and Ohm (1997) and Lucock and Coyne (2003; 2006a; 2006b; 2006c) in nursing and health

care management. These studies have used interviews to identify the views of people who

have participated in job rotation schemes (Creager 2007) and those who supervised or

managed job rotation (Lucock and Coyne 2006c). In terms of methods of analysis, versions

of grounded theory were employed by Ohm (1997), Brunnetto (2002) and Creager (2007),

whereas Lucock and Coyne’s research drew upon hermeneutic dialectic process. It could be

argued that there is less methodological diversity across the qualitative studies (although the

parameters of the ‘grounded theory’ category are quite broad) but there are too few of them to

permit the findings to be transferred with confidence beyond their contexts of origin. They

also vary in terms of how readily they satisfy criteria suggested for the evaluation of

qualitative research (see Elliott et al. 1999; Yardley 2000), with Brunnetto’s (2002) work

particularly falling short in terms of clarity of presentation and coherence. For example, she

offers no clear definition of job rotation; she claims that job rotation both reduces and

increases flexibility and that nurses have fewer and more choices; and she makes a poorly-

supported case for comparing one group of workers with another.

Some mixed method studies have been undertaken (that is, where qualitative and quantitative

methods of data generation and analysis have been used within the same study). These

include research in nursing by Aldrich (1988), Dufault et al. (1992), Komara and Stefaniak

(1998) and Buchan and Ball (2003); in the pharmaceutical industry by Champion, Cheraskin

and Stevens (1994); in libraries by Pierce (2001); and amongst occupational therapists by

Taylor et al. (1995). Generally they used interviews, questionnaires and organisational

records as methods of data generation. These studies represent a potentially useful approach

to job rotation research because they accept that, as key terms in the field are not well defined

(and, as can be seen from section 2.4.1 above, there are multiple synonyms or apparent

synonyms for job rotation), it is necessary first to establish participants’ understandings

before trying to quantify these and establish relationships between relevant variables.

Moreover, the value of mixed methods research as a means of addressing diverse research

aims and speaking to diverse audiences of (potential) research consumers has been

recognised in various disciplines (for example, see Todd et al. 2004).

About 30 of the 120 articles on job rotation that were identified for this review fall within the

category of experience-based commentaries, case studies and observational pieces and

reviews. These are based on experiences of job rotation among diverse populations in health

51

and business sectors (for example, among IT staff). They also vary in the extent to which they

provide and adhere to a clear method (of necessity, more loosely defined here) and a

systematic reflective, evaluative process. Nonetheless, they could be said to have a

potentially wide ‘reach’ as they appear in influential journals such as the Harvard Business

Review (Capelli 2008), the Health Service Journal (Coyne and Beadsmoore 2001) and

Training (Weinstein 2009). Generally authors refer to other forms of evidence to support the

opinions presented in the articles but they primarily use their own experience gained in the

workplaces from where they have drawn their opinions on matters such as how best to

manage job rotation for specific outcomes. At this early stage in the development of the

evidence base for job rotation, these articles are important for their potential contribution to

the development of research questions and strategies (and, outside this context, for

managerial decision-making) concerning the use of job rotation.

Finally about 20 policy studies or policy papers have been identified which use various forms

of evidence to offer proposals for the future direction of job rotation, amongst other

workforce initiatives. These papers are diverse in their sources (for example, from the

Canadian Policy Research Networks, 2008 and policy development bodies like the King’s

Fund – Buchan, Finlayson and Gough 2002) and contexts of concern (for example,

universities – Baguley et al. 2006; government recommendations – Department of Health

2002). Sources of evidence are often both literature reviews and surveys undertaken by the

writers with the aim of informing governments or specific sectors (for example, prison

services). On account of their sources of origin, these papers carry much potential for

influencing policy and practice in promoting the use of job rotation or recommending against

it, for example, because of the possibility of costs outweighing the benefits (Commonwealth

of Australia 2002).

I do find the findings of some studies inflated e.g. Sullivan (2008) or contradictory e.g.

(Brunnetto 2002). Brunnetto makes various claims e.g. that job rotation both reduces and

increases flexibility, that nurses have fewer and more choices, and makes poorly supported

cases for comparing one group of workers with another, and little reference to any literature

about job rotation. It also has no clear definition of job rotation. So whilst Brunnetto’s

article is interesting and thought provoking, it has limited application to the use of job

rotation. It should be noted that this article was found as a result of general searching on the

Internet for job rotation, and did not come up early in the search. I have included it here

52

because it represents the tangential nature of the knowledge about job rotation, looking at the

management of change and job rotation.

My claim about tangential knowledge is also supported by the barely mentioned, but

fundamentally important issue that job rotation may not be voluntary in an organisation e.g.

Jarvi and Uusitalo (2004); a situation which is likely to influence the outcomes from the use

of the tool, rather than reflect the potential value of the tool itself. With respect to

understanding the benefits and costs of job rotation, few studies sought evaluations from the

‘whole system’. This is supported by Eriksson and Ortega’s (2006) review of the existing

research literature, with case studies being common, and few seeking to use large data sets

from different organisations, or prospective studies. One exception is the Richardson,

Douglas, Shuttler and Hagland (2003) study where not only were job rotatees surveyed, but

their senior colleagues and their supervisors were also studied. This study highlighted that

these key stakeholders did have views about job rotation, benefits and costs, and had ideas

about improvements. It is important to describe, explain and to predict the details of the

structures and processes associated with the use of job rotation (Bendall-Lyon and Powers

2004; Ho, Chang, Shih and Liang 2009), rather than just the claimed outcomes. This could

enable managers to better manage rotation schemes and also ensure that participants and

those involved as stakeholders are satisfied with the overall approach to change e.g. job

rotation.

It is noticeable that few of the studies available have commonly recurring authors, indicating

a lot of single studies, not part of planned research programmes targeted at generating on-

going and useful evidence about the best use, and the effective and efficient management of

job rotation. It is also clear that simply looking at nursing literature, as opposed to a broad

search of related literatures, to find out about job rotation would have yielded few research

studies.

2.8.3 Shortcomings and collateral effects of job rotationKepner and Tregoe (1960) identified a number of shortcomings in various educational

approaches to staff development including job rotation, in particular how to emphasise the

role of learning theory in schemes. One of the potentially negative findings of Campion,

Cheraskin and Steven (1994) was that the longer a worker has worked in an organisation, the

less likely they were to rotate. This is a factor that has been noted by Buchan (1999) when

describing the need to continue education for long-serving employees, who could become

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disinterested, and who perhaps might value a substantial career development opportunity,

rather than a less ambitious program. Lucock and Coyne (July 2006a) clearly identified that

some experienced and long-serving staff were actively seeking radical job changes, and

welcomed job rotation. A further potential unwanted outcome of job rotation was described

in the health field with the notion of ‘The Transfer Syndrome’, suggesting that mental health

patients in this instance suffered as a consequence of the regular turnover of medical trainees

(O’Rielly 1987). Burke and Moore (2002), identify not only the scarcity of job rotation

research and its lack of conceptual work, but also the effect on non-rotating employees. This

is also addressed by Ishii and Ishii (1983), not least in relation to the ethical issues of justice

and autonomy. The effects of job rotation on colleagues was extensively explored in earlier

studies of this action research project, with a variety of effects, mostly positive (Lucock and

Coyne 2006a, b,c).

2.8.4 Misrepresenting the evidence baseOne of the concerning factors about the diverse literature on job rotation is the emphatic

nature of the findings of studies within various reports and advertisements. A notable

example is the long list of suggested outcomes, particularly the strong suggestion that job

rotation can improve the ethical decision making of organisations (Offstein and Dugresne

2007). I wonder whether any enhancement of ethical decision making, may be related not so

much to job rotation but to a number of supporting structures and processes. From my

experience, job rotation can result in the rotation of staff who are under performing and

undermining, thus leading to the corruption of teams and organisations. There is little in the

literature about the potential damage that could result from poorly led and managed job

rotation schemes; or schemes subject to insecure funding and resourcing. It is also frustrating

that many of the studies on job rotation appear to have been done within companies, with

little formally published and thus unavailable to the broad professional or managerial

audiences that could be interested in their findings. Finally it is notable that few research

studies re-occur in the reference list of articles with the exception of Champion, Cheraskin

and Stevens (1994) and Cheraskin and Campion (1996), illustrating the scarcity of

knowledge, lack of cross citation, and either the difficulties of finding other research articles

or the lack rigour in searching.

2.8.5 Developing the evidence base Consequently the overall purpose of the research element of this action research study i.e.

attempting to identify the detail of job rotation for my local environment, continues to have

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relevance in the fields of management and nursing, by attempting to capture the general and

specific key factors associated with job rotation, and to provide a more comprehensive focus

for job rotation decisions, schemes and their evaluation. I have specifically not treated the

review of the literature in a chronological manner so as not to give the impression that there

is a cumulative learning process amongst commentators and researchers, as few documents

cite widely other studies and commentaries on job rotation. Clearly it is timely to review the

breadth and depth of the diverse literature related to job rotation.

2.8.6 A research paradigm for evidence generation and researchOne of the difficulties and strengths of the literature is its enormous diversity. Whilst many

views are offered, little coherence is present to support further systematic knowledge

generation. To overcome research prejudices about knowledge generation and hierarchies of

knowledge, critical realism (Bhaskar 2008) could be used as an encompassing paradigm

which would fit well with the diverse approaches to knowledge generation in this field. It

would also fit with the diverse modes used to disseminate findings e.g. opinion articles,

surveys, grounded theory reports, evaluation studies, controlled studies and action research

projects.

To summarise my concerns about the limitations of the literature, there are very few signs of

the understanding of job rotation moving forward, with a preponderance of descriptive

studies. There is a sense of ‘re-inventing the wheel’ with very little awareness of or reference

to past learning. Exceptionally the re-conceptualisation of change management approaches is

proposed by the notion of a talent-on-demand system (Capelli 2008). Additionally it appears

that there may be confusion amongst researchers, participants and commentators about what

they actually mean when the term ‘job rotation’ (or indeed any synonym) is used, leading one

to wonder whether participants are referring to task rotation, rotation to a similar job in a

different place, or to a different type of job all together (Jorgensen, Davis, Kotowksi, Aedla

and Dunning, 2005). Interestingly the little evidence that does exist about job rotation needs

to be ‘handled with care’ in the light of changing circumstances, as noted by Hsieh and Chao

(2004) in the study of job rotation in Taiwan. The outcomes for a job rotation scheme may

no longer be valid where circumstances change e.g. in high-technology companies, where job

rotation was used to reduce the potential for burn out, but where rapid change in technology

means that the context is now less repetitive and predictable. This point emphasises the need

to focus on change projects e.g. using job rotation for specific local claims, concerns and

issues (Guba and Lincoln 1989) of communities, be they health, business organisations or

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neighbourhoods. It is also notable that there is little comment in the literature about

managers choosing not to use job rotation, I was able to find only one example in a survey of

management training in pharmaceutical companies in Turkey (Hepkaya and Sar 2001), a

choice which is contrary to the suggestions Champion, Cheraskin, and Stevens (1994) in their

study of a pharmaceutical company.

2.8.7 Unanswered and ‘unthought-of’ questions A number of potential research questions have already been identified above. The literature

focuses on job rotation schemes which have formal status in the organisations, and does make

me wonder about the job rotation that is undertaken in organisations without formal policy

and management. In particular I wonder about their nature, the reasons for use, as well as the

ethics and fairness of offering highly influential job rotation which may not be available to

others. I also wonder about the education and learning that rotatees accrue on job rotation

schemes; the learning is poorly addressed in the literature, despite many claims being made

for it. It is also worth speculating about the connection between job rotation and service user

or customer satisfaction, especially since the overall purpose for an organisation of the use of

job rotation must be the benefits that customers gain. Clearly there are a large number of

unanswered questions about job rotation, and no doubt a large number of questions as yet to

be thought of.

2.9 Conclusions The literature used in this review includes circa 120 papers, with approximately 50% that

could be described as formal research studies. Among these, the most common research

approach is quantitative (principally questionnaire-based), with a few mixed method studies

and fewer qualitative studies. The attempts by diverse researchers in diverse countries and

fields of enquiry to create knowledge about the commonly used management tool of job

rotation are admirable. However there are a number of weaknesses in key areas which need

to be borne in mind in future research endeavours which could take the evidence base to a

new level.

There are a wide number of definitions of job rotation which include unique, complementary

and contradictory views of what job rotation is. Job rotation is included in national and

professional policy to some degree, albeit in highly limited ways, despite the wide use of job

rotation. There are many claims made about it, some descriptions of important structures and

processes, and some evaluations, involving opinion-based papers, surveys, case studies,

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phenomenological studies and hypothesis testing. However there are few studies that

comprehensively explore the overall conditions of the ‘job rotation’ tool used, few extensive

explorations of the key factors, useful outcomes, hindering factors, and recommendations for

improvement with the possible exception of Lucock and Coyne (2006c). There are few

extensive reviews of literature on job rotation and associated factors. There are no evaluations

by expert nurses working in policy development and commissioning or by expert managerial

or nursing professional leaders about the key factors involved in an overall model of job

rotation.

It should be noted from the literature that whilst job rotation is attractive to some staff and

some organisations, it does not necessarily accord with the desires of some individuals or the

cultures of some organisations and thus has to be matched appropriately to employees and to

organisational culture. Whilst the studies that do exist produce local knowledge of the

development of job rotation in one organisation or in one country, there are few studies that

are cited widely. Prospective long term studies on the nature, benefits and use of job rotation

are few in number, notably the series of studies undertaken by Central and North West

London Mental Health NHS Trust and West London and Broadmoor Mental Health NHS

Trust (Lucock and Coyne September 2006; www.nurserotation.com). There is a lack of

prospective studies on job rotation, with most studies being one-off retrospective studies.

This on-going action research study’, which is a prospective study, has allowed knowledge to

be reflected upon and used in action to test its usefulness (Bhaskar 2008). Thus it contributes

in a strategic way to the slow but continuous development of practice-based knowledge and

theory.

From the perspective of developing evidence related to the use of job rotation in health

services, the literature developed from the health field should be fully explored. The review

found that approximately 50% of all relevant pieces of literature came from the health field.

In particular it is important where the effective development of members of the nursing

profession is concerned to pay attention to those specific studies. However, having said that,

understanding the movement of personnel within and indeed across organisations via job

rotation will benefit from an awareness of a wide range of literature on job rotation including

from other fields of activity and professions. The literature is very limited at the moment and

I believe it needs to encompass broad understandings of organisations and systems in order to

inform local projects. An overly focused reading of the already limited job rotation literature,

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(for example, relating only to nursing or a specific branch of nursing) will provide a highly

limited, impoverished evidence base for job rotation endeavours.

2.10 Knowledge gaps in the job rotation theory and knowledge baseAs a nurse leader working in the mental health service in London, I am left to wonder what

local studies conclude about job rotation and the key structures, processes and outcomes, as

well as mode of evaluation and research, that are needed to run a successful job rotation

scheme. I am also interested to know what leaders in commissioning and policy, as well as

local professional leaders and managers, consider to be the key factors which could help them

to use job rotation successfully in their boroughs and organisations. I suspect that to have a

greater understanding of these issues could be of equal interest to those leading and managing

in other health and social services, and indeed other industries and professions.

2.11 Research questionThus from the gaps identified in the literature a research question emerged for me, the

responses to which would be of great interest to myself and my colleagues:

What are the key features that would contribute to a successful model of job rotation?

The following chapter will address further the issues of the emergence of the research

questions and the methodology to used to provide responses to the research questions.

2.14 Lessons learnt from writing this chapter:I have become aware of the limitations of the brief literature review that was undertaken at

the start of the action research project ten years ago. To some degree this was due to our

focus on nurse rotation as the search term, and our ignorance about synonyms. What has also

become clear to me was the need for a regular search and up-date of the literature review.

This would have been informative, especially as I would have developed a much greater

awareness of the diversity of the synonyms and could have taken advantage of the ever

developing internet library and search services.

Although I have not found a conceptual analysis of the term ‘job rotation’, this review has

confirmed my suspicion that such a study is needed and could help to draw together a very

diverse literature on the matter and related issues. It could spearhead a new phase of

knowledge generation in this area. Most definitely it could help managers and professional

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leaders who are thinking about job rotation and who have difficulty finding sufficient

research evidence.

I have learnt about the usefulness of the diverse literature on job rotation i.e. newspaper

commentaries on the use of job rotation in public services in Vietnam, and employees’

surveys of satisfaction (Vietnam News 2004). I am also more aware of the potential for

confusion in the literature unless readers are aware that job rotation and allied terms may not

be synonyms. There are clearly a number of pitfalls which have emerged from this review

which hopefully researchers and stakeholders will find useful.

I have also learned more about the formal job rotation schemes described and explained in

the literature but am left aware of the many forms of ‘informal job rotation’ which exist and

yet which are absent from the literature. This raises many questions for me not least of which

concerns the equality of opportunity that may or may not be associated with this highly

influential tool’s availability to marginal groups.

What has also proved enlightening is the reliance in the literature upon one or two studies on

job rotation, which are cited regularly, when other studies are rarely mentioned. This

revelation goes hand in hand with how seldom authors’ names are represented in the

literature, highlighting that job rotation evidence is being developed by individuals rather

than actual teams of researchers. It also suggests the absence of ongoing support and funding

for a stream of job rotation research, particularly describing its use and lessons for its use in

practice and organisational change. This situation reminds me of the ‘good fortune’ that I

have had to have been able to secure on-going funding from research organisations for my

series of research studies in practice situations.

The breadth of research does make the whole area of job rotation more exciting for me and

does reinforce my interest in continuing to explore its nature and use, particularly in health

and social care settings, but also as a general organisational change tool. Interestingly the

review has raised a large number of areas for further study.

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Chapter Three: Methodology

3.1 One of a series of studies as part of an action research project on job rotation

This study is one of a number of studies in a series on job rotation that I have led

(www.nurserotation.com). This particular study’s aim is to formatively evaluate the previous

studies, the merit of the key factors identified and their worth within the context that they

were identified (Guba and Lincoln 1981). The design for this study emerged as the study

progressed, with the details of the story addressed later in this chapter [see figure 3 ahead].

The study exists in the context of an action research study, most meaningfully defined for me

by Carr and Kemmis, particularly their notion of participants in communities learning

through reflection and their clear statement of justice as an ethical aspiration:

Action research is a form of self reflective enquiry undertaken by participants in social situations in order to improve the rationality and justice of their own practices, their understandings of those practices and the situations in which those practices are carried out.(Carr and Kemmis 1986)

There are many models to describe the action research process (Susman and Evered 1978;

Winter and Munn-Giddings 2001, Lucock and Coyne 2003; McNiff and Whitehead 2006;

Reason and Bradbury 2008). This study was carried out in the context of an action research

programme but is not itself action research, due to word restrictions please refer to Lucock

and Coyne 2003 for a comprehensive review of action research. Its use by nurses has

increased primarily to develop ‘useful knowledge’ for the change and improvement of patient

outcomes through evidence-based development in clinical practice, clinical education and

management (Manley 1997, Clark 2000; Bellman 2003). Based on my understanding of the

models and my own experience, I believe that it is necessary to emphasise some key elements

[see figure 2] i.e. systems thinking, learning communities, emancipation, partnership, action,

learning through research, producing knowledge, and the opportunistic elements e.g. having

‘good ideas’, and finding previously unidentified resources .

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At any point, but probably mostly by reflection amongst community members, the

opportunity for ‘spin-off’ projects exists (McNiff and Whitehead 2006). Thus new cycles of

development, evaluation and learning can occur at any point. The notion of action research

Figure 2 - My model of action research

as a cycle does have validity. However it is an insufficient metaphor. A more meaningful

metaphor would be a spiral – demonstrating an on-going process of reflection and action,

leading to an overall increase in capability amongst the participants together with

accomplishment (McNiff and Whitehead 2006). The spiral model also emphasises the notion

that communities can both improve, and also fail, or disintegrate i.e. ‘spiral downhill’ when

they are not learning together and sustaining improvements e.g. repeated National Health

Service failures (Department of Health Expert Group 2000).

This section is divided in to several parts:

1. The emergence of the research question

2. My own ontology and views on epistemology

3. The approach and methods used in the action research study as a whole

4. The design and methods used this study

5. The intent and nature of the research report

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6. The criteria to judge the value of the research report

3.2 The emergence of the research questionFollowing the successful exploration and evaluation of a number of rotation schemes in west

London (Coyne, Walsh, Dixon, Hunt and Kelly 2001; Buchan and Ball 2003; Lucock and

Coyne 2003; Lucock and Coyne 2006a, 2006b, and 2006c), the question that emerged for me,

as a professional leader of nurses was:

‘what does all this data (research reports, diaries, literature) add up to?’.

On reflection (Kember, Wong and Yeung 2001) it seemed to me that we, as an action

research community, had collected the views of many stakeholders about job rotation i.e. the

embryonic models that we had developed for the funding applications, and their

implementation (Appendix 5). I was happy with the evaluations which had provided the job

rotation participants, their managers and peers, the commissioners and the University staff, as

well as senior managers in the organisation i.e. policy makers, with knowledge about:

what the schemes involved

what was useful about the job rotation schemes

what was not useful about the job rotation schemes

what could have been improved now or in the future

new knowledge i.e. conclusions and recommendations from the

researchers.

I was also happy about the fact that I had been able to secure resources – mainly from friends

and colleagues, to develop a website that would disseminate the original concepts and

bidding papers, as well as the research results and reports, to help them in their considerations

about using job rotation and indeed using action research. In particular I believed from the

ethical perspective of my own integrity, that it was ethically necessary that those who

participated could easily access these research reports, to inform their own understandings of

the projects they had been involved with.

I was particularly pleased by the approach that we had taken as a group i.e. emancipatory

action research (Grundy 1982; Holter and Schwartz-Barcott 1993; Lucock and Coyne 2003),

and the fact that we had been able to undertake a number of prospective and in-depth studies.

These studies had provided detailed accounts of the experiences and understandings of those

directly and intimately involved with the use of job rotation as a recruitment and retention

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tool for ‘hard to staff’ health services. The approach also modelled an organisational change

tool (Iles and Sutherland 2001) i.e. job rotation, and a highly inclusive ‘way’ to undertake

professional research i.e. emancipatory action research – which they themselves might

choose to use or recommend later in their careers.

The action research approach had already proved useful in providing other organisations that

were considering the use of job rotation, with information about our progress as we

developed rather than reports written some time after their completion (and possibly of no

current relevance to the political and managerial climate). The accounts of job rotation [see

section 3], rare in themselves, had been analysed in a number of ways to provide good quality

and accessible research findings. This is reinforced by citations of the work in policy

documents (Department of Health 2002; Buchan, Finlayson and Gough 2002 & 2003;

Baguley, Gallon, Alexander and McGonagle 2006).

Maintaining the professional vision

Thus, despite the fact that I now had a very different job i.e. Nurse Consultant for Substance

Misuse and Mental Health (dual diagnosis), I believed passionately that it was important not

to ‘waste scarce resources’ and thus wanted to maximise the learning from the action research

project within the organisation and profession, by acting as an exemplar of good practice

(Benner 1984). I wanted to continue to learn from the studies that we had completed and

how the findings could be transferred into my new work context of leading on the

development of dual diagnosis services (Coyne, Ward and Doran 2003). Whilst the previous

studies were designed to evaluate a local solution(s) to a local problem, it seemed to me that

it would be a ‘waste’ of learning if I and indeed the others involved did not find a way to

summarise the learning that we had gained from the studies. We needed to do this in such a

way that the learning could transfer, probably with modification, to others considering the use

of job rotation to address similar problems of staff recruitment, retention and development.

The Declaration of Alma-Ata (1978) ethically identified that there were scarce resources in

the field of health and that every opportunity should be taken to reduce waste and maximise

effectiveness and efficiency. This ambition is one that has motivated much of my leadership

of this research work. In this project, I believe that it is ethically necessary to promote as

much gain from the endeavour as possible by developing stakeholder networks, using

emancipatory approaches, disseminating useful findings, and aiming for the inclusion of

findings in policy documents. Clearly the negative issues that may be related to job rotation

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are as useful to know as are any benefits, and are perhaps more important for policy

development and the prevention of waste.

3.2.1 The research questionThus the professional question that emerged or ‘re-emerged’ for me was:

What are the key features that would contribute to a successful model of job rotation?

This question seemed to me to be a ‘useful’ question for us locally, the nursing profession,

and health service organisations and for service users who might benefit. I was particularly

interested in the notion of a ‘successful model’, with the emphasis on identifying those

structures, processes or outcomes that could contribute to ‘excellence’. I was also aware that

the research reports that we had already produced and allied stakeholders in our ‘community

of practice’ (Wenger 1998; Wenger, McDermott, and Snyder 2002), as well as my desire to

continue the work, all added up to a ‘unique situation’ and one that could be harnessed to

contribute to knowledge development.

In order to answer this question I needed to present my ‘vision’ for the project and negotiate

with my new line managers and the organisation as whole, to get their agreement for

colleagues and I to explore this question. We were successful in this negotiation. This

success, in my view, highlights both the active and latent desire by individuals and the culture

of the organisation to promote and support learning, and the organisation as a ‘learning

organisation’ (Senge 1990). I also believe that the inclusive participatory and emancipatory

action research process had provided sufficient evidence of the usefulness of the process and

the ‘products’ to convince very busy senior managers to agree. I also believe that the process

had enabled the building of relationships with colleagues in the organisation and other

stakeholders to ‘trust’ me and my professional leadership and to support me further with the

project (O’Connor 1998).

This report tells my story of how colleagues and I undertook a ‘formative evaluation’ (Guba

and Lincoln 1989) of our previous learning (in the form of research studies/texts, literature

and diaries) to negotiate and form an evidence-based model of job rotation. The model will

provide a persuasive argument for a number of the key factors that could comprise a

successful model of job rotation. Knowledge of the enablers and the barriers, successful

strategies and ‘ideas’ could teach colleagues and I more about our own endeavours and

capabilities, and could be of use to others within the local organisation and the profession as a

whole.

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3.3 My philosophical approach to this research projects: ontology, epistemology and ethics

3.3.1 OntologyMy own views of knowledge and the world have influenced the approach to the ‘change

management’ associated with the overall job rotation project, and in particular the choice of

action research as both a change management tool (Iles and Sutherland 2001) and a model of

evaluation (Guba and Lincoln 1989; McNiff and Whitehead 2006; Winter and Munn-

Giddings 2001). My overall view of ‘being’ i.e. ontology5, is that I do believe that there are

absolute truths ‘out there’ in the world, but that as human beings we are in a process of

discovery and revealing, with very little chance of ‘knowing it all’. It is also my belief that

knowing is possible, with concepts and meanings being constructed at anyone time, which

best explain to individuals and groups the evidence at that time e.g. antibiotic theories and

gravity. As with the move from the flat earth theory to the round earth theory, knowledge

moves on sequentially in an evolving way or in dramatic and revolutionary ways (Kuhn

1996). Whilst local knowledge and understandings may be valid, it does however follow that

some may be more useful understandings than others, and indeed that some proposed

understandings may be judged unsubstantiated or wrong (Bhaskar 2008) e.g. ‘women deserve

to be paid less than men’ or racist apartheid social theories.

3.3.2 EpistemologyIn line with these general beliefs my epistemological 6 stance is that the methodology and

methods used depend on what is being researched e.g. looking at microbes under a

microscope, observing and talking to people. Where people are concerned, as in this study,

asking questions to find what can be ‘found out’ is an important means of ‘finding out’ new

knowledge about human beings. I believe it is important to ask individuals and groups what

their experiences are, how they interpret them, but also to accept that my explorations of

other peoples’ experiences are highly influenced by my own experiences, values and

understandings. My interpretations and understandings need to be reflected upon critically to

wonder about the different influences that affect them e.g. social structures such as faith,

sexual orientation, gender, ethnicity, profession and class (Lather 1991). Thus I am

5 Ontology can be defined as a theory of being, which influences how people perceive themselves in relation to others and the rest of their environments ( McNiff and Whitehead 2006 p.258)

6 Epistemology can be defined as a theory of knowledge (what is known), incorporating a theory of knowledge acquisition (how it comes to be known) (McNiff and Whitehead 2006 p. 257)

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interested in working with other human beings to try and understand our own individual and

shared experiences, and to better influence our lives and societies.

From a professional viewpoint, how we work towards equity in health care and health

improvement in the most knowledgeable, effective and efficient ways is of major importance,

and requires a humble and pragmatic approach to knowledge construction in general.

3.3.3 Ethics7

A key professional and personal issue is the ethics of knowledge generation – ‘knowledge is

power’, is in my experience a ‘truth’. I do believe that knowledge and increasing knowledge

and understanding are important to promote health and freedom in society e.g. accurate

knowledge about the transmission of HIV. The absence of knowledge either because of lack

of knowledge e.g. how to create a vaccine against the HIV virus, or through power relations

e.g. keeping key knowledge from certain groups – women, faith communities and

economically disadvantaged groups, undermines the potential for a healthy and free society.

Thus from a professional point of view I am keen to know as much as possible about how to

promote health and how to enfranchise as many key stakeholders as possible in local

communities. Enfranchisement or partnership can promote basic nursing ethical views

through the collaborative construction of locally defined and useful knowledge and can also

offer guidance on how to critically use knowledge effectively and efficiently, to promote the

best conditions for key ethical aspirations i.e. beneficence, truthfulness, non-malificience,

autonomy, justice and integrity (Yeo and Moorhouse 1996).

In line with work-based learning (Boud, Solomon and Symes 2001) and the nature of this

study, I believe that it is ethically useful to promote a harmonisation and congruence between

education, my work and myself. I am very aware of the enormous amount of education and

learning that is not used in the work setting and of organisational endeavours that are not well

informed. I am equally aware of my own frustration when I see colleagues unable to use

their learning, a situation that profoundly irritates me when I am unable to influence the

improvement of services because of ‘splits’ between education and educational institutions,

work endeavour, and individual employees.

7 Ethics can be defined as ‘a matter of principled sensitivity to the rights of others’ (Cavan, S. 1977 the American Journal of Sociology, 83, 810 cited by Cohen and Manion 1994)

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3.3.4 Overall approach to research: Critical realismThus in my reading and discussion with colleagues and friends, I find that I am in great

agreement with what is called Critical Realism (Bhaskar 2008, Collier 1998, Wilson and

McCormack 2006, Winter and Munn-Giddings 2001). Critical realism is an attempt to

integrate traditional human sciences often known as positivism, a highly useful product of the

enlightenment approach to knowledge (i.e. move from explanation and justification through

‘reason’ to a search for absolute facts/truth), with what has become known as postmodernism

(Gergin 2001) with local or situational views of knowledge with perspectives such as

phenomenology, constructivism and constructionism .

Essentially the approach proposes that both forms of knowledge are valid, in that they

explain different things – nature and social experience, which in themselves are different – if

for no other reason than the ‘fact’ that individual human beings hold and construct very

different meanings of their experiences (unlike plants or base metals), and that those

meanings influence how they are, behave and are experienced (observed, measured,

understood etc) by others. Positivist views are valid as a special form of knowledge –

developed within closed systems and ‘standardised’ or unreal ‘controlled’ conditions.

Additionally other features of this approach include a set of values about human existence –

notably Marxist, ideas of social structures which could undermine the potential of human

beings i.e. class systems, and which perpetuate ‘master-slave’ relationships, which may

appear to benefit some social groups but which distinctly marginalize and exploit others and

ultimately undermine the conditions and experience of all people. Thus critical realism

includes the idea that knowledge creation is ultimately about emancipation – an ethic of

autonomy or freedom, which is based on notions of equality and fairness and a key to nursing

professional practice and congruent with my own personal values.

From my readings, these views are not new but have existed in one form or another before

but, in this synthesis, they form a very useful and comprehensive paradigm of knowledge,

which I consider to encompass much of what I believe. Criticisms of this view of the world

are many, not least the difficulties produced by the prose style of one of the leaders of the

paradigm - Bhaskar (2008). Other criticisms include notions that the author has a

transcendent view of knowledge, and a belief in a ‘god’. Recent work by Bhaskar (2008)

focuses on a synthesis of eastern and western mystical beliefs, which may for some be

considered little more than crazy notions but which for me do not undermine the value of the

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paradigm nor its potential to facilitate better collective understandings of similarities and

differences in society at large.

3.3.4.1 Developing knowledge – concepts, theories, models, ideasThere are many types of theory aiming to describe, explain or predict (Chinn and Jacobs

1987; Walker and Avant 1988) and which may be developed at different levels e.g. situation

naming, situation relating etc. (Dickoff and James 1968; Dickoff, James and Wiedenbach

1968) For the purpose of this study I am interested in developing local or professional theory

about job rotation (Bellman 2003; McNiff and Whitehead 2006), in particular, ‘successful’

job rotation. I see myself as a ‘practitioner theorist’, working and taking action, in highly

complex and continuously changing systems, attempting to provide a ‘living theory’ (McNiff

and Whitehead 2005). I see myself as continuously learning and sharing my (our)

understandings of job rotation, in this instance, within and beyond my profession. The theory

to be produced from this study i.e. model, with specific factors and specific relationships, will

be a way of trying to share my (our) interpretations and understandings, which will be open

to interpretation themselves, and to modification and/or rejection.

Ultimately I expect it to contribute to the improvement of the effectiveness and efficiency of

health care via improved recruitment, retention and better development of nurses through job

rotation as well as supporting the development of learning organisations, innovation and

change, including the use of emancipatory action research.

Generalising findings from research studies has its limits (Guba and Lincoln 1989) in that

conditions, issues, claims and concerns alter from time to time and across social contexts and

social groups. However it is an ethical issue to share or transfer useful knowledge i.e.

beneficence, in a considered and critical way. The findings and understandings about

research ‘products’ and ‘processes’ that may be of use to others, in this instance a model of

job rotation, can be used to facilitate emancipation and improvements in health care (Shapiro

2007). As such, as has been the case with other studies in this action research project, I will

disseminate widely the findings for critical review and for use by colleagues.

3.3.5 Summary of key factors that I bring to this study as pre-judgementsIn summary I present in the above my own ‘pre-judgements’ about ‘being’, knowledge

development and values and ethics, as well as my own views about action research as a

useful approach and tool for organisational learning, innovation and improvement, in this

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instance when key stakeholders such as nurses and service users are involved in or lead such

initiatives. As health services have funding and resource limits, I do believe that research in

general, and this study in particular, needs to maximise its impact, to facilitate learning, and

that colleagues and I should act an ‘exemplars’ (Benner 1984) of good practice to encourage

other nurses and colleagues to pursue health and social change as well as the evaluation and

dissemination of knowledge.

3.4 The approach and methods used in the overall action research study on job rotation

3.4.1 Context of uncertainty, ambiguity and opportunityThe overall context of the change project on job rotation and on the evaluation by the use of

action research occurred within a highly volatile and changeable context, with regular policy

documents produced by the government, where demands on services were changing. Thus a

tool for change and evaluation needed to be selected that would accommodate change in

general, support change, and realistically evaluate that change. There was no sense of

‘standard conditions’ as those required for positivist controlled studies within a closed

system, and thus for the most part the methods I selected attempted to learn from the almost

‘chaotic’ context, or the ‘edge of chaos’, as Stacey (2001) would describe the situation, a

situation not wholly dissimilar to Lewin’s (one of the originators of action research) model of

change i.e. the unfreezing stage (Lewin 1947) – with very little ‘freezing’ or ‘crystallising’

into a steady state.

The organisations that I work with, NHS health trusts, can be viewed as successful social

structures i.e. particular complex systems operating as organisations within local and national

(indeed international) communities. It should be said however, that the notion of

‘organisation’ is itself highly complex and dynamic and one that is understood both

consciously and unconsciously in different ways by different stakeholders, a key point for me

to bear in mind in my negotiations (Armstrong 2005). The development and transfer of

knowledge within and around these systems represents processes that face many limitations

(Frazer 2007), including cultural tendencies in Western organisations towards individualism

and ‘great man’ leadership approaches, as opposed to group approaches and collaboration

which have perhaps a greater tendency within Eastern organisations (Morton 1998). The

pursuance of individual intentions has the tendency of promoting fragmentation and lack of

synthesis and could undermine the impact of what may aim to be a ‘joined up’ endeavour.

Whilst collaborative work can deny the role of the individual, successful leadership in

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organisations takes the contributions of individuals (strengths) and enfranchises those into a

collective approach i.e. a community of practice (Wenger 1998), that is more holistic, and

potentially one with greater overall learning and impact. In addition to the fluidity and

change in systems, as well as individualist and collective forces, conscious and unconscious

(in awareness or out of awareness) factors also influence leadership, professional decision

making, partnership working, and indeed identification of the ‘primary task’ and methods for

achieving it (Obholzer and Roberts 1994).

So in what might be considered by a pessimist as an impossible situation, health care is

needed and needs to be delivered – metaphorically in a ‘war zone’ featuring issues of life and

death, threat and promise, fight and flight, competence and ignorance, ultimately with the

intention of winning worthwhile outcomes. Many nursing care outcomes are described in

the theory building of nursing theorists (Marriner 1986) and include such aspirations as a

peaceful death, maturation of personality, recovery from illness or adaptation to limitations,

self care and meeting an individual’s potential.

It is within this context that my colleagues and I work seeking to make improvements to our

practice; in this instance job rotation to improve recruitment, retention and development of

nurses. From an optimist’s point of view, my perspective for the most part, there are many

opportunities to make changes and improvements, enhanced by a good understanding of

professional practice and its evidence, networking and leadership capabilities. This report is

the ‘story’ of that endeavour.

3.4.2 Useful research and learningOne of the most important issues in the overall approach to learning via a research process

was the intention of colleagues and myself to undertake a process of organisational change

that would be ‘useful’. I had experience of working in research and management teams

where change and evaluation was both useful and useless. I wanted to learn from past

failures and promote a project that was successful but one which maximised the learning for

all concerned. Ethically I did not want another team of NHS staff to have to go into a

planning programme for ‘nurse rotation’ or ‘job rotation’, as we had done with very little

literature or policy guidance, a situation that was no doubt common amongst many teams in

the UK trying to use job rotation at the time. The notions of social and intellectual capital

(Nahapiet and Ghoshal 1998) were new to me at the time but as I understood those ideas,

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they seemed to fit well with my intentions for change and evaluation by maximising the

learning potential and capabilities of nursing and other personnel.

3.4.3 Emancipatory action researchIn a previous study (Lucock and Coyne 2003) colleagues and I reviewed in-depth the action

research approach selected for this action research study. Essentially we have chosen an

emancipatory action research approach (Lewin 1946; McCutcheon and Jung 1990; Grundy

1982; Holter and Schwartz-Barcott 1993), with the intention of promoting equality of

learning and participation. In this study this overall approach is continued in the choice of

the evaluation approach – 4th generation evaluation, or ‘responsive evaluation’ (Guba and

Lincoln 1989). I have selected a method of data collection which is consistent with this

approach i.e. nominal group technique, to reveal the interpretations of expert panel members

(Delbecq, Van de Ven, Gustafson 1986). Finally the data analysis method of dialectic

hermeneutic process has been used to develop interpretations and understanding (Gadamer

1975; Guba and Lincoln 1989; Thompson 1990) and Template Analysis to construct a model

of job rotation (King 1998, 2008) [see forward Chapter 4].

Common to all of the different levels of approach are issues of collaborative working,

systems, emancipation, respect for individuals and their understandings, pursuance of useful

and transferable knowledge, as well as a frank presentation from a critical perspective of my

own influence as well as the possible influences of social structures upon the processes of

research and interpretation.

It is also important from me not to pretend that I can be objective and remove my own pre-

judgements. And as with many of the other studies, an element of interpretation by a using a

hermeneutic process will be a key part of the approach. I tried to combine my understandings

with those of the other participants and indeed the texts that emerge from the research process

and attempted a process of ‘fusing of horizons’ (Gadamer 1975). Overall my interpretations

emerged, which form part of the development of the model of job rotation that I propose [see

Section 4.6].

Additionally I have sought, and will seek the reflections of colleagues, critical friends, and

supervisors about the process and content of the work with the aim of improving my learning

and research capabilities as a practitioner, and also to maximise the overall ‘usefulness’ of the

study and the report for colleagues and service users.

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3.5 The design and methods used this study3.5.1 4th generation evaluation – ‘responsive evaluation’This study is a formative evaluation (Guba and Lincoln 1989), a secondary analysis of

primary data, and is focussed on evaluating the merit and worth of the findings of a number

of research studies undertaken in two local organisations. It includes interpreting those

findings, using a hermeneutic dialectic process, with a view to the development of a

‘successful’ model of job rotation i.e. one that includes a critique of those forces that could

enable or hinder job rotation as a useful human resources tool. It is a design that has emerged

as the study has unfolded from my own reflections on the study and in consultation with

colleagues and supervisors. This is a process not dissimilar to the paradigm shift and

emergence described by Merz in 2002. Since this process did not unfold in a simple linear

way a clear methodological narrative has developed only gradually as shown below.

Figure 3 - The methodological process

Critical realism

Emancipatory action research

4th generation evaluation

Nominal Group technique

Template analysis

Hermeneutic dialectic process

Model of job rotation.

Because the gradual development of this design it is only at this point that its elements can be

usefully explained.

I have chosen to use a fourth generation evaluation approach because it fits with the overall

emancipatory approach of the action research study, and because it seeks out the views of key

stakeholders i.e. claims, concerns and issues about the ‘evaluand’ i.e. job rotation (Guba and

Lincoln 1989). Simply it is a means of evaluation which includes both political and

participatory components of evaluation with a view to providing ‘useful’ knowledge. A full

explanation of 4th generation evaluation can be found in Lucock and Coyne (2003). The

dynamic process of negotiation between the key stakeholders and with the ‘texts’ of the

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studies, is a key element of this approach to evaluation. The approach encourages key

stakeholders to provide views and to negotiate amongst themselves and with the evaluators’

understandings and meanings. It also seeks to promote a ‘consensus’ of views where

possible as a pre-cursor to future social action. For the purposes of this study I modified the

approach, in particular the data collection and the data analysis aspects by selecting a specific

form of data collection i.e. nominal group technique (Delbecq, Van de Ven and Gustafson

1986), which provides a simple, transparent, and collaborative learning approach.

3.5.2 Formative merit evaluationThis study is a formative merit and worth evaluation (Guba and Lincoln 1981) which used

panels of stakeholders to identify what they considered to be key factors associated with job

rotation. As reference points they used their own experience, literature that they may have

been familiar with, the five research reports that I led on job rotation, plus a process of

sharing and listening. The explicit objective of this interpretative process was the production

of a ‘successful model of job rotation’. It should be understood that this type of evaluation

will inform stakeholder groups about the project, its strengths and weaknesses and the

learning that has been attained. Following this evaluation, there will be a variety of possible

future actions for those considering the use of job rotation. Providing that they are confident

that job rotation will lead to the outcome that they desires, they can decide to use this model,

with or without modification, to inform their decision making and actions.

In accordance with the overall approach to knowledge generation in this study (that is,

Emancipatory action research), I reviewed a number of designs/methods that could be used to

generate evidence. These involved randomised controlled trials, questionnaires, individual

interviews, focus group interviews, the Delphi method and nominal group technique. Each

had its strengths and weaknesses. In line with the ontological assumptions that inform the

work and because the learning needed by key stakeholders is my paramount concern, I sought

methods of data generation and analysis that had (potentially) localised foci (rather than

foregrounding aspirations to generalisation) and that could readily build upon existing work

and generate new substantive themes from stakeholder data. Thus randomised controlled

trials and structured questionnaires were excluded. Previous studies indicated that interviews

carried much potential for exploration of stakeholder views and experiences, especially in the

form of focus groups where participants could stimulate and query each other in a process of

mutual inquiry (provided that the group dynamics were constructively harnessed by

facilitators). The Delphi method was considered not only useful for gathering viewpoints

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from stakeholders and also for involving them in an ongoing process of evidence generation

(something that could be considered as providing ‘added value’ in comparison to a focus

group approach). Despite this, practical considerations had to be borne in mind because the

method does take considerable time to implement if used properly (and practical

considerations represent valid criteria for methodological decision-making when conducting

research in real-life applied settings). Through these deliberations, the desired criteria for

choosing a method in this research became progressively clearer and ultimately informed the

decision to use the nominal group technique (Delbecq, Van de Ven and Gustafson 1986).

This offered a structured, group-based approach to data generation incorporating a rigorous

process of iteration and reflection; specifically it offered the opportunity of considering the

ongoing generation of key themes by the group through having the group reflect and

comment upon emergent themes, all within a short period of time. In addition, the process of

formative merit evaluation seen in the nominal group technique seemed to accord with the

fourth generation ideas of utility and political sensitivity. Finally, the fact that participants are

treated as equals in a process of discovery within the nominal group technique fitted well

with my overall aspiration for the action research project, that is, that it should be

emancipatory through supporting the discernment of key relevant issues and providing for

learning and empowerment for future action by the participant and indeed by the wider

community, including interested readers.

3.5.3 Nominal Group Technique

This latter objective of informing potential stakeholders’ decisions and actions, was a major

reason for selecting nominal group technique (Delbecq, Van de Ven, Gustafson 1986) as the

main method for data. Whilst Guba and Lincoln (1989) do describe the use of the

hermeneutic dialectic process as the means of encouraging dialogue and of stimulating the

emergence of meanings and consensus amongst stakeholders, I was very interested in finding

a method that the stakeholders and I could easily use, that was highly transparent, that would

encourage a clear learning process and facilitate the emergence of key views about the

important features of a successful model of job rotation. Delbecq and colleagues specify

clearly that this data collection and decision making method is ‘nominally’ a group technique,

in that, whilst it does involve a group of people, they are not encouraged to discuss amongst

themselves, or to debate, but do participate collectively in a process of iteration of individual

views; listening and rating or voting may be encouraged to draw collective conclusions.

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The advantages of the method are that the purpose of the group can be easily kept to the fore,

and not ‘waylaid’ by forceful individuals or ‘red herrings’. In addition the group members

are strongly encouraged to listen to or read the verbal contributions made by fellow group

members and to reflect on these. No contribution by an individual or representative of a

stakeholder group can be challenged, supported or negated by group discussion. Power in the

group is, hopefully, more evenly distributed, allowing the ‘quiet’ members, those less

assertive or those with ‘lower status’ to have a more equal contribution to the generation of

interpretations and to any voting or prioritising process.

The role of the group facilitator is highly important in this method. They need to be able to

set up a group; provide the members with a clear description and explanation of the ground

rules and then ensure that those assertive and perhaps powerful members of the group who

want to move the group into discussion, are unable to do so. It is also important to

summarise the process and the findings on a regular basis and ultimately to point to the

overall findings, be they voted for or not at the end of the proceedings.

3.5.4 Nominal Group technique processThis technique for working with groups to develop group learning and consensus decision

making was developed by Delbecq, Van de Ven, and Gustafson (1986). My decision to use

this method of data analysis and interpretation followed a brief cost/benefit analysis of other

forms of data collection that I had some familiarity with. The following section describes in

detail the actual process undertaken.

3.5.4.1 Preparing to access and contact key stakeholdersFollowing the selection of the method, I then commenced the process of seeking permissions

from within the organisations (see 3.5.4.3). I also developed a briefing paper for the

organisations and participants that explained the aims and objectives of the ‘expert panels’;

the process of the work and the issues of confidentiality.

3.5.4.2 Ethical permissionAs the work was a formative evaluation of the studies completed to-date, further ethical

committee approval was not required, as this study was part of the original proposal to

evaluate the job rotation scheme.

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The original studies were approved by an ethical committee and registered with the national

research register.

3.5.4.3 Purposive sample - Setting up the expert panelsThe expert panels were a purposive sample, including two major groups of stakeholders. The

first was a panel of senior clinical staff and clinical managers within one of the original two

organisations involved with the job rotation schemes. This group was set up in response to a

recommendation by a research colleague who suggested that they might have a different set

of interpretations from the other group (commissioner level) that I was intent on involving.

The second group of participants were service commissioners, senior university staff

(because they could provide work-based learning), and lead professionals. I had tried to get a

senior stakeholder group together in the local areas that the two health Trusts operated in but

could not get diaries organised to get everyone together. So via my professional and personal

network, I was able to secure a senior group of health service stakeholders, most of whom

were nurses, who would provide views which included reference to senior policy and funding

perspectives. For the latter group I invited Branch Secretaries of two unions, both senior

clinicians.

Additionally I also invited my colleague, Dr. Lucock, who was co-researcher on four of the

previous studies, to act on the day as an adviser to me about the process. From the first group

I learnt that I could benefit from a colleague to reflect with on both the structure and process

of the groups, helping me to get feedback about how clear I was being and whether I was

missing anything from the proceedings. Details about who was involved are in Appendix 4

For both groups I was helped by individuals locally, who in effect set the groups up for me

and without whom I would not have been able to get the panels together and thus would been

unable to complete the evaluation.

On reflection I was gratified and assured of the professional aspirations of colleagues, by

their general willingness to give time and attention to this evaluation, despite their very busy

jobs, and to participate readily in an ‘unknown’ process [see section 4.7].

3.5.4.4 Distributing data for analysis to participantsTo ensure that participants had access to the research reports (Buchan and Ball 2003; Lucock

and Coyne 2003, 2006a, 2006b, 2006c) of which I was seeking their views, I supplied the

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local organisers with electronic copies of each report. As the reports were long, though all

had extensive contents pages and clear sections, I thought that the sooner they had access to

the reports, the sooner they could begin to explore them, and begin to develop their

interpretations of job rotation from them. Closer to the date of the groups, following the

suggestion of one of the organisers, who believed that the reports were too long and possibly

daunting, I prepared summary documents, essentially containing the extensive tables of

contents, the conclusions and the recommendations. All of the participants received the

research papers at least one month before the commencement of the groups.

3.5.4.5 Time line for the data collectionThe overall project commenced in 1999 (Coyne, Walsh, Dixon, Hunt and Kelly 2001) the

five research reports were completed at the end of 2006. The project was a prospective study

and thus results and reports emerged from the project at different times.

This evaluation, as a new phase of research in the action research study, commenced at the

end of 2006, with the first group occurring in west London on the 23 rd of January 2007 and

the second in Northampton on the 5th of February 2007. These initial findings i.e. the table of

interpretations, were sent to the organisers in the middle of March 2007. By March 2008 the

findings were analysed and were ready to be presented in this research report.

A key feature of all of the studies has been the time required for the project, the prospective

nature of action research and the isolation of time resources to complete the final analysis (at

this stage in the project) of the data. One of the most important characteristics of the

professional leadership of this has been a long-term vision of the development of job rotation

as a useful human resources tool, which puts into perspective anxieties about producing

‘rapid results’. Additionally, as the context was constantly changing, policy and personnel

leaders within the various stakeholder groups have needed to take a ‘realistic’ view of

knowledge development and the on-going need for time management.

3.5.4.6 Collecting the dataTime

Each group (approximately 10 people in each) met in a pre-booked room, which was private

for the duration of the group [see figure 4]. The participants had been requested to be

available from 10:00am until 3pm, with a lunch break, to ensure that they had time to

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participate in the data gathering in a relaxed and thoughtful way and not have to ‘squeeze’ the

event into very busy diaries.

As with the whole study, one of my major aims was that participants would have time to

read, think and learn, and not find themselves being or feeling exploited for the data. All the

participants agreed in advance to the time requirements and structure of the day.

Preparing the room and materials

As the ‘researcher’ I arrived at the venue early to check that the rooms were available; to set

up seats in a circle; to set up flip charts and to put out ‘yellow sticky’ note pads and pens. I

also wanted to thank local organisers, as well as find the whereabouts of facilities, drinks and

lunch. I also wanted to brief them about the objectives and process of the day and the

expected outcome of the study.

Introductions and expectations

As people arrived, I welcomed them and introduced myself. When everyone had arrived, we

began with an opening circle to provide names and roles and to clarify the aim and objectives

and the tasks and timetable. I also sought and charted (for the group and I to reflect upon

during the day and at the end) the expectations of the individuals to ensure that I understood

their aims for the day, as well as any misunderstandings that might exist.

One of the key issues for them was that this was a ‘work day’ for experts, a day where a

different approach to meetings was going to be followed, and one which would lead to

decisions about what could be key factors in the development of a human resources tool. We

also covered the group rules – confidentiality, time keeping, informing the facilitator of

concerns, no debating or arguing.

Three ‘nominal group’ events occurred, two in the morning and one in the afternoon (six in

total for the two expert panels). One to one and a half hours was given to each group event.

For each group, participants were asked to focus on one of the five research studies and to

read the summary document for half an hour. I recommended but did not insist that they

followed the following order during the day:

Group 1: Lucock and Coyne 2006b - Cohort Four

Group 2: Lucock and Coyne 2006c - Supervisors

Group 3: Lucock and Coyne 2006a - Experienced Nurses Two

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One member of the second group looked at Buchan and Ball 2003.

Selection

During the reading and reflection time, they were requested to identify ten important factors,

in their opinion, that could contribute to ‘a successful model of job rotation’. Those key

factors could come directly from:

the research reports themselves,

their own interpretations of the reports and their contents,

their own previous experiences and reading

or simply an idea that came to them, that they considered important.

Prioritisation and allocation to a system template

After the reading and interpreting period, they were then asked to prioritise the ten items they

had chosen and to present to the group their top two (or later 5 – see below) most important

factors. They were also asked to consider which part of a system (as a template of a model)

those ten items most clearly fitted into. Because I selected the themes a priori, the expert

panel members were asked to decide whether the factors were:

Structures

Processes

Outcomes.

These factors were written down, one on a piece of yellow ‘sticky’ pad paper and their

allocation to one of the three components of a system clearly marked (see Appendix 5).

Following a suggestion by one of the groups, the west London team were asked to consider

what would be ‘undermining’ factors, which were recorded using the central template. This

was followed in the second Expert Panel, by asking the Northampton group to identify

factors which could sabotage a good job rotation scheme.

Following consultation with my colleagues at the second panel, it was suggested that, in line

with the move to ‘consensus’ in nominal group technique, we should ask participants to

identify five key factors, and to rank them 1-5, with number one being the most important

factor (see Appendix 5). This was undertaken for both the research reports on the views of

the supervisors and the experienced nurse report.

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Feedback

The selected factors were fedback to the group and myself. I put them on a large flip chart

paper at the front of the group, under the headings – structure, process or outcome (template

of a systems model). In line with nominal group technique, no discussion or challenge by

group members was allowed during the feedback. Listening was encouraged.

Summarise

At the end of the feedback, as facilitator I attempted to summarise the feedback as displayed

on the flip chart and in the form of a ‘system’ (Donabedian 1966; Fawcett 1989, Senge 1990).

The flip chart papers and their yellow papers with the ‘key factors’ on them were stuck up on

walls in the room to allow participants the opportunity of looking and reading at their leisure.

Their written contributions on the flip chart operated as parts of a visual model of a group

view of a ‘successful system for job rotation’.

Debriefing and reflecting on the process

I also encouraged a short discussion (5-10 minutes) about the process of the group, and how

they ‘found it’. Whilst this did lead to comments on the contributions, I reminded

participants that the process would only work if the individual contributions were not

discussed or criticised but that their views could be expressed in further feedback sessions.

This process was repeated for three other research reports. After the second group, a 45

minute break was provided, where colleagues could talk as much as they liked about the

process and content.

Final debriefing and reflection

The final reporting and feedback round included a reinforcement of their ‘key factors’ as

component parts of the three key elements of a system i.e. as structure, as process or as an

outcome.

At the end of the day I ensured that the group had time to talk and feedback about the

nominal group technique process – what was useful and what not; what they had learnt from

the process and the contributions they had individually and collectively made.

The first Expert Panel was asked to consider and provide feedback on ‘what benefits they

believed they achieved from participation in the Nominal Group Technique process?’ Their

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responses were recorded. Following reflection with my co-research and identifying an

important gap in our knowledge acquisition, the second Expert Panel were asked two final

questions. The first question was ‘What could sabotage a potentially successful job rotation

scheme?’. This would allow colleagues to specify any barriers or threats that might exist and

which should be factored into a model if it was to be realistic and successful. The second

question was in three parts: ‘What was useful and what was new about the experience of the

day, and what would they take back, as learning, to work?’ These comments were recorded

and formed part of the reflective element of the data analysis.

Thanks and contact details

I also thanked them for their time, and stressed that they would be sent the results of the day’s

work on completion. I gave them my contact details to allow them to contact me if they had

questions or concerns.

Maintaining respect and identifying ‘useful’ data and interpretations

This approach valued the individual ‘voices’ (Lather 1991) within the original stakeholder

group – be they junior nurses, supervisors, managers, or senior stakeholders, by presenting

them directly to the expert panels as quotations in the large research reports. It also values

the interpretations of the researchers who undertook the studies and their interpretations. At

no point did the ‘researcher’ or ‘facilitator’ comment on the ‘voices’ or judge them.

Additionally the actual words of the experts in the nominal groups were not altered,

challenged or modified by any of the group members or the facilitator. What they had to say

was of value and did not need to be judged or mediated.

3.5.5 Analysis of data I interpreted the expert panels’ findings by reference to their selected interpretations, the

original studies, other literature, my diaries and other sources of information using both

template analysis (King 1998) and hermeneutic dialectic process (Thompson 1990) to

provide stakeholders (including myself) with a more comprehensive understanding of job

rotation and the key factors associated with its past success and possible future (see section 4

ahead).

I used an a priori basic systems theory template of structure, process and outcome, I explored

the findings from the members of the expert panels and the nominal groups. In addition to the

feedback and interaction with the expert panels, I used hermeneutic dialectic process to

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interact with previous texts (that is, research studies) as well as with the written contributions

of the expert panels and my own diaries and notes to develop meanings related to the

identification of key factors associated with successful job rotation. As part of my

interpretation of the material, further themes were sought that were not necessarily identified

by the expert panel members, as well as links between themes.

Questions and sub-questions were developed from the main research question (see 3.2.1

above and 3.8 ahead) to form the basis of my interaction with the ‘texts’ and to support

attempts at the development of a ‘fusion of horizons’ between the texts, previous

respondents, current expert panel members and myself. These tools helped to support the

establishment of dialectic and helped me to discern, interpret and gain understandings about

the possible key factors associated with successful job rotation. The precise nature of the

analysis unfolded in accordance with the standard procedures that characterise this form of

research approach (see chapter 4 for a detailed procedural account). An audit trail of

references to the process emerged, involving, for example, many mind maps related to

respondents’ own interpretations, discussions with informed colleagues and members of the

community of interest, and my own developing reflections; these were used to ground

interpretations and consequent key factors and their relation to each other within the evidence

which supported the emerging models. This audit trail allows readers to evaluate the rigour of

the analytic process and the results that emerge from this work.

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Figure 4 - Nominal Group Technique Process (repeated four times for each document being evaluated)

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3.6 The intent and nature of the research reportThis research report or ‘story’ seeks to both illustrate my capabilities at level five as per the

Middlesex University capabilities for a Doctorate of Profession Studies, and also to provide

an accessible and ‘readable’ research report, in a case study format, that will share the

interpretations of key stakeholders as well as my own, involved with nursing and job rotation,

that could contribute to a successful model of job rotation, based on our experience and

learning.

Figure 5 - Summary model of fourth generation evaluation (central) and nominal group technique method (outer)

The report includes a visual model of job rotation (see figure 9 ahead) based on our

evaluative explorations and discoveries [see figure 5] and a written account of my

interpretations of the views gathered. The discussion considers the limitations of this study,

elements of useful knowledge that will emerge and critical reflections on the study and its

products. The report will be made widely available to key stakeholders and others who might

be interested in our experiences and views. To address different styles of reading and

learning amongst readers, many of whom will be very busy professionals, I include detailed

tables of contents, summaries, diagrams, colours and reference to websites and other

resources. It will also be possible for readers to communicate with me, as the author, via

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email from my website, which could allow further sharing of understandings, development of

learning and utilisation of the findings in practice.

3.7 DisseminationFor the ethical reasons beneficence, justice and autonomy I will continue to share reports

from this action research study with colleagues who need information about job rotation in

health care settings. Findings will be shared locally through management team feedback,

conference presentations, publications and the website (www.nurserotation.com). Thus we

have shared the learning and sought feedback as we have progressed with the change process,

always attempting to improve our effectiveness and efficiency, and will do so in the future.

The results of this study will also be disseminated through these methods.

3.8 The criteria to judge the value of the research reportA number of criteria of quality have been aimed for in this research study and report. Clearly

they include the Middlesex University Criteria for a major project at level five. . Other factors

such as those that define quality of 4th generation evaluations e.g. trustworthiness,

dependability and authenticity will need to be considered (Guba and Lincoln 1989). From a

critical realist perspective a number of criteria could be considered, many summed up by

Elliott, Fisher and Rennie (1999) who identify 14 criteria – some addressing quantitative

issues (e.g. appropriate methods) and others qualitative issues (e.g. owning one’s

perspective). Finally my own criteria were also aimed for namely:

that I have improved my leadership and research capabilities

that I have made good use of my personal and professional time

that the findings are of use to health service users

that a wide variety of colleagues were able to participate actively in change and

research

that colleagues were able to reflect and learn about change

that the findings from the study on job rotation are of value to others

that the study is cited in policy documents and other professional and research

projects.

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Clearly both examiners and key stake holders will have an opportunity to provide their own

views and influence the content of the report and my own developing capabilities and

learning.

3.9 Learning from writing this chapter.Whilst I set up and developed this project in the context of my on-going learning, the

exploration involved in writing this chapter has increased both the breath and depth of my

understanding about research paradigms, critical realism in particular, as well as its harmony

with emancipatory action research.

I have also gained a greater appreciation of Guba and Lincoln’s approach to evaluation, in

particular the local nature of knowledge generation. I have increased my awareness of

nominal group technique, which I have previously used to facilitate groups towards

management decisions. It has proved, in my view, to be a useful approach for enabling

expert panels to make decisions, one which encourages participation and on-going group

learning.

I have also become more familiar with the use of ‘I’ i.e. the first person, in writing this

research report, something I have rarely done before. The taking of responsibility for the

report, rather than a perhaps safer 3rd person perspective, is somewhat fear provoking.

However I am trying to accommodate myself to that fear and to take the risk to explore and

learn. Fortunately I can appreciate a synergy of the research approaches, methods and means

of interpretation in this chapter.

I have a greater awareness of how influenced I am by the positivist modernist view of the

work, and how difficult it is to un-weave the influence of this view of the world whilst trying

to take a more comprehensive view within the critical realist paradigm.

I have re-familiarised myself with the benefits of specific ‘reading time’, something I

normally do ‘on the hoof’ in my daily practice, where I have to be familiar with a wide range

of knowledge – clinical, managerial, leadership and research. Often I have to read

intensively – ‘just in time knowledge’, in order to make judgements in ever changing

environments. I have secured specific time for the write up of this research project which I

have used to search and read new material, as well as refamiliarise myself with old material.

I have had the time to ‘wonder and think’ about the knowledge, its application to this study,

and indeed have had time to find links between components.

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I have also reinforced my belief in the usefulness of social networks of informed colleagues

and critical friends, to discuss issues and develop insights. The time issue is raised again; in

that I have had time to ‘discuss’ with colleagues in a way that I do not normally have time

for. An interesting question has arisen i.e. did anyone ask to be emancipated? Whilst

colleagues and I have indeed pursued this objective avidly, a friend asked this question,

which has left me wondering about the answer? I have had time to wonder. Small things

have also been learnt, e.g. how to do diagrams using the Microsoft Office Word programme,

something that I have not had time to learn before. Finally I have also got time to re-write,

something that I rarely have time to do.

The write up has reinforced for me the need to make this report useful and to avoid useless

activities and waste, so I set about the report in that light and not just as a report to satisfy the

university in order to pass a module.

There are many other things I have learnt about, which will emerge in other sections of the

report.

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Chapter Four: Project activity and findings

4.1 Introduction to the project activity and findings chapterThe members of the two expert panels, who participated in the nominal group technique, as

part of a formative evaluation, and drew conclusions about the key factors associated with a

successful model of job rotation are listed in the appendix (Appendix 4). Using template

analysis (King 1998) and hermeneutic dialectic process (Guba and Lincoln 1989, Thompson

1990) their analyses and conclusions were further analysed and interpreted by me with a view

to synthesising a model of job rotation. My analysis and interpretations of their analyses

seeks to respect their views and language, and the ‘voices’ of the original participants and

researchers in earlier studies.

Overall the findings of this research study represent my conclusions at this point in time.

These conclusions are part of an ongoing process of learning about job rotation in general for

the stakeholders who have participated so far and indeed for me, as a Nurse Consultant trying

to influence the development of nursing and the effective and efficient provision of nursing

services.

My interpretations of the expert panels conclusions did require me to interact critically with

their findings (see appendix 3) and templates (see Appendix 6), showing analysis and

categorised into the primary and a priori themes of:

Structure

Process

Outcome.

I will develop a dialectic process by questioning their analyses in several ways:

a. What have they considered, as stakeholders, to be the important factors for successful

job rotation?

b. What have they considered to be important structures, process and outcomes

associated with job rotation?

c. What similarities and differences, absences and continuities can be seen in their

analyses?

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d. What do I think is confirmed or missing based on my reflections of my own

experiences of job rotation?

e. What would a model of job rotation include and ‘look like’ that could be of assistance

to an organisation wondering about using job rotation to improve organisational

success and the employability of their employees?

f. Finally how has the process of the research itself made a contribution to ‘action’ and

indeed ‘emancipation’ of those associated with the research, job rotation and the

purpose of the organisation itself i.e. health care?

The process of interpretation requires an immersion in the texts, the breath and depth of data,

and an attempt at ‘fusion of the horizons’(Gadamer 1975), of the expert panels with my own,

a process which, whilst difficult, is perhaps facilitated by the fact that I have been working

and writing about job rotation for the last ten years.

4.2 My interpretations of the findings from the two expert panels – using template analysis

The expert panels were chosen to provide different decisions about which were the key

factors associated with a successful model of job rotation. I believed that the model needed

to be a synthesis of the diverse key factors considered important from the perspectives of the

stakeholders and their interests. It may well be that the conclusions of the panels might

appear to be ‘obvious’ to some readers. However, it is important to remember that those

involved in job rotation, particularly professional rotations, are not necessarily trained

managers or clinicians. So the overall intention was to synthesise the various views, without

losing the voices or language of the professions, in order to produce a model that will be of

use to teams of diverse stakeholders who are trying to implement organisational change.

The analysis of the findings of expert panels was carried out using template analysis to

develop a series of templates [see Appendix 6]. Their conclusions were interpretations from

the research data of those originally involved in several job rotation schemes and their

decisions about which factors (themes) were the key structure, process and outcome factors .

These are interpreted by me throughout the analysis, with the development and synthesis of

templates as an interpretive act itself [see Appendix 6].

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At this point the model that was emerging came from the original research studies and the

views of the expert panels. However, in line with the action research approach (McNiff and

Whitehead 2006) to the whole job rotation project, my own views are of some importance,

and thus have been contributed regularly throughout to the process. As I have made clear

before, I brought my own values and my own professional expertise to this research project

and to the analysis, and cannot pretend to be objective or disinterested, nor can I appear to be

a magical discoverer of a ‘lost land’. I do have my own views based on my own extensive

professional experience and learning, and consider that I would be doing an injustice to

current and future stakeholders if I did not make my own explicit contribution, one which

could make the emerging model more complete and successful.

Consequently, in addition to the views of the panels I have added my own interpretations and

understandings about the factors which emerged as I clustered [see Appendix 6] the themes.

I noticed several other important factors arising from the previous studies, the literature, and

my own experience which in my view were important to include. These additional factors

were either individual themes or were themes that emerged from a group of other factors

mentioned by expert panels.

My involvement in the interpretative process could be considered to be a non-emancipatory,

hierarchical imposition upon the contributions of the expert panels. However, the overall

purpose of my additions was to enhance stakeholders’ understanding about job rotation by

providing a comprehensive, evidenced, and well reasoned argument for a specific model and

I think my views contribute to this.

4.2.0.1 Limitations due to the word count As can be seen from the research reports and the templates in the appendix, there is a large

amount of data to report upon and to interpret. This reflects the complexity of change, and

the diverse disciplines of knowledge and other influences within and upon those systems.

Consequently I will focus primarily on the final two templates (Appendices 24 and 25)

summarising the primary and secondary themes of a model of job rotation. From these I will

report and refine further a model of job rotation including my own interpretations, with

further reference to the originals research studies (see ahead figure 9). Further analysis and

reporting from the research papers and the expert panels will occur after this study and will

be reported in academic journals and my website, with feedback and modification an on-

going process of learning.

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4.2.0.2 Audit trailTo allow the quality of the interpretations to be judged by key stakeholders, in addition to the

main body of the text, the appendices include additional examples of the analyses, in

particular, copies of some of the yellow post-it note data, the tabulated data, the first

templates developed from the nominal group analyses and my own interpretations, analyses

of different findings of nominal groups, together with a first draft of a model of job rotation.

This information has been provided, in addition to our earlier research studies, to help readers

get a sense of the process of interpretation, to help them to develop their own understandings

of the data in addition to my own interpretations and to be able to judge the value of the final

model.

4.2.1 Overall approach to reporting the project activities and findingsThe project activities and findings will be presented in the following order:

1. Outcomes

2. Structures

3. Processes

4. A final model

5. Reflection on process and overall intentions.

The reason why I chose this order was to concentrate on the essential components of a basic

model of job rotation in line with the intention of the research study, building on the original

project characteristics (see Appendix 2). Within each of the sections I also commenced with

the expert panels’ conclusions about the interpretations and understandings from the original

studies in the following order:

Findings, conclusions and recommendations from cohorts 1-3 and cohort 4

Findings, conclusions and recommendations from the experienced nurses

Findings, conclusions and recommendations from the supervisors of the rotatees.

My reasoning for this was that I wanted to ensure that the views of the employees, nurses in

this instance, were kept to the fore in this process. I did not want to disrespect their

contributions. I wanted to focus on the expert panels’ conclusions in the above order, ending

with the panels’ analyses of the supervisors’ views. The supervisors’ views were in many

respects similar to the perspectives of panel members i.e. not being direct participants

themselves, but ‘using’ the model of job rotation for a specific organisational and

professional purpose.

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4.3 Key outcomes for the use and successful implementation of job rotationI decided to start to present the findings of the research study by focussing ‘at the end’ of the

model of job rotation i.e. the ‘outcomes’ (see figure 6). Whilst the original study’s outcome

was aimed at using job rotation to recruit staff to ‘hard to staff’ services, it has become

apparent that the participant rotatees on the various cohorts, the experienced nurses, their

supervisors and other stakeholders have suggested that job rotation can be used as a tool to

achieve a wide variety of useful outcomes. Clearly this is supported by the literature review

above. I wonder if the diverse interests of the members of the expert panels have led to a

wide number of outcomes being considered as possible organisational or professional uses for

job rotation.

4.3.1 Cohort 4 (plus Cohort 1-3) research studiesThe two panels identified a number of possible key outcomes of the use of job rotation:

A tool that could be used for change to improve the quality of services

Useful – for nurses, carers, with economic advantages

Benefits e.g. education and retention of staff, as well as positive impacts on

colleagues

The production of clear evidence e.g. of service improvement, as a key factor in a

model

The prevention of organisational problems e.g. such as institutionalisation.

4.3.2 Experienced Nurse Job Rotation StudyFrom the Experienced Nurse Job Rotation Scheme research the panels concluded that a

number of additional outcomes could form the basis of using job rotation as a tool for

organisational change:

Production of value for the organisation as well as the rotatees

Developing leadership capabilities amongst employees

Increasing job satisfaction

Yield gains from the educational programme that would form part of the job rotation

scheme

Retain employees, in particular those who were most experienced and able

Increase research capabilities amongst rotatees

Change the way that employees undertake their work e.g. their thinking and speaking

with clients

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Clearly there are similarities in conclusions about the outcomes that could result from the use

of job rotation. For example, the notion of having or increasing ‘value’ is similar to the

notion of ‘useful’. However, it is important to delve further into the comments of the panels

to understand these terms e.g. benefits to employees and rotatees, to customers or service

users, and also for colleagues. The stratification of the knowledge as illustrated by the

templates i.e. with primary, secondary, tertiary levels and more, illustrates the complexity of

job rotation. It also illustrates the need to gather the breadth and depth of understandings

about this change tool, if it is to be understood, so as to lead to appropriate and sustained

change.

4.3.2.1 How to present the complexity of the findings – produce a useful report and modelA problem with this complexity is how to present the knowledge about job rotation to busy

managers and professionals. The temptation is to ‘summarise’ and to focus on ‘the most

important’ or ‘rate limiting’ factors. I am concerned that that approach could over simplify

and thereby present an incomplete and misleading model. My experience, and indeed the

reports of participants in the original research, suggested that sustaining job rotation e.g.

through ‘sustained’ and consistent leadership was a key factor in successful job rotation.

Lack of awareness of key factors does lead to poor management decisions, and ultimately

waste and failure, despite the fact that many stakeholders acknowledge that job rotation is a

useful tool. Hence the full research reports are available but include abstracts and stand-alone

chapters of findings and recommendations for those who do not want to or do not have the

time to read the whole reports.

4.3.3 Supervisors’ research report The expert panels’ conclusions about the possible outcomes of the use of job rotation, after

reflecting upon the views of the research reports and the views of the supervisors suggested

further possible outcomes:

Retention of staff

Budget management

Developing more capable nurses

Transfer of knowledge and improvements – from policy to practice, from theory to

practice and good practice within and around the organisation.

Consistent with the other suggestions about outcomes is the staffing factor of ‘retention’ of

staff, as well as the budgetary issues of staying within budget, making savings e.g. reducing

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the costs associated with agency workers, as well as the issues of increasing the capabilities

of staff. It is also notable how the panels have identified the ‘ripple effect’ of this change tool

i.e. ‘transfer’, and the possibility of organisational gains, that might not be obvious e.g. the

increased motivation amongst the supervisors of rotatees, through an increase in their own

knowledge and skills from working with the rotation scheme and individual rotatees.

An explicit factor concluded by the panels was that of ‘transfer’ of knowledge, policy and

good practice into and around the organisation. This factor seems to fit with Senge’s (1990)

notion of a learning organisation and the potential of the organisation to respond rapidly to

external changes e.g. policy priorities and commissioning requirements, as well as the

transfer of successful ideas and practices within an organisation e.g. co-ordination of care in a

neighbourhood where staff are rotating amongst different services within a particular

geographical area and improving the connections therein.

4.3.4 Sabotaging and undermining factorsIn the first expert panel a key factor emerged, one that should be avoided, which was poor

teamwork. I pursued this question further about factors that could influence job rotation in a

detrimental way, with both panels. Two further potentially undermining or sabotaging

factors that I added are:

Lack of explicit evaluation or research knowledge as an outcome

Lack of leadership decisions about job rotation.

Whilst various panel members suggest that value, usefulness, transfer, retention etc are

possible outcomes of the use of job rotation, they do not explicitly state that research

knowledge per se should be a specific outcome of job rotation, even thought those outcomes

could be made clear by the use of research. In other words the need for research is essentially

implicit rather than explicit in the conclusions of the expert panels. This is frustrating to me

as a leader of the pilot schemes and as the leader of the research studies and indeed the

facilitator of the two expert panels, as all of these activities are research activities trying to

find knowledge about job rotation that would improve its appropriate use and effectiveness.

4.3.5 Links within the modelOne of the issues that have clearly emerged for me is that of evaluation, which needs to be

built into any job rotation model, with clear structures, processes and clear outcomes. For me

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it seems that ethically it is essential to evaluate well in order that knowledge based decisions

can be made by very busy managers, with very limited resources. Informed decisions could

relate to either continuing, developing or stopping job rotation within an organisation. At this

point many managers are operating with little or no evidence-based knowledge about job

rotation. Hopefully this series of the initial studies, the study of the expert panels and my

own views, together with the model that has emerged from this study, will help managers to

set project plans that will be of greater use to them and their organisations.

A visual display of the template analysis is presented on the next page opposite to help to

capture and make easily available to the reading audience the contents of the text above.

The next section will address those structures, inputs or resources that are required to set up

and run a successful job rotation scheme i.e. to achieve whichever of the organisation’s

desired outcome(s) [see figure 6].

4.4 Key structures required for successful job rotation:4.4.1 Cohort 4 and Cohort 1-3research reportsThe rotatees identified a large number of resources that were required for job rotation to be

established and implemented well, a substantial number of which were also considered key

factors by the expert panels. As noted in the literature review above [see Chapter 2], few

operational issues were identified for the implementation of job rotation. As such these

findings, based on the earlier studies in the series, make an important contribution to the

knowledge base on job rotation.

The structures included:

Identifying stakeholders

Setting up a steering group

Establishing leadership

Having a model of job rotation

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Figure 6 - A visual representation of key outcomes for successful job rotation

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Agreeing clear aims and objectives for the job rotation scheme

Ensuring the presence of a handbook about the scheme

Providing information about the scheme ‘up-front’ to stakeholders

Ensuring that the appointment and employment process for the scheme and after the

completion of scheme is a clear part of the model

Establishing and managing appropriate placements

Ensuring the inclusion of specific educational elements, and quality education in

particular

Establishing communication structures was considered essential

Resources that could be considered to be supportive were considered important e.g.

extra supports for ‘hard to staff’ areas, in addition to the job rotation scheme itself.

The list of structures or inputs reads like a list that could been read from strategic and

operational management books (Johnson and Scholes 1993; Hersey and Blanchard 2007).

However my experience of establishing job rotation schemes is that there was a lack of

consensus or awareness amongst the stakeholders of the key factors that needed to be in

place, which was undermining to the implementation of the schemes. Two missing elements

in the above list appear to me to be:

The employing organisation

Evaluation and research

Whilst these may be considered to be implicit, it is clear that the expert panels did not

specifically identify these issues as core structures that were essential for a successful model

of job rotation. I wonder if it exemplifies the often experienced practice in the health service

of starting new initiatives, and of changing or stopping them before a through investigation

and conclusion about their worth and merit can be made (Frazer 2007). In the past the

absence of evidence at the initiation of the a job rotation project plus the limited evidence that

has been developed over the years both within the nursing and health arenas, has caused

problems with seeking on-going funding. This evaluation study will hopefully support others

in their case making for further funding.

4.4.2 Experienced Nurse Job Rotation Research StudyThe Expert Panels’ conclusions from reading the research reports that evaluated the

experienced nurse job rotation scheme identified a number of additional key structural factors

for job rotation:

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Commitment

Long-term stakeholder relationships

Service users

The recruitment and employment processes

Work based learning, action learning and accreditation of learning

Educational need assessment and the recognition of current knowledge and gaps in

knowledge.

These factors emerged from the learning about the experienced nurses’ job rotation scheme,

with commitment being a highly important factor. In the original scheme, it was clear that

this ‘spin-off’ project (McNiff and Whitehead 2006), one suggested by senior professionals

and managers involved with the junior nurse job rotation scheme, would have failed if they

themselves had not been keen to pursue the establishment of the scheme. Despite having

secured funds for one cohort, I had few other resources and thus they needed to negotiate

with managers and they needed to advertise the scheme to make it viable. In effect they

needed to operate to a great extent as a ‘self managed team’, a recommendation that emerged

in one of the previous studies (Lucock and Coyne 2006a). As this scheme was new and we

had little guidance on what would make it work well, we needed to persevere even when

matters were difficult e.g. participants wanting greater support and understanding of the

working of the scheme. Paradoxically this was something that could only come from trial

and error and reflection. This was inherent to the research and evaluation components of the

project itself.

Whilst the picture of the key structures is emerging from the panels’ analyses, it occurs to me

that a key structure has been missing from the contributions made so far:

The rotatees themselves – their intentions, abilities and qualities

The point was made by one of the panels that the staff group that was being targeted for the

job rotation scheme needed to be clearly defined, in that instance the ‘experienced nurse’.

From a project leadership perspective I found the notion of ‘flexibility’ a very difficult key

factor to work with at times. However I believed that we did not know enough about job

rotation to exclude willing participants and as the overarching outcome of the project was to

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recruit staff to ‘hard to staff’ areas; flexibility about recruitment could be justified, and was

clearly a key factor.

It is also of interest to me that the panels placed such emphasise on work-based learning and

the accreditation of learning, as well as educational assessment, as key factors in a successful

model of job rotation. It was definitely the belief of the key stakeholders at the

commencement of the action research project that high quality and adaptable education was

needed to act as a support to staff but also to increase the gains for the organisation as a

learning organisation. It is also interesting to note that work based learning, about which we

knew very little at the start, has proved to be of significance as an educational approach that

could fit well with job rotation. In a way it proved to be another ‘spin-off’ of the project

planning, realised by the action research approach to change; perhaps it would not have been

taken up and developed by more rigid approaches to change and evaluation.

4.4.3 Supervisors’ research report The panels’ conclusions from this research report confirmed a number of the previously

identified key factors e.g. stakeholder involvement, leadership and mutual values and vision.

They, however, expanded these factors by adding more:

Endorsement by the Trust Board

Involvement of key stakeholders

Specific job rotation posts as placement options

The organisation – as an entity itself and a key stakeholder

Additional key factors were:

Emancipation – the freedom of participants to contribute, learn and choose

Training for supervisors about supervision and about the job rotation scheme

Both of these additional key factors expand the notion of job rotation in line with the notion

of the learning organisation (Senge 1990), viewing those involved as ‘partners’ rather than

‘employees’, using their abilities to make the business or public service a success. The idea

of emancipation fits well with my own notions of encouraging patients/clients to develop

their own sense of self and agency (Marlatt and Gordon 1985), as well as leading clinical

professionals and managers to develop organisations which promote health rather than

illness. These ambitions could be enhanced by organisational development and change tools

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which themselves explicitly promote emancipation for those involved (Peck 2005), not least

of which is the increased use of action research.

The key factor of training supervisors fits well with the notion of emancipation, empowering

them via their explicit inclusion in a model, with consultation and education to better support

rotatees. It could also enable them to consider their own contribution to the organisation and

their own employability (Van Dam 2004), and indeed perhaps encourage the establishment of

a job rotation scheme for themselves e.g. the experienced nurse rotation scheme.

4.4.4 Sabotaging or undermining factorsThe two expert panels, based upon their own experiences, and their reflection upon the

research reports identified a number of factors, which if not prevented or managed, would

undermine or sabotage the successful establishment and implementation of job rotation:

Lack of stakeholder support, partnership working and/or engagement of the primary

care trust

Lack of leadership

Lack of clear aims and objectives for the job rotation schemes

Lack of work based learning modules.

These factors support the conclusions they drew about the key factors needed for successful

job rotation, and re-enforce their importance. I have included them in the model and coded

them with a triangle (a warning sign) to ensure that these views are obvious to readers. One

of the repeated complaints and suggestions in the original research was the inconsistency of

leadership at times over the five year project, particularly as the project came towards its end.

This emphasises for me the panels’ conclusion that there needs to be sustained leadership

throughout a project. One of the major elements of the sustained role of leadership is to both

have clearly defined goals (aims and objectives) and to ensure that these are communicated

regularly to those involved in an enterprise (O’Connor 1998). The following diagram

illustrates the structural factors that have been suggested above [see figure 7]:

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Figure 7 - A visual representation of the key structural factors for successful job rotation

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The next section will address how the structures can be utilized to deliver the desired

outcomes from the use of job rotation.

4.5 Key processes necessary to implement job rotation successfully.This section of the model is about how key stakeholders act, or use the structures, to achieve

the desired outcome(s). Each research report presents accounts of participants’ and

researchers’ views [see 3.5], which have been analysed and interpreted by the experts’ panels

and myself, and are reported below.

4.5.1 Cohort 4 (cohort 1-3) research reportsThe two panels concluded that a number of processes need to be undertaken for job rotation

to work:

Communication

Robust collaboration

Buy-in

Learning

Supervision

Clear information systems

Educational components

More placement options.

These factors are those that rotatees, local managers and supervisors, senior professionals,

project leaders, internal and external key stakeholders e.g. education providers and

researchers/evaluators need to ensure are implemented, in an on-going way, to ensure that the

job rotation project works. Going hand in hand with this is the need to have leadership to

maintain ‘buy-in’ or commitment to the project but to also explore and facilitate the on-going

buy-in that is needed when key individuals leave the organisation or change job or new

individuals join the scheme. It is clear that entrepreneurial characteristics and passion are

needed by leaders to keep the momentum and the value of the scheme to the fore, maintain

and enhance awareness. Otherwise the project could ‘drop off the agenda’, and be

undermined.

Leadership through orchestration and maintenance of collaboration is clearly a key issue, as

is the issue of exploring the organisation for possible rotational posts, which could be added

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to the scheme, perhaps to maintain the scheme if some existing posts become established

posts. The issue of supervision was one that was mentioned repeatedly by the members of

the panels as one of the most important key factors.

4.5.2 Experienced Nurse research reportThe two panels confirmed supervision, motivation and commitment as key factors – which

could be interpreted as being synonymous with ‘buy-in’, and went on to conclude a number

of other key process factors:

Experience of reflection as being sustaining

The provision of work (job) opportunities for rotatees

Managing conflicting job demands

Being released from a job (post) in order to rotate to another post.

On reflection three further themes emerged for me from the panels’ conclusions about these

key factors i.e.

Inhabiting a job/post

Managing

Identifying costs and benefits.

It seems to me that these factors and capabilities are to some extent implicit, being needed by

rotatees and local managers in particular, in order to both settle in quickly and effectively to

new rotation posts. They would be needed both to prepare for and to exit those posts so that

they can move to new posts. It was clear in the supporting research studies that one of the

key factors was good preparation for the rotations, with notice of the rotations, which I

understand as being factors which would allow both rotatees and supervisors to manage the

transitions into and out of posts, and for supervisors to best manage employee performance in

new posts.

4.5.3 Supervisors’ research report It was believed by the panels that supervision and reflection were key factors for successful

job rotation, as were:

Leadership

The views of service users/patients/clients

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As already mentioned it appears to me to be especially important that the role of leadership

continues to be considered important and in this instance perhaps the leadership role of

communication and getting ‘buy-in’ from key stakeholders i.e. the users of the service. This

emancipatory idea, of involving key stakeholders by both listening to them and giving them

choices, particularly the most important stakeholders i.e. those subject to the service

provision, could help them to influence the nature of education and the nature of important

work-based projects.

For me, yet again, there occurs another key factor that has not been prioritised explicitly by

the expert panels, yet which seems to be a key factor:

Rotatees/employees/practitioners

Whilst it may be considered implicit that rotatees need to be consulted as a key part of the job

rotation process, they have not been explicitly identified. I wonder whether they may be

viewed as passive agents in the rotation process i.e. being moved around, or whether it is

‘assumed’ that they are fully involved, can make choices, can contribute ideas and can share

concerns, problems and issues. What is of value to me is the experience of working with the

rotatees, in particular the evaluation events and research process, where they have been keen

to participate, and to share their ideas concerning:

What has been useful about the schemes

What could be improved in the schemes

These views have formed the major component of the research studies in the action research

project so far, and have been considered highly enlightening by those who have provided

their views and those who read their views.

4.5.4 Sabotaging and undermining factorsThe panels were able to identify a number of key factors which could undermine the job

rotation scheme management and leadership:

Lack of commitment to the continuation of the process (due to success)

Lack of preparation of the ‘shop floor’

Lack of team working

Lack of co-ordination throughout

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The ‘bull dozer’ approach to leadership and management of change.

Yet again these factors all reinforce the need for leadership yet again, which is sustained,

with good preparation of supervisors and an on-going co-ordination of the complex processes

and team working that have been mentioned before.

However I am yet again aware that evaluation and research as a key process, has not been

explicitly identified by the experts in the expert panels, despite their list of outcomes for job

rotation and their identification of ‘clear information systems’ as a key process factor. It does

raise for me the issues of ‘unconscious’ processes in organisations and within individuals

(Obholzer and Roberts 1994). As is often clear in my clinical practice, clients may not be

aware of how their own choices and behaviours can contribute to ‘relapse’ to drug and

alcohol use (Marlatt and Gordon 1985) and I, without good supervision, could be unaware of

key issues in my practice, leadership and management. I wonder about how and the extent

to which those factors are present amongst the expert panel members, and indeed how I

addressed within this research project itself.

Clearly it is highly important to me that reflection and supervision should be key structures

and processes in the model of job rotation. This was reinforced frequently by rotatees,

supervisors and expert panel members, yet a key process, i.e. identifying and working with

‘out of awareness’ or ‘unconscious’ processes have not been explicitly mentioned. Thus I

believe that two further key factors are [see figure 8]:

Scanning the horizon, becoming aware of internal and external changes within ‘open

systems’

Working with unconscious undermining or sabotaging factors.

A holistic or ‘whole system’ approach is needed to the leadership and management of a job

rotation scheme, to include the less obvious or unconscious operations affecting an

organisation; otherwise success will be undermined.

One further element of those ‘missing factors’ could be the ‘equal opportunities’ element of

employment to a job rotation scheme. Whilst the panels did identify ‘emancipation’ as a key

factor for successful job rotation, earlier research has identified that equality of opportunity

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Figure 8 - A visual representation of the key process associated with a successful model of job rotation

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could be achieved by employing a ‘rotation scheme’ rather than to a fixed post. This could

help to make inclusion and selection fair, thus not denying the opportunity to rotate to those

interested and obliging others who are not interested. It also supports rotatees by

legitimising their own initiative and negotiation with prospective line managers.

The next section will draw together the three key primary and secondary themes that have

emerged and have been explored in the analysis so far to produce a model of job rotation.

4.6 Overall conclusions – Job Rotation Model The following page includes the full model, including the various contributions from the

expert panels, as well as my own interpretations and findings. It can also be seen that the

recurring them of ‘feedback’ or in this instance ‘research’ has been incorporated into the

model. [see figure 9].

Job Rotation Model April 2009

Based on the expert panels’ analyses and interpretations using the nominal group technique,

and my own analysis using template analysis and interpretation using the dialectic

hermeneutic process by linking structures, processes and outcomes, a model of job rotation

has emerged, as illustrated in figure 9.

This model highlights key outcomes that job rotation could realise. It also highlights key

structures that need to be in places, so that key processes can be performed to achieve the

desired outcome(s). I have also emphasised a number of key issues that were either implicit

or missing from the analyses, and a number of warnings i.e. key factors which, if not in place,

could well lead to the sabotaging or undermining of the scheme e.g. such as jointly agreed

and clear aims and objectives.

The model itself is a contribution to the ever developing evidence base and policy on job

rotation. From my own perspective it would have been highly useful to have had a model at

the commencement of the job rotation scheme(s) to enlighten me and also key stakeholders

about the diverse key factors that we would have to manage. I see the model as assisting

others who have similar challenges. Indeed it has already been useful to a colleague from

Wales who has sought advice about enhancing job rotation schemes (Appendix 7).

One of the most interesting themes that have woven through the analysis is the presence and

absence of feedback, evaluation or research. Whilst ‘feedback’ is a key element of most

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Figure 9 - Job rotation model – April 2009

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Figure 10 – Reflections by the Expert Panels on their participation in the research process

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understandings of systems models, I have been surprised that I did not use it as an a priori

theme for the template analysis with the expert panels and also that the panels themselves

said so very little about feedback and evaluation. I am curious about the often identified lack

of ‘closure of audit cycles’, lack of evidence used in practice and the conscious and

unconscious issues associated with this situation. I do believe that this model does address

this feedback and evaluation issue, hopefully in a way that has meaning to stakeholder

groups.

It is also interesting to reflect upon this analysis and to be aware of how some of the key

factors have been highlighted and others not. An example of this is the idea of a Job Rotation

Scheme Handbook, which was considered highly important in the original research and by

the expert panels but the analysis does not emphasise how much the panels felt that this factor

was important. An interesting paradox related to this issue is that, without a model such as

this one, the development of a handbook would be difficult to produce since the key factors

and the model would in effect from the chapters and paragraphs. This is an objective for the

work to be done upon the completion of this evaluation (see ahead 6.3 number 3).

The use of template analysis has facilitated the development of the visual model above,

which in itself is highly useful to many people who like to ‘visualise’ systems (O’Connor

1998).

4.6.1 Extending the ‘community of interest’ and increasing the abstraction of the model

The model presented in Figure 9 is an ‘idea’ about the key factors that are necessary for job

rotation to be implemented successfully as suggested by research studies, expert panels, and

my own experience and reflection upon the findings and processes of this emancipatory

action research study. However, its presentation for a doctoral examination allowed the

model’s ‘community of interest’ to be extended to include members of the viva voce

examination panel. In this process, a question emerged from the panel about whether and how

a higher level of abstraction could be developed in the model which might increase its

accessibility to some stakeholders and increase the likelihood of their engagement with it and

consequent the transfer of it to their own contexts.

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On reflection and continuing to develop interpretation using the hermeneutic dialectic

process, I considered a number of questions that could be used to raise the model in Figure 9

to a higher level of abstraction. The central concern of the whole research endeavour lay in

the utility of any model for key stakeholders. Hence I decided to focus on one of the early

sub-questions for the research, which was (see 4.1 e.) ‘What would a model of job rotation

include and “look like” that could be of assistance to an organisation wondering about using

job rotation to improve organisational success and the employability of their employees?’

Through reflection with others, this was developed into more specific questions relevant to

stakeholders wishing to implement job rotation. These concerned what would be useful to

organisational decision-makers; what would be useful to potential rotatees; and the role

played by ‘warning factors’ within the model (that is, factors that, if present, could undermine

the possibility of successfully implementing job rotation).

These questions informed my renewed engagement with the model in Figure 9 and provided

me with a set of criteria for attempting to discern shared dimensions across the constituent

components of that model, with the aim of producing a ‘higher level’ version of it. The

outcome of this process is presented in Figure 9a. Of necessity, this version of the model

‘glosses’ the detail and specifics of the model in Figure 9 but both models have been

developed from the researcher’s informed analytic engagement with the data and the

categories in both reflect the concepts and language used by participants. The focus on

structures, processes and outcomes in Figure 9 has been retained in Figure 9a but the

categories that appear under these headings are pitched at a more general level.

To begin with the outcomes to which the model is oriented, these have been summarised as

‘benefits for rotatees and staff members’, ‘benefits for the organisation’, ‘benefits for service

users’ and (overlapping with these categories), ‘increased knowledge about the effective use

of job rotation’. These categories capture core dimensions of concern expressed by members

of the expert panels and also accord with my conclusions from engagement with literature on

outcomes related to job rotation (see 2.5.1).

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The core structural factors required for the achievement of these outcomes have been

rendered in Figure 9a as ‘work-based learning’, ‘stakeholder support’, ‘partnership working’,

‘consistent and ongoing evaluation’ and the presence of ‘clear aims and objectives’ for the

job rotation endeavour. The last mentioned category represents a necessary condition for the

meaningful presence of the other conditions. For example, participants expressed strong

support for work-based learning as a key factor in job rotation (see 4.4.2) but this can only be

delivered if it is part of the aims and objectives of a job rotation project from the outset.

Finally, a consideration of the processes required for the achievement of the specified

outcomes in Figure 9 resulted in the identification of six core processes: ‘consistent

leadership and management’; ‘effective team working to facilitate change’; ‘stakeholders to

show sustained commitment to job rotation’; ‘effective consultation with rotation placement

sites and with rotatees’; ‘support for rotatees in the education component of the rotation

project’; and ‘evaluation processes and on-going decision-making’ (about the project in light

of the outcomes of this ongoing evaluation). The need for leadership and management

processes to be implemented in a consistent and sustained way was identified by participants

on many occasions during the research and earlier in this study (4.5.2) and is supported by the

work and model of Etherington and Jones (2003). It is clear from participants’

views/experiences that the absence of this factor would seriously inhibit success: indeed, the

other processes can be seen as instances of the macro-category of ‘consistent leadership and

management’. The categories here (and categories of structures and outcomes) are by no

means mutually exclusive but are interrelated: for example, meaningful evaluation of the

project requires effective consultation with rotation placement sites and with rotatees. They

are presented separately here for clarity; their inter-relationship is shown in Figure 9 and in

the textual elaborations of this.

One dimension that is relevant across the entire model is that of evaluation. This is not

something that should occur only at the end of a job rotation cycle so that it can shape future

cycles. Instead, there is a need to have structures and processes in place to support consistent

and ongoing evaluation in order to allow changes to be made during a cycle to address

emerging challenges and increase effectiveness.

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The more abstract model in Figure 9a and the detailed model in Figure 9 constitute evidence

sources for effective decision-making among those interested in job rotation within their own

organisations or indeed for individuals to decide whether to participate in job rotation per se

or in a particular job rotation scheme. This evidence base will be available on the internet,

giving ready access in a hopefully emancipatory way.

Consequently further interpretation of the 2009 model has resulted in the production of a

more abstract model (figure 9a):

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Figure 9a (Model February 2011)

Model of Job Rotation

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Work based learning

Stakeholder support

Partnership working

Consistent and ongoing evaluation

Clear aims and objectives

Consistent leadership and management

Effective team working to facilitate change

Stakeholders to show sustained commitment to job rotation

Effective consultation with rotation placement sites and rotatees

Evaluation process and ongoing leadership decision making

Support for rotatees in the education components

Benefits for rotatees and staff members

Benefits for the organisation

Benefits for the service users

Increased knowledge for the effective use of job rotation

Structures Processes Outcomes

As stated ahead in section five, despite limitations, the learning from this project is available

to existing and future colleagues to explore and draw their own interpretations with a view to

transferring learning to their own situations. One of the most obvious future actions to

maximise the utility of the learning from this work would be to use the more abstract model

in Figure 9a to provide chapter headings for a manual or book on job rotation, with the more

detailed model in Figure 9 providing subsections within chapters. This would help

stakeholders to acquire both a broad and specific sense of the key factors that I and other

colleagues, based on our experience and exploration, consider to be important for the success

of a job rotation scheme.

The next section will consider how the research process per se has maximised the

effectiveness of the research for those key stakeholders who have participated in it, in line

with critical realism and the emancipatory action research objectives of the study [see figure

10].

4.7 Critical reflection upon the emancipatory elements of the study.Although this research study has produced a product, i.e. an evidence based model of job

rotation, more was aimed for by the selection of the research approach and methods. In line

with critical realism and emancipatory action research as described in the methodology

chapter [see 3.4.3] I have attempted as much as possible to develop this research study in

such a way as to maximise its ‘usefulness’, and in particular to enfranchise the participants in

a collaborative learning process.

This section will report on my findings from the reflective exercises about the expert panel

members’ participation in the research, which hopefully will provide some insight into the

potential benefits and possible risks of participation in this type of evaluation/research. The

reflection can be summarised as having had five elements:

Their expectations of participation in the nominal group technique process

Their benefits from participation

What participants considered to be new to them from their participation

What they considered useful about participation

What they had learnt that they would take back to work and use.

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To present the finding more succinctly a mind map of the reflective elements is presented in

figure 10.

4.7.1 Expectations of participation in the expert panel and nominal group processParticipants identified a number of different expectations. Whilst one might consider that the

key expectation might have been to learn what the key factors for a successful model of job

rotation were, they provided a variety of expectations, some to do with job rotation, others to

do with evaluation and research and others to do with sharing their learning with colleagues

at work. From the point of view of the development of a model of job rotation, many were

interested in particular in how local ‘informal’ job rotations might be related, and could

perhaps be made more formal. They were also interested in being with others, and in hearing

different perspectives about job rotation, as I understand this, to reflect and make more

informed decisions about job rotation (both its use and components).

4.7.2 Benefits from participation.Participants identified a number of benefits:

Job rotation; knowing more; becoming convinced; being better able to implement;

becoming optimistic and understanding the values of stakeholders.

Nominal group technique, meeting others, not just a few people contributing, and

making decisions.

Learnt things they did not know, realising, and making connections to outcomes,

remembering the ‘good rotation scheme nurses’ that they had known.

Having time ….to think.

From the point of view of participants not being ‘used’ by me as a researcher, I do believe

that this evidence justifies the approach. It also justifies my belief that the action research

approach and the 4th generation evaluation formative evaluation both actively involved key

stakeholders in the process of constructing knowledge or theory, which has a much greater

chance of reaching key audiences and of influencing the use of the findings than traditional

research approaches. However I am most pleased with the opportunity that I was able to

present to these partners, i.e. legitimising the time and providing and facilitating the context

for them to think, listen and share and to draw their own conclusions about job rotation. I

was struck by comments about how rare it was for them to have time to think at work, a

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situation that I am only too well aware of, albeit one that I put a lot of energy into trying to

ameliorate especially when participating in this work-based doctoral programme.

4.7.3 What was new about participation in the research project? There were several ‘firsts’ mentioned by participants, from being the only male in the

nominal group, to the first time participating in an expert panel and participating in nominal

group technique process. In particular meeting new people and hearing their views were the

most obviously new elements.

4.7.4 What was useful about participation in the research project? In addition to the time to think, participants found that the Nominal Group Technique process

itself was useful, a powerful source of information and a process that enabled their learning.

Two pieces of feedback struck me in particular. One was the opportunity to learn from the

research studies that we had previously conducted and a statement about being empowered

by the evidence. Additionally the idea that they had learnt from the structure and process of

the nominal group technique seemed to parallel the development of the model itself and its

potential usefulness.

4.7.5 What could be taken back to work by the participants from their participation in the research project?

One participant stated that there was little they would take back to work from the exercise,

leaving me to wonder just why that was. However others were particularly impressed by

nominal group technique itself and its potential use to facilitate projects, to keep people on-

board and to develop guidance for local job rotation schemes. One person, very specifically,

was going to find out more about the work of local trainers and the local ‘informal’ job

rotation schemes.

4.7.6 Summary of reflection upon the expectations and benefits of participation in the research project.

Overall, the evidence does support the emancipatory element of the research approach and

the action orientated elements by both enabling participants to learn and to be more able to

take useful action in their own places of work. Clearly all of the results have to be tempered

by other factors such as:

Expressed and espoused views may not always be in harmony

People may find that their local systems are not supportive of change and put up

resistance

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The research process and the research findings, can lead some people to attempt

change and to find themselves harmed by the process, with colleagues undermining

them, with adverse effects on their morale and possible career.

Thus once again the ethics of research, leadership and management come to the fore. In this

instance colleagues were as fully consulted and given opportunities to reflect with others

about the realities of job rotation and organisational change and could therefore be more

resilient to resistance and ‘backlash’ than more naïve colleagues.

4.8 Learning from writing this chapter I have tried to report the views, language and words of my partners in this research project

and to include my own interpretations explicitly and am pleased with the diversity of

responses and the confirmation of many of the key factors identified in the literature, our

previous studies, and my own experience. However, I realise that these findings may not

satisfy those that are from a positivist orientation. I am not providing ‘reliable truths’,

significance tests and ‘incontestable proof’ as in positivist research. Throughout this work I

have used illustrations from my decision trail which provide the reader with an audit trail. I

hope that this, together with my findings, will convince those do not adhere to a narrow

positivist perspective. I am happy that the model is a useful representation of the key factors

needed for job rotation, yet I am aware that this is not a sufficient argument to convince

fellow professionals. The reality is whether it is useful to practitioners, something that is yet

to be tested in practice. I am pleased that I have not over interpreted the responses of the

panels, especially my use of their language and modes of expression. I am aware that for

readers in my workplace to engage and understand the findings here, they will most probably

appreciate seeing the key factors expressed in their own terms, and not re-fashioned in

management or research speak.

I believe that I have had some success in fusing my horizon with the participants, in so far as

we seemed to understand each other during the data collection events, which went very

smoothly. I am also aware that they seemed to find the language and concepts identified by

previous participants and researchers accessible and meaningful and were able to write them

down on the feedback papers. Whether the panel members will find the final model an

authentic and valid representation of their views has yet to be tested and will form another

stage in the development of this work.

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I am pleased with the mind maps or templates, which according to my discussions with

Professor Nigel King (the originator of template analysis) have a great deal of similarity.

They do identify many of the key factors, support participants’ views, and confirm many of

my own understandings. The model in particular, whilst busy, does have a lot of information,

in a structured way, which would have definitely been of use to colleagues and me nine years

ago when we set up the job rotation schemes locally. I am also pleased that a colleague who

is setting up job rotation schemes in Wales, on a brief view of the model, informed me that it

was useful, especially the warnings, and also that it would benefit from further chunking of

themes. It occurred to me that whilst this may be so, it was also an opportunity for local

groups to do their own chunking, without me having perhaps hidden key pieces of

information.

I also realise that many other factors do not exist on the model which could well be

encompassed in a manual of job rotation and are identified in the appendices and available to

readers for information and perhaps explanation.

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Chapter Five: Discussion

5.1 IntroductionThis section will explore and discuss the findings from this research study; in particular the

development of a model of job rotation as well as the benefit of using the emancipatory

action research approach. These discussions contribute to the discussion that has punctuated

the report throughout, not least of which are the expert panels’ reflections in sections 4.4 to

4.5.

This section could be termed the ‘so what?’ section. Following the development of the

model, the question arises about the value of the findings and their potential utility. I will

summarise the study, the limitations, suggest what I would do differently if I were doing it

again, reflect upon the findings - those that confirm the literature, those findings that are

novel – and offer suggestions about further areas of potential research to enhance our

understanding of job rotation. Finally I will comment upon the learning that I have accrued

from writing this chapter.

5.2 What has been undertaken in this study? As described at the end of the introductory chapter, the study set out to produce a model of

job rotation, to enhance the capabilities of those involved and to use the knowledge gained

within the local context to improve health services. That said it is important that I emphasise,

so as not to mislead readers that because of financial constraints there were many other things

that the study could have done but which were not done, many of which will be mentioned

later e.g. other research studies.

5.2.1 Research process to produce a modelIn this study two groups of experts in the health field, using nominal group technique,

reviewed the research projects which had been undertaken early in the action research study.

Using learning from their own knowledge and experience, they combined them with what

they considered to be key factors from the studies to recommend key factors for the

successful implementation of job rotation. From this formative evaluation, aimed at

determining the merit and the worth of the previous findings, and their own interpretations, I

had interpreted their expert conclusions to develop an evidence-based model of job rotation.

The model which is a product of this process emerged around an a priori systems template of

structure, process and outcome. It has emerged as a complex model, including a large

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number of important factors, which are likely to be needed to successfully implement a job

rotation scheme. It has also raised a large number of further questions about job rotation and

its implementation.

5.2.2 Emancipatory component

In addition to undertaking a formative evaluation and producing a ‘product’ i.e. the model of

job rotation, this study has also taken an approach that sought to develop the capabilities of

those stakeholders involved to learn more about research methods and about the subject

under investigation, i.e. job rotation. As most research remains unpublished or unused, the

important ethical issue and question is whether this study has been of use and whether it is

likely to be of further use. From the reflective elements of the process [see 4.7], it can be

seen that those who participated found elements of the process e.g. nominal group technique

and the allocated ‘thinking time’, as enabling. Additionally they speculated about what

learning they would take back and how they would take it back to their own workplace. So

the study did more than use the participants for data; it provided a learning opportunity which

appears to have been of value to the participants. It has also been of interest to two Trusts,

one of whom have commissioned work, and to a clinician who is using the finding to support

her own work.

5.2.3 Ethical issues – equality of opportunity

The model that has emerged exists in a context of ‘informal models of job rotation’, which

highlights the ethical issues of equity and justice. As both the literature review and this study

point out, job rotation is a highly powerful and influential organisational change and career

development tool but one which is not as widely and freely available as it could or perhaps

should be. From the inclusive and participative nature of this research study, not only have

we acquired further knowledge about job rotation but the whole community of participants

has had many opportunities to learn about job rotation, to participate in active discussion and

debate with others and to use or consider job rotation as a useful tool for themselves or

colleagues. This model of research furthers the uncovering of some of the ‘barriers to entry’

(Johnson and Scholes 1993) that may exist where formal job rotation is used but, more

importantly, in those situations where informal job rotation exists. The participants also form

a community of people who are aware of and potentially interested in participating in further

job rotation schemes and their evaluation, a highly potent situation that could be to the

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advantage of my local organisation and the nursing profession. As will be described later, the

local community is interested in taking the knowledge generation and application further.

5.3 Limitations of this studyThere are a number of limitations of this study that will be identified and discussed below.

However, I will also identify useful findings and learning that have accrued from the study.

5.3.1 Limited theory and literature sources

The literature on job rotation is limited, with few formal research studies and even fewer in

the health and nursing fields. This limits to some extent the basis for the study, in that

making a reasoned case for the project and funding was hampered by the lack of evidence.

Additionally there is great confusion about terminology and definition, little critical review of

the opinion articles or research reports and few citations of existing work or a strategic

approach to the development of knowledge in this area. There is also very little said about

the structures and processes associated with job rotation implementation, i.e. the operational

management and planning, with little said about follow-up studies, or indeed the limitation of

the literature itself. That said the diverse literature is increasing and this study contributes a

critical review of the current evidence.

5.3.2 Limited time for the formative evaluation and feedback

This study has been produced some seven years after the first research study (Buchan and

Ball 2003). In the prospective nature of the studies, whilst all of the succeeding studies do

refer to previous studies and learn from them, it was not possible to have a whole system

reflection upon job rotation until the final study was completed in late 2006. Thereafter, with

a full-time job as a Nurse Consultant in dual diagnosis, I have had limited time to undertake

this formative evaluation, using nominal group technique with two different expert panels.

Thus the findings of this study are in the process of being returned to the stakeholder group -

which in itself has intrinsically changed over time - for further consideration and planning.

This process could be a limitation for those who want evidence generated quickly (in my

experience a common demand), making this longer term approach potentially less appealing

to funders. Because of the wide interest in job rotation, and the on-going human resources

challenges, in this instance, the local and wider professional community are likely to have

interest in the findings.

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5.3.3 Fear and/or apathy amongst stakeholders could limit their potential contribution

A limitation that emerged for me was the potential fear that stakeholders may have about

being identified i.e. that maintaining their confidentiality would not be possible because of

the nature of their post or the characteristic nature of their opinion. One of the advantages of

the study progressing over several years is that participants have had time to be promoted or

move, and are thus less likely to be identifiable (despite our efforts to ensure that they were

not). Another limitation, in this case related to fear, is that participants may be apathetic

about their contribution to this research study. The ‘so what?’ question may be affected by

their belief that they have so little influence, that we as researchers together with other

stakeholders including managers and policy makers, would not be interested in what they

have to say. Whilst there may be some foundation to such a view, it is my opinion that I have

striven to ensure that individual views of all participants are well represented in the full

research reports and in the case of the expert panels, that views are also well represented.

5.3.4 The limits of my assumptions or ‘map of the world’

One of the limitations of this study is that it is highly influenced by my assumptions about the

world and my notions of what is possible and impossible. This has made ‘fusing my

horizons’ with others as part of the interpretative process both difficult and easy. Those

elements of others’ views that I do not agree could have been dismissed and those that I agree

with could have been prioritised. I countered this by using the words of the participants as

much as possible and by providing the supporting evidence in the appendices as an audit trial.

Additionally what this study may not emphasise enough is how unique the context is, i.e. how

my interests and ambitions about job rotation and its research are in harmony with other key

stakeholders, e.g. service directors and chief executives. Again my selected approach to this

research, i.e. this ‘view of the world’, could be construed as patriarchal, another imposition

by a person in power upon less powerful members of the profession or organisation, i.e. a

‘should’ rather than an ‘offering’ from one person to another. Finally it is important that the

model that has emerged from this study is used in a reflective way (Kember, Wong and

Young 2001) and is not simply imposed upon any organisation at any time. The adopter

criteria are clearly important, albeit that the research is very limited at this point.

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5.3.5 Limits of my developing capabilities to construct a persuasive argument.

As I am learning about research and developing my capabilities, this study is limited by my

abilities to describe, explain and reason. I have attempted to provide a systematic series of

research studies to share with the local community and a wider audience via the internet. In

this study, I have attempted to share the emerging knowledge in partnership with many key

stakeholders about job rotation by chunking it up using a basic systems model approach and

by using visual diagrams as well as text. I am aware that to communicate the knowledge

developed here will require a variety of media for dissemination and a listening approach, as

well as an intention to continue to lead in this field. One of the key issues with managing

such complexity has been to ‘surf’ the feelings of being overwhelmed by the number of

different factors involved with successful job rotation and to seek and use supervision with

colleagues and critical friends to manage the anxiety and confusion that I have felt at times.

5.3.6 Limits associated with the absence of numerical data

Whilst the series of studies involves mixed methods, there is very little numerical data

presented in the studies about the numbers of people who joined and who finished, which

would be important in a different study. Whilst there is some data available on these matters,

I have been reluctant to rely upon this data as it can lead to false impressions and

misrepresentation of the evidence about job rotation and unsubstantiated claims. It is the case

the majority of the ‘hand to staff ‘posts that were available to each cohort were filled, yet this

does not generalise to all such advertisements. Additionally whilst it is the case the majority

of those who started the schemes completed the first 8 month placement, and more than 50

per cent completed the academic course and yet more remained with the Trust for the 2 years

of the scheme, it does not follow that such schemes would definitely secure such outcomes.

We were fortunate to secure the funds for a very good work-based educational degree

programme and were fortunate to have a responsive and experienced educational institutional

as a partners. However, it is not necessarily the case that such ‘hard to staff’ areas, with their

intrinsic problems and fears, would definitely benefit to the same extent. Based on the

findings of this study and the model that has emerged, future research studies may well

include the use of numerical data, assured by the ground work that has been done in this

study, those in the series and those identified in the literature review.

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5.3.7 Limits of embodying the perspectives of insider/outsider researcher

One of the potential limitations of the study is my own multiple roles in the leadership,

management and research of the job rotation scheme and the formative evaluation to develop

a model of job rotation. It would have been difficult for me to ask stakeholders to provide

their judgements on what was useful and what needed to be improved, when implicit or

explicit in their response is a criticism of my own practice, e.g. sustained leadership.

Fortunately I did not need to do this as I was able to secure research funding for each project

and decided to employ as partners highly experienced and well respected researchers to work

jointly with me on the studies, particularly the gathering through interviews, maintaining the

confidentiality of participants and the first drafts of the findings. So whilst some of the

findings of these studies are sensitive and provide criticisms of my own contribution to the

leadership and management of the schemes, I do believe that those criticisms are

fundamentally important for identifying key factors for the model and may not have been

revealed without the partnership with external researchers.

My insider role also helped in providing insight about the many facets of the scheme and

helped to provide a more comprehensive understanding about the factors involved, rather

than the less informed perspective of outsider researchers. Finally the worth and merit of the

findings in the health care context would be considered of less value if they had only been

produced by me, as an insider, than as a partner with well respected external partners. Whilst

these findings are not claiming to be unbiased and ‘objective’, the fact that the other partners

in the research with independent perspectives contribute to the credibility of the findings

renders them more persuasive. The fact that internal and external points of view are fused in

the research process may provide a more holistic view of job rotation.

5.3.8 Hermeneutical dialect interpretation – limits of negotiation and interpretation

Whilst the data analysis method includes both identifying the key themes through template

analysis and the hermeneutical dialectic process, a limitation could be the prevailing

positivist culture in the National Health Service where there is a disinclination to translate

into policy and practice evidence that does not come from sources that are credible with their

particular hierarchy of knowledge. I believe that this study provides rich data and an

extensive audit trail to readers and allows them to judge the worth and merit of the findings.

Nevertheless, for the model to be persuasive within the culture that I work within, my own

interpretations need to be carefully considered and provided so as to be transparent so that

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readers have the opportunity to determine the good faith of those interpretations. The success

of this task will be the overall response that this work receives from colleagues in the future.

5.3.9 The limits of the visual model

The model that was produced from the analysis of the data provided by the expert panels is

complex. The complexity does interfere with the potential readers’ grasp of its content and

meaning. Whilst the a priori template of structure, process and outcome does help to chunk

up the findings about the useful factors, it does still remain complex. The model does not

claim to make links between factors nor to prioritise those factors which could call into

question its usefulness. However at this point in the development of knowledge about job

rotation, it not clear what are the most and least important factors, what is limiting and what

is not, so at this stage of development this study presents some knowledge that could have

been found in the literature and as well knowledge which could not have been found there. It

provides the model to readers with the expectation that they will form their own opinions.

One consultation with a colleague in Wales who is developing job rotation highlighted that

the model did convey a lot of information and that it was useful to have the potentially

hindering factors clearly identified. She recommended further chunking of the themes, which

may well be undertaken in future studies by others and by myself. It also leaves open the

possibility that local groups could use the model presented here to create their own model,

which may be of greater meaning to them, e.g. using their own terminology, and highlighting

their own priorities, strengths and weaknesses.

5.3.10 Limited consultation with original rotatees

Those who originally participated as rotatees, managers, educationalists, and commissioners

have had very little opportunity to comment upon the emerging model, and would no doubt

have some important and varying reflections and interpretations to offer the emerging model.

This would also constitute another study which may well be undertaken. In particular those

rotatees who were employed to work in ‘hard to staff areas’ have themselves not commented

on the model and would no doubt, with hindsight, have some interesting comments to make

about the model and its use. Additionally they may provide greater insight into the negative

factor associated with job rotation that as yet remains barely explored. A follow-up study

with these stakeholders could yield useful knowledge.

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5.3.11 Limited opportunity for the expert panel to comment upon the emerging model

The expert panels that provided their views on what they considered to be the most important

factors for successful job rotation have not had an opportunity to view and reflect upon the

model that has emerged from my analysis of the data they provided. As such there is at least

another study to be undertaken to validate and to refine the model.

5.3.12 The limits of a changing action research community of practice

It emerged that many of those who were leading in the study displayed enduring leadership,

and a determination to support the pursuance of both nursing and human resources

knowledge. However, whilst action research study normally occurs within a defined group,

there have been substantial changes to the group over time. Little is said in the literature

about the changing nature of such communities or communities of practice (Wenger 1998)

and the impact of the gain and loss of community members, who can be key to success.

However, in this instance, many stakeholders have left, changed job or have joined the

project and many of those who were job rotatees have now become managers themselves.

Thus the community that had a problem for which job rotation was a possible solution and

which set up the research studies is not as it was 8 years ago. The feedback is to a modified

community, potentially some of whom might not be interested. It should however be said

that there are many members of the original community still working for the organisations

and still interested in job rotation. In addition the issues of staff recruitment, retention and

development remain priority issues due to early retirements of mental health nurses and the

on-going privatisation of NHS services. Finally the stakeholder group, in the light of the

breadth of the literature reviewed above, has become larger including engineering and

general business, national and international, and so the local action research community in

some respects can be seen as part of a larger community of interest.

5.3.13 The limits of my interest, values, persuasiveness and endurance

Finally one of the key limitations of this study has been my own interest in job rotation,

action research, sustained organisational change, learning and ability to negotiate and

persuade others to support this endeavour. There have been times when I have had to be very

patient with colleagues and allies who have been unable to support the project or have been

hampered and times when I have been distracted by new posts and other professional

challenges such as consulting to the high impact relapse prevention project in Brent. The

length of time required for the writing up of this study necessitated taking unpaid leave from

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work to finish it, as my job requirements meant that I just did not have the time to ‘think’ and

write in this highly reflective way. So it is possible that more could have been made of this

study. However it is also fair to say that much has been achieved with limited resources and

a drive to contribute ethically to my profession and to not waste the potential of the

endeavour.

In conclusion there are a number of limitations to do with the available knowledge and theory

in the area, my developing capabilities, the undertaking of the study and the construction of a

persuasive argument. Finally my own potential and actual contributions have enabled and

limited the study. However, there are many elements of the study that have been and are of

use to my local organisation and my profession.

5.4 Learning from this study – what I would do differentlyLearning from trial and error, or in effect learning from my mistakes, and within a reflective

and supportive network of colleagues and supervisors leads me to suggest a number of

possible differences that I would make should I be repeating this study.

5.4.1 Greater involvement of rotatees as an expert panel

I would invite a group of rotatees to comment upon the research studies undertaken and seek

their views about the key factors associated with successful job rotation. I believed that

senior professionals and policy makers needed to be exposed to the views of rotatees in the

other research studies. However, on reflection, I think that, in addition to gathering the

rotatees’ views of the research findings, their views of the scheme from their positions some

years on would also have been of use and would have modelled the notion of emancipation

much more fully.

5.4.2 Key local partners as an expert panel

I would also involve the key partners, especially service uses and carers, partnership

organisations, the education providers and the local commissioners. This would not only

provide the view of key participants but would also increase the potential for increased

sustainability of job rotation in the local environment. Politically, their views are now needed

as part of the grant applications process and for commissioning applications, so from become

a ‘good idea’ their involvement has rightly become essential.

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5.4.3 Expert panels and co-facilitation

The second expert panel included two key differences from the first, i.e. a co-facilitator and

an explicit exploration of potentially hindering factors. I would ensure that both groups

included these features to provide me as the lead researcher with on-going reflection and with

more information about those factors that need to be explicitly managed or avoided if job

rotation is to be successfully used.

5.4.4 Time

I would be much more realistic about time for both the expert panels and also the analysis

and write up. Although this action research project and job rotation for nurses is a passion of

mine, it is not a priority for my current post. As such, there were enormous time and

prioritisation conflicts for the studies in the series and this one in particular, despite the fact

that I have received support from my employers. Whilst a work-based learning doctoral

study should be a key part of a post, it is also clear that my job and context priority changes

led to difficulties in sustaining my interest and ability to complete the project. This did

require local negotiation, endurance, support, good planning and more time than I had

expected.

5.4.5 Critical realism and action research

I have learnt a number of important matters whilst undertaking this write up of the study,

especially about the critical realism perspective. One of the benefits is that I feel that

different types of study, mixed methods, and triangulation, are much easier to coordinate and

justify within the idea of stratified knowledge and the testing of theory by its practical use.

These benefits are enhanced by the close fit between this paradigm and action research and

thus will provide me with a much clearer ontology and epistemology for future work on job

rotation and indeed other areas of professional and clinical interest.

5.5 Yet…What findings are of worth and merit?

5.5.1 An important research question

One of the implicit findings of this study is that job rotation per se is worth researching. It is

clear from the literature review that job rotation is widely used for many purposes and yet

there is a dearth of research. From the point of view of health services with limited funds,

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whilst job rotation is used, it appears to me that little is known about when and how to

implement job rotation, not least because of the small body of published evidence.

5.5.2 Whole system and action approach to develop useful practice theory

The findings support the proposition that a community focussed, emancipatory action

research based approach to change and job rotation was a useful approach to take. It is clear

that the various key stakeholder groups have important contributions to make about how to

understand job rotation and are prepared to go out of their way to participate in the research

studies, and the expert panels associated with this particular study. It is also clear that the

participants had much to contribute to the understanding of job rotation captured in this study

under the headings of structure, processes and outcomes. Consequently this approach

enfranchises stakeholders, discovers new knowledge and also disseminates knowledge

rapidly through the on-going learning and community approach.

5.5.3 Drawing together a number of methodological techniques

The study also shows the benefit of building up bodies of knowledge and of undertaking

reflective reviews of the knowledge, in this instance a merit and worth formative evaluation.

This type of reflection helps to set the scene for future work from a thoughtful perspective,

rather than rushing forward to make claims that might not be substantiated and ‘building on

sand’. The approach used here brings together evidence from a number of studies and

approaches, via the expert panel and nominal group techniques process, to allow key

knowledge to emerge.

5.5.4 Views of those actually experiencing job rotation as managers, supervisors, and

rotatees

This study does respect and acknowledge the views, i.e. personal and professional

knowledge, of those members of the expert panels who offered their opinions about the key

factors associated with successful job rotation. Not only are their views tabulated in the

appendix, but also the process of template analysis and interpretation has attempted to use

participants’ own words and to avoid over interpreting their contributions.

5.5.5 Work-based learning approach and personal circumstances

One of the results of the study for me has been my increasing appreciation of the work-based

learning approach, in particular the need to set up learning objectives that are useful to the

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organisation, to me and to the university. This study has benefited from the on-going context

of work-based learning and from the supervision I have received to undertake and complete

this project. In effect the work-based learning approach has supported not only the

emancipatory objectives of this study, but also my own in relation to this course and in

inhabiting the role of nurse consultant and taking the role forward.

5.5.6 Contributing to sustainable change

This action research project, and this study in particular, exemplifies its usefulness as a tool

in my professional leadership, which on reflection was my intention when I took up the post

to lead job rotation. Whilst my clear intention was not to waste the opportunity and to

establish research studies to learn and share from the work, I had not expected that the studies

would take ten years and would be a sustained piece of research and management, nor indeed

that the result would contribute to policy development. From a leadership theory point of

view, the neurolinguistic programming notion of developing a well-formed outcome has been

something that was important at the start of the project, i.e. to make a substantial contribution

to the knowledge base on job rotation from the learning that colleagues and I would achieve

in the course of our projects. However this objective has had to be revisited and realised

many times over the years to develop plans to take the project forward, all of which has

benefited from supervision was several key colleagues who have helped me with the practical

and emotional elements of the leadership work.

5.6 Findings that could have been anticipated from the literature

5.6.1 Useful for recruitment and retention

The literature does confirm the original belief that job rotation could be useful to managers

for recruitment, retention and staff development, albeit with flimsy evidence to support this.

Consequently, whilst a number of issues could have been anticipated from the literature, there

is much that is unknown and much that has been ‘unthought-of’. Thus the findings from the

studies in this series and from this study in particular add to the developing knowledge base

on job rotation and its use.

5.6.2 Diverse use of job rotation

The literature does describe the use of job rotation in a variety of different industries and

organisations and also shows that its use is global. Interestingly there is a small amount of

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evidence identifying differences between those organisations that use job rotation and those

that do not, i.e. adopter organisations, in particular the idea that job rotation is used by

organisations that are responding to changing contexts and organisations that are ambitious

for change, and realise the need to develop their workforce. It is clear from the literature that

job rotation is used as a tool to achieve a wide number of organisational and employee goals

and even community goals through return-to-work schemes. Recruitment and retention of

staff is one well acknowledged outcome for the use of job rotation, a key objective of this

action research programme. However the details about the structures and processes that need

to be in place to set up job rotation schemes, represent a gap which is of great importance

since these issues affect the effectiveness and efficiency of such schemes and inevitably their

sustainability. This gap has to some extent been addressed by the model produced in this

study.

5.6.3 Developing a body of useful evidence on job rotation

A commonly addressed issue in the poor utilisation of research findings (Bellman 2003;

Sheldon 2005) is the theory-practice gap, which this study set about addressing by

systematically developing knowledge about job rotation in a local setting and utilising and

testing the knowledge at the same time. The learning was disseminated rapidly and

continuously to allow colleagues to assess its merit and worth and to use it when they

considered it. Additionally this study has exposed many colleagues to a particular research

approach and process, which, in addition to increasing their awareness, may have increased

their research capabilities as part of its emancipatory approach. All stakeholders have been

involved with data gathering, critical evaluation and research application over the past eight

years. Although these matters are addressed in the literature, little is said about how this can

occur and, in this instance, the study highlights how emancipatory action research can be

implemented and how models can be developed using expert panels and nominal group

technique.

5.7 That which is novel from the findings/study Despite the limitations of the literature, methodology, analysis and findings, there is much

about this study which could be of use to the local community from which it emerged. It

could also be useful to health service colleagues and nurses and indeed to organisations

beyond health in mainstream industry and business. As it happens, I have already shared the

model that has emerged with a colleague who is trying to develop job rotation and have had

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some feedback on its usefulness. This is the beginning of the next phase of job rotation, i.e.

the refining and testing of the model.

5.7.1 Comprehensive literature review

Whilst other research studies have reviewed literature related to job rotation few have

reviewed very much and, as such, the literature review here is exceptional in its breadth and

depth.

Critically the review could be said to be highly descriptive. However at this stage in the

development of the knowledge base on job rotation, I find myself having to describe those

ideas that are available, albeit from studies that are highly limited, and yet do make a

contribution to the ‘thought pool’ about job rotation. An important finding from the review

was the confused nature of the literature with its many synonyms and different schemes,

leading to a large amount of confusion in knowledge generation and utilisation.

It is fair to say that little is said about key structural issues such as class, race, gender,

politics, poverty or war (Lather 1991). Yet these matters do occur in the literature with some

suggestions that job rotation may be used more in organisations with a high proportion of

women staff. There is little about race and culture except that Eastern countries may use it

more than western. There is a clear idea that job rotation is a key part of senior management

or executive development or alternatively used to induct new people to work but little is said

about the covert ‘informal job rotations’. There are issues in Europe, where those countries

that are more socialist have used job rotation as a means of getting people into work and

where the EU has attempted to use job rotation to facilitate the free movement of workers.

Little is said about poverty or war, except that perhaps in Europe the notion of free borders is

part of a plan to reduce the conflict between countries and, as such, a fluid approach to work

could form a cohesiveness that would undermine sectarianism.

I consider the five other studies in this series, and indeed this study itself, as contributions to

the societal need for good quality health services, which could benefit from the expanded and

more sophisticated use of job rotation. I would expect that their limitations are critically

considered, but in a way that takes the study of this organisational change tool forward rather

than ‘cutting the legs from under it’ at this stage.

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Finally a new definition of job rotation has emerged from this review, my personal definition,

as mentioned in section 2.4, i.e.

Job rotation is the purposeful and organised movement and education of staff

within and across organisations to enhance both the success of the organisation

and the employability of staff.

I expect that this definition will give colleagues a clear idea of job rotation and its potential.

5.7.2 Specific data and interpretations about structures

The study provides insight into the structures that need to be in place for a successful job

rotation scheme to be implemented and for the desired outcomes to be achieved. It addresses

both ‘hard’ structures such as stakeholders and stakeholder planning meetings as well as

‘softer’ factors such as commitment and support. Clearly these structures are costly for any

organisation or community to provide and intriguingly no mention is made in the expert

panels’ contributions about money or time as structures. It is, as with a number of issues

implicit or perhaps unacknowledged as specific structural items with cost implications.

The structures that are identified could form the basis of any ‘upfront’ manual of job rotation

that would be available to potential rotatees or indeed stakeholders and managers of such

schemes. It is interesting to me how rotatees and supervisors in earlier studies wanted

upfront information about the job rotation schemes and interesting that the action research

groups did at one point try and put together a manual of job rotation policies and procedures

but, as with many schemes in the NHS, it was not completed. Staff left or moved post and

the development cycle was not completed. It might well be said that the attempt was

hindered by a lack of understanding of what they were trying to describe. Many of the

structures and concomitant processes, indeed the potential outcomes, were unknown to the

working groups and to me as the leader and facilitator of the schemes, eventually across four

boroughs and two very large organisations. However the overall commitment to the on-going

research process did provide the potential for such knowledge to be gained and to develop

manuals, policies and procedures which might actually be useful. The model that has been

produced will help interested groups to develop their own evidence-based manual.

There is however, a political agenda to the emancipation of nurses and their access to job

rotation. Most nurses are women and members of the middle or working classes, whether

they or their stakeholders wish to see them in positions of power is open to question, in the

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health fields or other areas. Despite society’s needs and expectations that nurses promote

health and well-being, there are opposing forces. Twelve million professional nurses

internationally are a force, undertaking enormous amounts of work each day to maintain and

promote the health of individuals and their communities. However they could also to be

viewed as a potential threat to those who do not view these values and objectives as important

or who fear for their own position and power if nurses were permitted to make a greater

contribution.

5.7.3 Specific data and interpretations about processes

Processes for the implementation of job rotation for nurses, and indeed others, need to be led

and managed. As such, there needs to be structural commitment to such roles and, as the

participants here and elsewhere recommend, that commitment needs to be sustained. As is

often the case, in my experience of the health service, projects finish not when completed or

evaluated and shown to be no longer of use but when pushed off the priority agenda.

Consequently this research study is uncommon and does identify key processes, many of

which could be the core of general leadership and management texts (Hersey, Blanchard,

Johnsson 2007), but which may not always be known by all of the potential stakeholders. As

such the processes identified here and included in the model of job rotation can illuminate

grey areas, and promote more successful job rotation schemes.

However it is worth wondering about those processes that are out of sight or awareness and

not presented to the researchers and possibly not even known amongst those involved. For

myself, I am aware of my manipulation of circumstances to continue to develop the job

rotation schemes, of the compromises that I made to support the ongoing research process at

the expense of the satisfaction of some of the rotatees or their managers. I am aware of my

fury at rotatees who decided that some patients were more important than others i.e. acute

adult patients vs. elderly patients. Thus there are, I suspect, many other issues to do with

establishing and implementing the process of job rotation within health services which are yet

to be uncovered, let alone explained or presented within the context of predictive level

theory. The model produced here does make clear the notion of the need to manage

unconscious or out of awareness forces as key to success (Obholzer and Roberts 1994).

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5.7.4 Specific data and interpretations about outcomes

The possible outcomes from job rotation that have been identified by the expert panels

confirm many of those identified in the literature review, but also introduce new outcomes,

e.g. sustainability, increased research capabilities and reducing the risk of institionalisation.

However these are to some degree implicit in previously identified outcomes, e.g. business

success, local assessments of usefulness, and promotion of a creative learning environment.

Thus they are present in their negative or tangential form. Additionally little is said about the

potential negative outcomes of job rotation, such as dissatisfaction. In only one study is this

mentioned in the literature, it was amongst highly educated employees who wanted more. In

this study, it is clear that job rotation can contribute to satisfaction and thus its absence could

lead to dissatisfaction, noted by some participants when they identify frustrations with

limitations to the scheme. Participants in this study considered that the transfer of learning is

useful generally useful. Consequently in the absence of job rotation, a barrier to the transfer

of knowledge, in a useful way, may exist.

What is not clear in all of the outcomes is the precise economic benefits or indeed the precise

health benefits of job rotation. In our earlier studies, we did find that participants highlighted

better coordinated care and greater understanding of patients as outcomes. However those

outcomes were related to both job rotation and a structured programme of learning.

What is key from this study is that experts found, that whilst job rotation per se might provide

useful outcomes, it was clear they felt that important supporting structures and processes

were needed, e.g. an accredited and indeed work-based learning education programme was a

key structure and process that contributed to the outcomes. It is interesting that learning is

implicit if not explicit in the literature. However the nature of the learning is rarely specified

and, in this series of studies, the work-based approach, where employees identify learning

targets that are of use to themselves and the organisation in partnership with the educational

establishment, does seem to impress key stakeholders, as it did the rotatees and their

supervisors in the earlier studies. Paradoxically participants have said very little about

building evaluation structures and processes into the ‘successful model of job rotation’,

despite being involved in the evaluation of the scheme, leaving me feeling as though I had to

contribute this factor if the model was to be useful.

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5.7.5 A model of job rotation

The major result or product of this research study is the evidence-based model of job rotation

in section 4.6. Whilst, as can be seen from the literature review and our own studies, there

are many ideas and theories about job rotation with varying degrees of evidence and rigor in

their construction, this model is the only comprehensive model that I am aware of. It

includes the contributions, reflections, interpretations and conclusions of various experts in

health and nursing, rotatees and their supervisors and various researchers who have been

involved with the projects. It also includes my own interpretations of the data and is thus a

view that I hold about job rotation, albeit highly informed by others.

The model contains the claims, concerns and issues of a highly diverse stakeholder group,

including myself, from the local action research community and others in the nursing

profession and health fields. In line with Guba and Lincoln (1989), Winter and Mumm-

Giddings (2001) with Bhaskar (2008), the proof of the value is in the usefulness of the model

to the key stakeholders and their actions. Clearly knowledge from this action research study

has been of use to many and cited by many. It will be interesting to me see how this model is

received and used.

The next phase is to disseminate the model to various local and interested stakeholder groups.

This will be undertaken by conference presentations and by publications, as well as making

the report and model available on the internet. The expectation is that the model of job

rotation will assist professional leaders and managers to identify the necessary structures and

put in place the processes that are needed to achieve the outcome(s) they are seeking to

achieve by the use of job rotation. With this structured approach, they would also be able to

put in place - ideally as a key structure - an evaluation mechanism to develop the knowledge

base about job rotation. All in all this model should help policy makers to target post

registration education for nurses and others and should also help them to specify the need for

focussed research.

I am aware of the personal and professional responsibility that I have to previous and current

stakeholders and those that gave of their time and energy in the various research studies to

take their views forward. There are times when job rotation does seem to be low on my list

of priorities. However, the fact is that I have chosen to work in this area and to lead the

research and, as such, I find myself driven to continue to develop knowledge in this area and

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to promote the career development of nurses, particularly within an emancipatory context,

and one that model the emancipatory approaches that exist to patient care and public health. I

believe that my time and resources have been used well.

5.7.6 Emancipatory component

Using the critical realism ontology and the emancipatory action research approach required

that methods chosen that were consistent and, as such, the use of nominal group technique,

with template analysis and the hermeneutic dialectic process for interpretation of the results

does have a degree of internal consistency. What is perhaps unclear to me at this point is the

degree to which those who participated might be aware of these approaches. There is a sense

that I as the researcher chose those approaches and techniques without consultation with

others. Thus there is a question about whether the study enfranchised the key stakeholders

sufficiently and whether there was an improvement in the balance of power, and an

opportunity to learn and become empowered.

As mentioned earlier there is the question about whether the stakeholders actually believed

that they needed to be empowered and that the reading is in fact my own. All of these critical

concerns have to be tempered by the conclusion that, as a professional leader I have to make

decisions and leave the choice to others of whether they follow or not. In this instance, from

the reflective feedback of the expert panels, there is both a mechanism to seek their views of

their experience and their learning, as well as a concrete opportunity for reflection and

learning, beyond being ‘used’ as sources of data.

The degree to which this study exemplified my values is in the hands of readers. However, I

would say that I do believe that I have made an attempt to live those values of freedom,

equality, autonomy, integrity and truthfulness, and to take the rhetoric of critical theory

forward by trying to implement it within my own practice and amongst my own colleagues

and indeed in my own professional life. I am aware that there are a number of limitations,

not least the privileged position that I hold in my own organisation and profession, which

gives me legitimacy to try these approaches out. My expectation is that readers who have

similar values take this case study as an example to learn from, the successes and the failures.

In so far as this study succeeds, I am pleased that it is in harmony with the nursing

profession’s core values. There is a need for congruence in a highly fragmented context and

this approach to knowledge generation could support that.

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5.7.7 Role of personal and professional reflection and support with critical friends

What is not so obvious in the study so far has been the support and supervision that I have

received for the project over the past ten years and for this study over the past 18 months.

Whilst I have had a determination to undertake and complete this study, there have been

times when I have been distracted by other work or personal priorities and have been grateful

for the help of colleagues. I chose to seek supervision from a colleague who taught me

neurolinguistic programming to help me to keep this study on my list of priorities. It was

useful to reprioritise as life events altered the horizon but to keep this project on the list.

Additionally I have been immensely lucky with my co-researcher on many of these studies

who has helped me to explore not only the studies, but who has listened to the innumerable

barriers and tolerantly supported my attempts to overcome them. I have also been

consistently and enthusiastically supported my supervisor at the University who has provided

sound advice about the tasks to be completed and helped me get a sense of perspective over

the tasks, at times when I have not know what I was actually attempting to learn and achieve.

Thus whilst it is true that I have led this study and done the vast majority of the work, I have

done so in a very supportive and skilled context, one that others need to be aware of and, in

my opinion, should consider developing such a professional network for themselves

Wheatley (2002). There is a notion of researchers ‘doing it all themselves’ which I believe is

often inaccurate, but rarely mentioned in the write ups of studies.

Also the authorship of this study could be mistakenly taken to mean that I am the only one

involved with it. As it happens I have done most of the work associated with this study, but

very much in partnership with the experts of the expert panels and many other colleagues.

The findings of this study are my interpretations of the contributions of the panels However

we all owe gratitude to those nurses who were employed in the job rotation schemes, their

supervisors and managers and many others in positions of power who supported and funded

the projects and who developed and delivered the educational packages, all to ensure that

service users of ‘hard to staff’ areas received at least basic nursing services and ideally much

more than that.

It is also an example of a piece of organisational research (Fulop , Allen, Clark and Black

2001; Iles and Sutherland 2001) that has several completed research studies that are easily

available and which have been subjected to regular and on-going evaluation by key

stakeholders in the practice, research and policy worlds. This is an exception in a context

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where many other potentially important projects have not been researched, completed,

published or made accessible to those who were involved with them, as well those who might

learn from them and who might have been able to pursue useful and sustained change and

improvements.

5.7.8 Reflections upon the criteria to judge the value of this research report and its

products

A number of criteria of quality have been aimed for in this research study and report as

specified in the methodology section. Every attempt has been made to consider the

Middlesex University Criteria for a major project at level five including developing original

knowledge and innovation, reflecting on the broad aspects of the context, ethics,

interpretation, professional practice, project development, communication, reflection,

collaboration and resource management.

Other factors such as those that define the quality of 4th generation evaluations, e.g.

trustworthiness, dependability and authenticity, have been considered (Guba and Lincoln

1989) with supporting information, consultation with the local community members,

supervision and audit trails, as well as my on-going reflections about strengths and

limitations, confusions and conclusions.

From a critical realist perspective a number of criteria could be considered, many summed up

by Elliott, Fisher and Rennie (1999) who identify 14 criteria, in particular I have endeavoured

to select appropriate methods that were congruent with the overall research approach and of

regularly sharing with readers my own contribution and owning my own perspective.

Finally I have aimed for my own evaluative criteria, particularly ethical issues, e.g. a ‘good

use of my personal and professional time’. Feedback from stakeholders suggests that this is

the case, as does citations of work and the requests of new stakeholders who are interested in

the results of this study. I also believed that for maximum impact there needed to be good

evidence that a wide variety of colleagues were able to participate actively in change,

reflection and learning about change and that learning from this study on job rotation would

be of value to others. It is my judgement that I have made every attempt to do this, and from

partners’ contributions I believe there is evidence to support this, not least the citation of

140

previous work in policy documents, and the feedback from colleagues, informally, on the

model.

Clearly both examiners and key stakeholders will have an opportunity to provide their own

views and to influence the content of the report. Their feedback will influence and contribute

to my development of my learning and capabilities.

5.8 What I have learnt from writing this chapterI have become aware of the potential of the model that colleagues and I have constructed,

particularly its potential to reduce the waste of time and effort that planning groups might

incur without evidence-based and accessible knowledge to guide them.

I am pleased that I have completed this study after such a lot of effort, mistakes, risks and

learning, and am pleased that I have a model to share with others. I am also pleased that, as a

spin-off, I have constructed my own definition of job rotation, which helps me to have a

better understanding of job rotation as I understand it and one which may be of assistance to

others.

I have also learnt that there are still many knowledge gaps that need to be addressed, in

addition to the many recommendations by colleagues, Dr. Lucock and I in earlier studies e.g.

Refinement of the model produced, including consulting the key stakeholders.

Economic evaluations to build up a body of evidence to judge the economic

evaluation of job rotation and to contribute to persuasive arguments for its use.

The nature and role of informal job rotation schemes and how they might be

formalised.

The effects of structural factors on the development of knowledge about job rotation,

particularly by nurses.

How can outcomes from job rotation be measured and explained and also how can

unintended consequences – useful or otherwise - be identified?

How can critical realism, emancipatory action research, nominal group technique,

template analysis and the hermeneutical dialectic process be further incorporated into

nursing and health care research?

How can nurses be supported to participate in work-based learning doctoral studies?

141

How can time be negotiated in organisations for the development of new knowledge

by nurses?

How can job rotation be used with other personnel and professions?

In-depth study of managers’ and commissioning stakeholders’ views.

Explore adopter organisations and non-adopter organisations – their differences and

similarities at any one time and across time/context.

How can a virtual institute(s) be developed and led to take job rotation research

forward in a co-ordinated and high impact way?

Software to co-ordinate job rotation across complex organisations.

I wonder, which if any, of the above I will be involved with. Finally I am wondering how I

will go about sharing this knowledge beyond the nursing and health fields and look forward

to the enterprise.

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Chapter Six: Conclusions and recommendations

6.1 ConclusionsIn conclusion, this study has met its aims and objectives by being a contribution to innovation

in nursing and mental health services and by its formative evaluation of the research studies

previously generated from this action research study in order to develop an evidence-based

model of job rotation [see figure 9]. It has maximised the impact of the research studies, the

processes and the time commitments of participants, their goodwill, as well as the methods

chosen to promote sustained change via emancipatory action. It has used the knowledge

generated from this local organisational study and previous studies to sustain change and take

forward its use, development and evaluation in the local context and beyond.

6.2 The productsThe products that have emerged from this work-based learning research study include:

1. The enhancement of my professional leadership by the development of my work-

based research capabilities and my ability to be flexible and adaptable enough to

innovate and to contribute to the development of local and professional knowledge.

2. An evidence-based model of job rotation

3. A job rotation model to support the development of local evidence based job rotation

implementation manuals to meet local objectives.

4. The most comprehensive critical literature review available on job rotation at this time

and my own definition of job rotation.

5. Collaborators and partners in this research study have learnt about research and have

found the process useful.

6. Further contributions to the increasing evidence held on my website

www.nurserotation.com which has been in development over the past ten years. This

site will continue to share job rotation related evidence with colleagues in an easily

accessible manner. It will also encourage networking and future job rotation

developments, including the development of evidence.

7. It is a practice example of the use of emancipatory action research to generate useful

practice knowledge.

8. The knowledge from the action research project has been disseminated and used, as

has the model from this study in the local context.

144

9. A number of knowledge gaps and possible future research questions have been

suggested.

6.3 Recommendations for future actionA number of recommendations for further work by professional leaders, researchers,

managers, commissioners and policy makers include:

6.3.1 Information for local decision makingMany stakeholders, including junior nurses, have been involved with the research, and

hopefully will be inspired and supported to participate and lead research themselves to

improve the effectiveness and efficiency of NHS management and leadership.

6.3.2 Incorporating work-based learning partnershipsDeveloping partnerships with educational organisations with good track records of

partnership and of work-based learning is a challenge for organisations. However, the

benefits accrued by this project should be considered and explored by workforce

confederations.

6.3.3 Involving all stakeholders in the change processThe involvement of all key stakeholders, including service users and carers, in the

organisational teams for research is an important recommendation from this study. It will not

only provide ideas that would not otherwise have been considered but it could also lead to

practice based projects that truly enfranchise service users and carers as ‘expert patients’ and

carers, in the development of services. It could also lead to skill acquisition and accreditation

of the learning undertaken by service users and carers something which could go some ways

towards their own empowerment and career development.

6.3.4 Inclusion in health policy The findings of this study should be widely disseminated in order to give policy makers an

opportunity to determine the potential usefulness of the findings, in particular those

encapsulated in the model. Thus an active programme for dissemination needs to be

developed, including taking the results back to the expert panels and others who have been

involved locally in job rotation to seek their assistance to disseminate the findings, and to

consider their implications.

It is also important to remember that much of the literature on job rotation describes its use

beyond the nursing and health fields. Thus it should be shared widely, seeking publication in

145

journals that are not health related and talking at conferences beyond those at which I would

normally present.

6.3.5 Use for nursing professional practice developmentIt is clear that job rotation is highly influential for the development of change agents and

leaders and, as such, should be widely used by nurses. It also has the advantage of needing to

be coupled with an educational programme, which organisations can strategically encompass.

As a consequence of this work-based partnership between organisations, educational

establishments, and the individual, it has the potential to result in educational and research

projects that are highly applicable to the patients and communities serviced by nurses.

6.3.6 Sustained leadership and managementConsistent and sustained leadership of job rotation projects is needed to establish and to

sustain such projects and the numerous potential benefits of its use. It is, of course, difficult

to maintain leadership with changing policy priorities and with career development changes

of personnel. Consequently it is worth senior managers and directors investing in long-term

and experienced leadership from the beginning and to put in place the development of

successors who have the values, vision and skills to lead complex teams in dynamic

situations.

6.3.7 Enhance evidence-based practice, audit and researchFurther research to maximise the impact and nature of job rotation through evidence based

job rotation implementation models and job rotation manuals is needed. Both dissemination

and consultancy support also needs to be built into job rotation projects and their allied

evaluations projects, with full utilisation of the internet and social networking sites e.g.

website www.nurserotation.com, youtube.com and facebook.com Finally colleagues need to

reflect upon the immense potential of the critical realist paradigm to overcome research

rivalries and to produce more emancipatory and useful research knowledge.

146

147

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Appendices -

Appendix 1: Summary of Programme Plan - Authorised.....................................................172

Appendix 2: Essential Characteristics of Job Rotation Scheme 2002...................................173

Appendix 3: Interpretation of Experienced Nurses Two research study by expert panel - West London...................................................................................................................................175

Appendix 4: Participants in the expert panels.......................................................................178

Appendix 5: Nature of data recorded on postit notes produced by Nominal Group Technique................................................................................................................................................179

Appendix 6: First template analysis – Cohort four, West London Expert Panel...................180

Appendix 7: Email from colleague in Wales about setting up job rotation schemes............182

171

Appendix 1: Summary of Programme Plan - Authorised

172

Appendix 2: Essential Characteristics of Job Rotation Scheme 2002

3 eight month placements Level 3 education: CPA;

Assessments: Management

Accredited work based

learning

Newly registered Staff nurse development D to E conversion against

competencies at 6 months

Development groups Overall project management

group

Project co-ordinator ‘join up

working’

Clinical Supervisors support Action research evaluation Partnerships: Trusts,

Education, Research, Nurses,

HR

Dissemination plan ‘hard to staff’ areas Substitute bank/agency

ROTATIONAL SCHEMES

Outcomes173215

D/E Intern/Rotation Scheme/Work-Based Learning

Experienced Nurse Rotation Scheme

174

NSFNSFResearcResearchhProjectProject

216

Appendix 3: Interpretation of Experienced Nurses Two research study by expert panel - West London

Input Throughputs Outputs

Structure Process Outcome

Characteristics of RAL –

educational needs

Motivated Value of the scheme for

the organisation

Educational needs Commitment Leadership programme

Lack of personal issues –

personal stability

Pressure of work – being

released from current job

Job satisfaction

Nature of the modules Commitment Gains from application at

work

Work based learning and

action learning

The experience of

reflection

Value of the scheme for

participants

Equal opportunity Change and development In terms of staff retention

it has been helpful

Partnerships with service

users

Supervision More knowledge about

research and educating

carers – I was able to pass

that on

Value of the scheme for

the clients of the nurses

taking part in the scheme

Educational support The way I think and speak

with clients has changed

for the better

Commitment Work opportunities - threat

Clear goals and purpose Sustained supervision

Aims and objectives

Desire to undertake the

degree programme not just

for oneself but for the

clients that we are looking

after

175

Interpretation of Experienced Nurses Two research study by expert panel -

Northampton

Experienced Nurse Two (prioritised):

Priority Structure Process Outcome

1 (top) Define ‘experienced’ i.e. time

or seniority or been around to

ensure appropriate rotation

Recognition of current

knowledge and gaps –

reflection of personal learning

Choice of experience nurse with

validated criteria

Long term relationships

between stakeholders

Accredited work based learning

– to help build up knowledge

base

More

motivated/effective

leaders with increased

knowledge based that

is recognised by the

wider NHS

Capture the learning –

inform and develop

the organisations

Retention of the most

able staff in

senior/experienced

roles

2 Negotiated learning with ‘open’

modules

Experienced nurse – aim and

objectives, core vs personal

Suitability of staff

Shadowing the replacement

rotational member prior to

covering the placement in an

unfamiliar area

Conflicts/demands

managed within the

rotation job rot ensure

time for study and

reduce the potential

for stress

Need organisations

infrastructure to

support the ‘loss’ of

the leaders and the

‘gain’ of a new one.

Opportunity to

develop and change

with increased

knowledge, skills and

job satisfaction

3 Replacement staff

Communication of knowledge

and implementation skills

Human resource processes and

functions

Monitoring the

progress of

experienced nurses

Self management in

regard to rotations –

Mutual benefits to

participants and

organisation as a

whole

Trust boards and

176

flexibility educational support is

on board with support

for seniors managers

i.e. negotiated risk

4 Process needs to be managed –

like for like, cost effective, cost-

neutral

Specific modules for level of

staff – leadership etc

Level of

supervision/supervisors

Education needs to reflect if it

not just clinical skills and

knowledge being accumulated –

softer skills e.g. influencing

Dissemination of

consolidated learning

outcomes

Career development

and service

development

This presents powerful

rationale for

transferable skills

5 Human resources infrastructure

for pay etc

Different levels of

commitments ‘shadowing’ to

job share, with shared

objectives

360 degree appraisal

Self direction and

management

Selection of

expert/highly skilled

experienced nurses as

future leaders

Demonstrable

improvements in

care/outcome to

support sustainability

177

Appendix 4: Participants in the expert panels (anonymised)

Names of participants on Expert Panel WLondon

Ward Manager

Clinical Nurse Specialist

Ward Manager

Ward Manager

Ward Manager

Community Nurse

Operations Managers

Expert Panel: Northampton

Role

Clinical Audit Lead

Strategic Nurse Manager

Head of Education

Matron Palliative Care

Speech and language

therapy manager

Deputy Dean, School of

Health

Branch Sec. RCN/CNS

Branch Sec. Unison/CNS

178

Appendix 5: Nature of data recorded on postit notes produced by Nominal Group Technique

179

Appendix 6: First template analysis – Cohort four, West London Expert Panel

180

First template analysis – Cohort four, Northampton Expert Panel

181

Appendix 7: Email from colleague in Wales about setting up job rotation schemes

182

183