Myth-management in the NHS

Medical leaders or masters?-A systematic review of medical leadership in hospital settings

Medical leadership is increasingly considered as crucial for improving the quality of care and the sustainability of healthcare. However, conceptual clarity is lacking in the literature and in practice. Therefore, a systematic review of the scientific literature was conducted to reveal the different conceptualizations of medical leadership in terms of definitions, roles and activities, and personal-and context-specific features. Eight databases were systematically searched for eligible studies, including empirical studies published in peer-reviewed journals that included physicians carrying out a manager or leadership role in a hospital setting. Finally, 34 articles were included and their findings were synthesized and analyzed narratively. Medical leadership is conceptualized in literature either as physicians with formal managerial roles or physicians who act as informal 'leaders' in daily practices. In both forms, medical leaders must carry out general management and leadership activities and acts to balance between management and medicine, because these physicians must accomplish both organizational and medical staff objectives. To perform effectively, credibility among medical peers appeared to be the most important factor, followed by a scattered list of fields of knowledge, skills and attitudes. Competing logics, role ambiguity and a lack of time and support were perceived as barriers. However, the extent to which physicians must master all elicited features, remains ambiguous. Furthermore, the extent to which medical leadership entails a shift or a reallocation of tasks that are at the core of medical professional work remains unclear. Future studies should implement stronger research designs in which more theory is used to study the effect of medical leadership on professional work, medical staff governance, and subsequently, the quality and efficiency of care.

Gaps Between Actual and Preferred Career Paths Among Professional Employees

Organizations are increasingly opting to offer alternative career paths to the traditional managerial ladder (particularly, a technical ladder). Although research has mainly focused on differences between the managerial and technical paths with regard to rewards and prestige, our study focuses on gaps between employees’ actual (current) and preferred career paths, that is, being on the technical path while preferring the managerial path and vice versa. We examine how employees experiencing career path gaps compare with employees experiencing career path fit, in terms of self-rated performance and burnout. The results, based on data from 210 professional employees working in four global high-technology companies, suggest that performance levels are lowest among employees who are currently on the technical career path but would prefer the managerial path, whereas burnout levels are lowest among employees experiencing career path fit. Furthermore, among employees experiencing the former, career path gap, performance is lower when supervisor support is high.

Lessons from understanding the role of community hospital director in Thailand: clinician versus manager

In 2001, Thailand adopted the Universal Health Coverage (UHC) policy. This policy focuses on primary health care (PHC), with the aim of reforming the Thai health system to provide health services to all, regardless of a person's ability to pay. The community hospital director (CHD) is the middle manager of the provincial health system and the leader of the district health system of Thailand. In recent reforms the emphasis for improving efficiency lies with changes in the provision of primary health services at the community level and this entails understanding the role of the CHD. A qualitative study, utilizing individual interviews and a focus group discussion, was undertaken in order to understand the factors affecting the implementation of rural health care in Thailand. Findings identified several barriers that limit the role of the CHD and a major result of the study was recognition of the dual role of the CHD as both clinician and manager. This study concluded that the goal of the UHC policy in providing equity of access to PHC to all citizens may not be achieved unless the role of CHDs is supported with training in health management and PHC and is supported by the government.

Developing an explicit strategy towards social responsibility in the NHS: a case for including NHS managers in this strategy

PURPOSE

To explore the concept of corporate social responsibility (CSR) within the UK National Health Service (NHS) and to examine how it may be developed to positively influence the psyche, behaviour and performance of NHS managers.

DESIGN/METHODOLOGY/APPROACH

Primary research based upon semi-structured individual face to face interviews with 20 NHS managers. Theoretical frameworks and concepts relating to organisational culture and CSR are drawn upon to discuss the findings.

FINDINGS

The NHS managers see themselves as being driven by altruistic core values. However, they feel that the public does not believe that they share the altruistic NHS value system.

RESEARCH LIMITATIONS/IMPLICATIONS

The study is based on a relatively small sample of NHS managers working exclusively in London and may not necessarily represent the views of managers either London-wide or nation-wide.

PRACTICAL IMPLICATIONS

It is suggested that an explicit recognition by the NHS of the socially responsible commitment of its managers within its CSR strategy would help challenge the existing negative public image of NHS managers and in turn improve the managers' self esteem and morale.

ORIGINALITY/VALUE

This paper addresses the relative lacunae in research relating to public sector organisations (such as the NHS) explicitly including the role and commitment of its staff within the way it publicises its CSR strategy. This paper would be of interest to a wide readership including public sector and NHS policy formulators, NHS practitioners, academics and students.

NHS trust chief executives as heroes?

This paper presents a reading of the transcripts of interviews with NHS Trust Chief Executives. Using a poststructuralist understanding of the interviews, it privileges a reading that (ironically) represents these Chief Executives as heroes. Following the classic hero story line, they leave the civilized order of home and journey into a threatening wilderness where they encounter dangerous and magical things but overcome them all because of their masculine characteristics such as rationality, strength and resourcefulness. One way in which these stories can be understood to have significance is that they (misleadingly but powerfully) portray management as obvious and necessary by evocatively drawing on a myth of ancient origin. The piece concludes with some reflections on the ontological implications of the analysis and reflexive comments on the production of truth as a problem.

Ignorance is not bliss. Doctors, managers and development

Current government policy places great emphasis on increased collaboration between disciplines and professions within health care, as in public services across the board. To date, analyses of doctor-manager relations have tended to focus on equipping doctors with management skills, once they have reached consultant level. In contrast, this paper evaluates a new management development initiative, designed to involve doctors and managers at an earlier career stage, and on an inter-disciplinary basis. Interview and questionnaire responses indicate that specialist registrars and young managers share common values; however, they also acknowledge a high degree of mutual ignorance. Evaluation suggests that inter-disciplinary programmes can provide a starting-point for closer collaboration in practice; in conclusion, some options for sustaining this in the long term are identified.

Comparative perspectives on doctors in management in the UK and The Netherlands

The role of doctors in hospitals continues to change due to both external (policy) and internal (organisational change) pressures. Comparisons between The Netherlands and the UK highlight that several models of medical management are formulated and exist alongside each other, leading to more flexibility in the roles of both doctors and managers. In particular, the agendas concerning the quality of clinical care and cost-effectiveness are converging, emphasising the increasingly important role of medical managers.