An investigation into the nature of individual and organisational capability and their linkage: how the competence of an NHS hospital is enacted through patient-care related actions and use of organisational artefacts by its doctors

The words 'competence' and 'capability' are used independently by the human resource managment and the strategy communities who relate the terms to people and organisations respectively. However, the linkage between the individual and organisational level is not well documented. A better understanding of this link is important in being able to understand how organisational and individual performance may be improved but also why things sometimes go wrong. This research based case study is to identify the linkage between individual and organisation capability through an examination of patient care provided by dcotors in St George's Hospital, Tooting, London using the perspective of the resource based view of the firm. The research showed that patient care is achieved through the emergent skilful exploitation by doctors of their own capabilities, interaction with others, an their use of artefacts representing technical systems, processes, and structural influences within which the doctor operates. The role of artefacts is particularly important because continuity of patient care is dependent on information provided via artefacts rather than doctors' individual knowledge of particular patients. Doctors need not only medical knowledge but also an understanding of 'how to work the organisation'. that is how to get the organisation to do what the doctor needs for the patient. Competent action of the hospital is dependent on a series of inter-relating and inter-locking activity systems, from the doctor carrying out direct actions for a patient through the operation of departmental support systems to the overall hospital level patient care systems. Contradictions or non-copetence occurred when there was a breakdown within or between the systems. A conceptual model and diagnostic is developed that will be of use in analysing these dimensions of organisational capability