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Sartirana M. Beyond hybrid professionals: evidence from the hospital sector. BMC Health Serv Res 2019; 19:634. [PMID: 31488149 PMCID: PMC6727521 DOI: 10.1186/s12913-019-4442-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 08/21/2019] [Indexed: 11/10/2022] Open
Abstract
Background The involvement of doctors in managerial roles seems to be the solution to reducing the friction between traditional professionalism and modern organizational paradigms. However, these “hybrid” professionals responded in different ways to these conflicting demands, and we need to better understand the contextual factors that explain such variation. Methods The paper studies hybrid professionals in a hospital characterized by numerous organizational changes. The site is located in Italy, a country in which healthcare organizations have been exposed to managerial reforms for years but where the degree to which professionals embraced management varies. A longitudinal case study was performed that involved gathering data through multiple sources of evidence to understand the complex organizational dynamics that take place in the hospital. Results The analysis shows that the taking up of hybrid managerial roles is enabled by a number of interrelated features of the social/organizational context. Professionals willing to become hybrids were favored by the support provided by the organization. While for those doctors initially more reluctant towards medical management, distinctive contextual factors, in particular, the presence of space for interaction with colleagues within the professional domains but beyond disciplinary boundaries, was of key importance. This second group also proved capable of interiorizing organizational values and practices in a reconfigured way. Conclusions In order to understand hybridization, it is necessary to look beyond hybrids at the context surrounding them. This study provides evidence for scholars and practitioners willing to understand how medical management is evolving and how this transition can be supported, and it contributes to the literature on hybrid managers by showing how contexts facilitating social interactions enable professionals’ hybridization. Trial registration The article does not report the results of a health care intervention on human participants, and material used in the research did not need ethical approval according to Italian law.
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Affiliation(s)
- Marco Sartirana
- CERGAS - Centre for Research on Healthcare Management, SDA Bocconi School of Management, Bocconi University, Via Rontgen 1, 20136, Milan, Italy. .,Utrecht School of Governance, Utrecht University, Utrecht, The Netherlands.
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Kuhlmann E, Shishkin S, Richardson E, Ivanov I, Shvabskii O, Minulin I, Shcheblykina A, Kontsevaya A, Bates K, McKee M. Understanding the role of physicians within the managerial structure of Russian hospitals. Health Policy 2019; 123:773-781. [PMID: 31200948 DOI: 10.1016/j.healthpol.2019.05.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 02/18/2019] [Accepted: 05/29/2019] [Indexed: 10/26/2022]
Abstract
This article examines the role of physicians within the managerial structure of Russian hospitals. A comparative qualitative methodology with a structured assessment framework is used to conduct case studies that allow for international comparison. The research is exploratory in nature and comprises 63 individual interviews and 49 focus groups with key informants in 15 hospitals, complemented by document analysis. The material was collected between February and April 2017 in five different regions of the Russian Federation. The results reveal three major problems of hospital management in the Russian Federation. First, hospitals exhibit a leaky system of coordination with a lack of structures for horizontal exchange of information within the hospitals (meso-level). Second, at the macro-level, the governance system includes implementation gaps, lacking mechanisms for coordination between hospitals that may reinforce existing inequalities in service provision. Third, there is little evidence of a learning culture, and consequently, a risk that the same mistakes could be made repeatedly. We argue for a new approach to governing hospitals that can guide implementation of structures and processes that allow systematic and coherent coordination within and among Russian hospitals, based on modern approaches to accountability and organisational learning.
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Affiliation(s)
- Ellen Kuhlmann
- Institute of Epidemiology, Social Medicine and Health Systems Research, Medical School Hannover, OE 5410, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - Sergey Shishkin
- National Research University - Higher School of Economics, Myasnitskaya street, 20, of. 221, 101000 Moscow, Russia.
| | - Erica Richardson
- European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
| | - Igor Ivanov
- Center for Monitoring and Clinical and Economic Expertise of the Federal Service for Surveillance in Healthcare, Slavyanskaya Square, 4, building 1, entrance 4, 109074 Moscow, Russia.
| | - Oleg Shvabskii
- Center for Monitoring and Clinical and Economic Expertise of the Federal Service for Surveillance in Healthcare, Slavyanskaya Square, 4, building 1, entrance 4, 109074 Moscow, Russia.
| | - Ildar Minulin
- Center for Monitoring and Clinical and Economic Expertise of the Federal Service for Surveillance in Healthcare, Slavyanskaya Square, 4, building 1, entrance 4, 109074 Moscow, Russia.
| | - Aleksandra Shcheblykina
- Center for Monitoring and Clinical and Economic Expertise of the Federal Service for Surveillance in Healthcare, Slavyanskaya Square, 4, building 1, entrance 4, 109074 Moscow, Russia.
| | - Anna Kontsevaya
- Department of Non-communicable Disease Epidemiology, National Research Center for Preventive Medicine, Moscow, Russian Federation.
| | - Katie Bates
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
| | - Martin McKee
- European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK; Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
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Abstract
PURPOSE The purpose of this paper is to give a comprehensive and updated analysis of the available academic literature (2000-2016) on management and reforms in the Nordic hospital landscape. DESIGN/METHODOLOGY/APPROACH A systematic literature review was conducted by searching articles in Scopus database, as well as applicable journals. FINDINGS The vast majority of the Nordic articles are relatively coherent on the following: first, the reforms have created a change in the manager role or rather there are new expectations about the content of the manager role. Second, the reforms entail tension between profession and administration. Doctors who are managers identify themselves primarily as doctors, implicating that the medical logic has not competed out by an administrative logic. Third, the reforms have brought new opportunities for nurses. Still, nurse managers perceive tension between the profession and administration. Fourth, new public management (NPM) is often the framework or background for understanding change in hospitals or manager roles in the articles. Fifth, the majority of the articles are focusing on management as a general key concept. RESEARCH LIMITATIONS/IMPLICATIONS The search was limited to the period 2000-2016 and have only included articles published in English. There are several limitations around these choices: first, research published in a language other than English (i.e. Norwegian, Swedish, Finnish or Danish) are excluded. Second, it may take years before consequences of hospital reforms have impact on management and manager roles. Some of the articles are published relatively shortly after the implementation of the reform. Third, many factors in a reform have impact on management or manager roles, thus it is challenging to give simple explanations. PRACTICAL IMPLICATIONS The authors would welcome a more pluralistic approach, and contributions that are not quite so busy describing and criticizing the NPMization of hospitals and management. In particular, the authors look forward to more research on how other reform trends, such as NPG, affect management in hospitals. ORIGINALITY/VALUE This review summarizes the literature on how academic literature (2000-2016) - in a Nordic reform context - has dealt with management in hospitals. The study reflects upon the academic literature per se. There are tendencies to explore reforms and management with some conceptual equivalence.
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Affiliation(s)
- Ralf Kirchhoff
- Department of Health Sciences Ålesund, Norwegian University of Science and Technology , Trondheim, Norway
| | - Erlend Vik
- Faculty of Business Administration and Social Science, Hogskolen i Molde, Molde, Norway
| | - Turid Aarseth
- Faculty of Business Administration and Social Science, Hogskolen i Molde, Molde, Norway
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Figueroa CA, Harrison R, Chauhan A, Meyer L. Priorities and challenges for health leadership and workforce management globally: a rapid review. BMC Health Serv Res 2019; 19:239. [PMID: 31014349 PMCID: PMC6480808 DOI: 10.1186/s12913-019-4080-7] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 04/09/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Health systems are complex and continually changing across a variety of contexts and health service levels. The capacities needed by health managers and leaders to respond to current and emerging issues are not yet well understood. Studies to date have been country-specific and have not integrated different international and multi-level insights. This review examines the current and emerging challenges for health leadership and workforce management in diverse contexts and health systems at three structural levels, from the overarching macro (international, national) context to the meso context of organisations through to the micro context of individual healthcare managers. METHODS A rapid review of evidence was undertaken using a systematic search of a selected segment of the diverse literature related to health leadership and management. A range of text words, synonyms and subject headings were developed for the major concepts of global health, health service management and health leadership. An explorative review of three electronic databases (MEDLINE®, Pubmed and Scopus) was undertaken to identify the key publication outlets for relevant content between January 2010 to July 2018. A search strategy was then applied to the key journals identified, in addition to hand searching the journals and reference list of relevant papers identified. Inclusion criteria were independently applied to potentially relevant articles by three reviewers. Data were subject to a narrative synthesis to highlight key concepts identified. RESULTS Sixty-three articles were included. A set of consistent challenges and emerging trends within healthcare sectors internationally for health leadership and management were represented at the three structural levels. At the macro level these included societal, demographic, historical and cultural factors; at the meso level, human resource management challenges, changing structures and performance measures and intensified management; and at the micro level shifting roles and expectations in the workplace for health care managers. CONCLUSION Contemporary challenges and emerging needs of the global health management workforce orient around efficiency-saving, change and human resource management. The role of health managers is evolving and expanding to meet these new priorities. Ensuring contemporary health leaders and managers have the capabilities to respond to the current landscape is critical.
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Affiliation(s)
- Carah Alyssa Figueroa
- School of Public Health and Community Medicine, University of New South Wales, UNSW, Sydney, 2052 Australia
| | - Reema Harrison
- School of Public Health and Community Medicine, University of New South Wales, UNSW, Sydney, 2052 Australia
| | - Ashfaq Chauhan
- School of Public Health and Community Medicine, University of New South Wales, UNSW, Sydney, 2052 Australia
| | - Lois Meyer
- School of Public Health and Community Medicine, University of New South Wales, UNSW, Sydney, 2052 Australia
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Jones L, Moss F. What should be in hospital doctors' continuing professional development? J R Soc Med 2019; 112:72-77. [PMID: 30507288 PMCID: PMC6378471 DOI: 10.1177/0141076818808427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 10/02/2018] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To ask those most affected by continuing professional development for senior doctors - patients, other professional groups and doctors themselves - what it needs to encompass. DESIGN The nominal group technique. PARTICIPANTS Six groups of between seven and nine members (n = 49). Separate groups were held for nurses and therapists (n = 9), patient representatives (n = 8), medical directors (n = 8), consultants (n = 8) and medical trainees (n = 7). An additional group consisted of 'Darzi Fellows' (n = 9), trainee doctors who were undertaking a leadership fellowship. SETTING Groups were held at the Royal Society of Medicine in London. MAIN OUTCOME MEASURES Priorities for the content of continuing professional development for senior hospital doctors, ranked in order of importance. Themes derived from analysis of group discussions. RESULTS We present the ranked priorities of different groups for what should be included in continuing professional development for senior hospital doctors. Analysis of group discussions identified the following three themes: developing and supporting the system of care; changes in the way medicine is practised; and personal wellbeing and caring for colleagues. CONCLUSIONS The implication of our findings for providers of continuing professional development is to consider the balance of content. Doctors and other healthcare professionals need to keep up with scientific advances and technical developments. But in addition, they need to be adept at working with the system changes required for translation of research into practice, the development of new ways of working, and for the organisational changes that underpin continual quality and safety improvement.
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Affiliation(s)
- Lorelei Jones
- School of Health Sciences, University of Bangor, Bangor LL57 2EF, UK
| | - Fiona Moss
- Dean, Royal Society of Medicine, London W1G 0AE, UK
- Academic Lead Collaboration, Learning and Partnerships North West London CLAHRC, London SW10 9NH, UK
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Medical leaders or masters?-A systematic review of medical leadership in hospital settings. PLoS One 2017; 12:e0184522. [PMID: 28910335 PMCID: PMC5598981 DOI: 10.1371/journal.pone.0184522] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 08/27/2017] [Indexed: 11/19/2022] Open
Abstract
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.
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Korlén S, Amer-Wåhlin I, Lindgren P, von Thiele Schwarz U. Professionals' perspectives on a market-inspired policy reform: A guiding light to the blind spots of measurement. Health Serv Manage Res 2017; 30:148-155. [PMID: 28508667 DOI: 10.1177/0951484817708941] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Implementation of market-inspired competition and incentive models in health care is increasing worldwide, assumed to drive efficiency. However, the evidence for effects is mixed and unintended consequences have been reported. There is a need to better understand the practical consequences of such reforms. The aim of the present case study is to explore what consequences of a Swedish market-inspired patient choice reform professionals identify as relevant, and why. The study was designed as an explorative qualitative study in specialized orthopedics. Nineteen interviews were conducted with health care professionals at different providers. Data were analyzed using a hypo-deductive thematic approach. Consequences for the organization of care, patients, work environment, education and research were included in the professionals' analyses, covering both the perspective of their own organization and that of the health care system as a whole. In sum, the professionals provided multiple-level analyses that extended beyond the responsibilities of their own organization. Concluding, professionals are a valuable source of knowledge when evaluating policy reforms. Their analyses can contribute by covering a broad system perspective, serving as a guiding light to areas beyond the most obvious evaluation measures that should be included in more formal evaluations.
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Affiliation(s)
- Sara Korlén
- Department of Learning Informatics Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Isis Amer-Wåhlin
- Department of Learning Informatics Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Peter Lindgren
- Department of Learning Informatics Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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