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This paper aims at understanding how clinical guidelines' use in the labour process relates to clinical autonomy, that is, the self-control medical professionals exercise over medical practice.

Drawing on a qualitative case study research strategy, this paper explores how medical professionals use clinical guidelines in the labour process in one public general hospital of the Greek National Health System. Supplemented by an extensive study of documents, semi-structured interviews were conducted with 33 doctors of several specialties.

The analysis shows (1) how clinical autonomy, as a self-control structure, mediates the use of clinical guidelines as a knowledge tool in the labour process, and (2) how employing clinical guidelines as a means towards coordinating medical work, but also towards regulating and standardising medical practice, is exercising pressure on the individualistic character of clinical autonomy.

Advancing the analytic value of workplace control structures, this paper contributes novel theoretical understanding of emerging tendencies characterising medical work organisation and clinical autonomy, and explains how medical professionals' non-adherence to clinical practice guidelines (CPGs) relates to CPGs' role as a resource to medical practice. Finally, this research proposes a more critical approach to health policy towards addressing the challenges associated with centrally introducing clinical guidelines in healthcare organisations.

This qualitative study aims to examine key stakeholders' perspectives of primary care group/trust prescribing strategies. Within the context of general practice prescribing, the paper also debates the wider issue of whether GPs' prescribing autonomy is under threat from managerial expansion following recent organisational changes in primary care.

Data were obtained from focus groups and a series of individual semi‐structured interviews with GPs and key primary care organisation stakeholders.

The data underlie a tension between the managerial objective of cost‐restraint and GPs' commitment to quality improvement and individual clinical patient management. In presenting both managerial and medical narratives, two divergent and often conflicting discourses emerge, which leads to speculation that managerial attempts to constrain prescribing autonomy will achieve only limited success. The contention is that GPs' discourse features as a challenge to a managerial discourse that reflects attempts to regulate, standardise and curtail clinical discretion. This is due not only to GPs' expressed hegemonic ideals that clinical practice centres on the interests of the individual patient, but also to the fact that the managerial discourse of evidence‐based medicine encapsulates only a limited share of the knowledge that GPs draw on in decision making. However, while managers' discourse presented them as unwilling to impose change or directly challenge clinical practice, evidence also emerged to suggest that is not yet possible to be sufficiently convinced of the future retention of prescribing autonomy. On the other hand, the use of peer scrutiny posed an indirect managerial influence on prescribing, whilst the emergence of prescribing advisors as analysts of cost‐effectiveness may threaten doctors' dominance of medical knowledge.

There is a continuing need to analyse the impact of the new managerial reforms on primary care prescribing.

This study provides a snapshot of managerial and GP relations at a time of primary care transition.

The aim of this study was to describe Jordanian critical care nurses’ experiences of autonomy in their clinical practice.

A descriptive correlational design was applied using a self-reported cross-sectional survey. A total of 110 registered nurses who met the eligibility criteria participated in this study. The data were collected by a structured questionnaire.

A majority of critical care nurses were autonomous in their decision-making and participation in decisions to take action in their clinical settings. Also, they were independent to develop their own knowledge. The study identified that their autonomy in action and acquired knowledge were influenced by a number of factors such as gender and area of practice.

Nurse’s autonomy could be increased if nurses are made aware of the current level of autonomy and explore new ways to increase empowerment. This could be offered through classroom lectures that concentrate on the concept of autonomy and its implication in practice. Nurses should demonstrate autonomous nursing care at the same time in the clinical practice. This could be done through collaboration between educators and clinical practice to help merge theory to practice.

Critical care nurses were more autonomous in action and knowledge base. This may negatively affect the quality of patient care and nurses’ job satisfaction. Therefore, improving nurses’ clinical decision-making autonomy could be done by the support of both hospital administrators and nurses themselves.

The Balanced Scorecard (BSC) emphasizes on the of information system to track a limited number of balanced metrics (measures and indicators) that are closely aligned with organization's goals. This study investigates how system integration in different forms is related to the success of using the BSC for performance measurement. The use of a BSC in performance evaluation is considered in five contexts: determining cost, measuring efficiency, ensuring quality and customer satisfaction measure, promoting continuous innovation and monitoring contract negotiation. The findings indicate that system integration defined in the study positively relates to the success of using the BSC in all five decision perspectives. The findings conclude that hospitals need a streamlined, information integration across the continuum of care to better assess the operation results, in both organizational and technical perspectives.

The purpose of this paper is to discuss the lessons learnt from the process of implementing a new model of governance within Living Well, a New Zealand statutory mental health agency.

It presents the findings from an organisational case study that involved qualitative interviews, meeting observations and document analysis. Archetype theory provided the analytical framework for the research enabling an analysis of both the formal structures and informal value systems that influenced the implementation of the governance model.

The research found that the move to a new governance model did not proceed as planned. It highlighted the importance of staff commitment, the complexity of adopting a new philosophical approach and the undue influence of key personalities as key determining factors in the implementation process. The findings suggest that planners and managers within statutory mental health agencies need to consider the implications of any proposed governance change on existing roles and relationships, thinking strategically about how to secure professional commitment to change.

There are ongoing pressures within statutory mental health agencies to improve the efficiency and effectiveness of organisational structures and systems. This paper has implications for how planners and managers think about the process of implementing new governance models within the statutory mental health environment in order to increase the likelihood of sustaining and embedding new approaches to service delivery.

The paper presents insights into the process of implementing new governance models within a statutory mental health agency in New Zealand that has relevance for other jurisdictions.

The purpose of this paper is to investigate how clinicians’ professional background influences their transition into the managerial role and identity as clinical managers.

The authors interviewed and observed 30 clinicians in managerial positions in Norwegian hospitals.

A central finding was that doctors experienced difficulties in reconciling the role as health professional with the role as manager. They maintained a health professional identity and reported to find meaning and satisfaction from clinical work. Doctors also emphasized clinical work as a way of gaining legitimacy and respect from medical colleagues. Nurses recounted a faster and more positive transition into the manager role, and were more fully engaged in the managerial aspects of the role.

The authors advance that health care organizations need to focus on role, identity and need satisfaction when recruiting and developing clinicians to become clinical managers.

The study suggests that the inclusion of aspects from identity and need satisfaction literature expands on and enriches the study of clinical managers.

The purpose of this paper is to contribute to the current debate on the implementation of clinical governance by exploring the understanding of clinical governance at different levels in an NHS organisation.

A case study method has been adopted with in‐depth interviews to understand how organisational actors make sense of the term “clinical governance”. Semi‐structured interviews were conducted with a heterogeneous group of 33 persons in an NHS hospital trust handling important responsibilities for clinical governance. In‐depth analysis of the data revealed the understanding of clinical governance at different levels in an NHS organisation.

The results indicate that clinical governance creates more confusion, debate and disagreement on quality of care, making it more a contentious issue than one promoting unanimity, uniformity and consistency. This could become a major obstacle in achieving continuous quality improvement in healthcare.

Further research on a wider scale is required to develop a better understanding of how people make sense of clinical governance for improving the quality of care.

To look into implications of clinical governance in NHS organisations, it is necessary to understand how people at different levels in the NHS understand clinical governance. The paper makes a valuable contribution by bringing out the practical implications which will be useful for policy makers and practitioners. A better understanding of how health staff make sense of clinical governance would enable policy makers to know the problems of implementing clinical governance.

From the current literature very little information is available on the above topic. This empirical research makes a valuable contribution by focusing on how stakeholders at different levels in an NHS organisation make sense of clinical governance.

The organization of the corporate marketing function has attracted increasing attention from marketers in the 1990s. This reflects both the significant conceptual developments in marketing theory and a questioning of the role of the centralized marketing department to organizations operating in post‐industrial service economies. Drawing on data from a broader research project into marketing activity in the acute health care sector in the United Kingdom, the paper examines the organizational solutions adopted by self‐governing hospitals in managing the marketing function. The core theme to emerge from the research is the imperative for such professional service organizations to facilitate the development of flexible, project focused marketing teams, effectively mirroring the notion of the buying centre, capable of integrating core technical professionals directly into the marketing process. Coupled to this is the notion of marketing professionals having to abdicate ownership, and even dominance, of the corporate marketing process.