Are healthcare middle management jobs extreme jobs?

A. Buchanan David (School of Management, Cranfield University, Cranfield, UK)
Parry Emma (School of Management, Cranfield University, Cranfield, UK)
Gascoigne Charlotte (School of Management, Cranfield University, Cranfield, UK)
Moore Cíara (School of Management, Cranfield University, Cranfield, UK)

Journal of Health Organization and Management

ISSN: 1477-7266

Publication date: 2 September 2013



The purpose of this paper is to explore the incidence of “extreme jobs” among middle managers in acute hospitals, and to identify individual and organizational implications.


The paper is based on interviews and focus groups with managers at six hospitals, a “proof of concept” pilot with an operations management team, and a survey administered at five hospitals.


Six of the original dimensions of extreme jobs, identified in commercial settings, apply to hospital management: long hours, unpredictable work patterns, tight deadlines with fast pace, broad responsibility, “24/7 availability”, mentoring and coaching. Six healthcare-specific dimensions were identified: making life or death decisions, conflicting priorities, being required to do more with fewer resources, responding to regulatory bodies, the need to involve many people before introducing improvements, fighting a negative climate. Around 75 per cent of hospital middle managers have extreme jobs.

Research limitations/implications

This extreme healthcare management job model was derived inductively from a qualitative study involving a small number of respondents. While the evidence suggests that extreme jobs are common, further research is required to assess the antecedents, incidence, and implications of these working practices.

Practical implications

A varied, intense, fast-paced role with responsibility and long hours can be rewarding, for some. However, multi-tasking across complex roles can lead to fatigue, burnout, and mistakes, patient care may be compromised, and family life may be adversely affected.


As far as the authors can ascertain, there are no other studies exploring acute sector management roles through an extreme jobs lens.



This research was funded by the NIHR HS&DR programme (SDO/08/1808/238). The views expressed are those of the authors, and are not necessarily those of the NHS, National Institute for Health Research, or DoH. This research has ethical and governance approvals from Cambridgeshire 3 REC (09/H0306/17), and NIHR CSP (14677), respectively. The authors would like to thank all the managers who contributed their valuable time and experience to this project.

© Queen's Printer and Controller of HMSO 2013. This work was produced by authors at Cranfield University under the terms of a commissioning contract issued by the Secretary of State for Health.


A. Buchanan, D., Parry, E., Gascoigne, C. and Moore, C. (2013), "Are healthcare middle management jobs extreme jobs?", Journal of Health Organization and Management, Vol. 27 No. 5, pp. 646-664.

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