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Article
Publication date: 1 October 1994

Stephen Willcocks

Reviews the role of the clinical director in the NHS, based on datacollected in a qualitative research study. Utilizes role theory toinvite insight into a relatively new but…

812

Abstract

Reviews the role of the clinical director in the NHS, based on data collected in a qualitative research study. Utilizes role theory to invite insight into a relatively new but important managerial role. Suggests that effectiveness in the role may be measured by the extent to which managers are able to meet the expectations of their role set, and also that the overall effectiveness of the clinical direction may be the extent to which he or she is able to influence, adapt, modify or change these role expectations.

Details

Journal of Management in Medicine, vol. 8 no. 5
Type: Research Article
ISSN: 0268-9235

Keywords

Article
Publication date: 24 April 2009

Chandra Som

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…

3393

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Research limitations/implications

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.

Practical implications

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.

Originality/value

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.

Details

Clinical Governance: An International Journal, vol. 14 no. 2
Type: Research Article
ISSN: 1477-7274

Keywords

Article
Publication date: 1 September 2002

S.A. Lewis, N. Saunders and K. Fenton

The implementation of effective frameworks which support the clinical governance agenda is proving to be a significant challenge for management teams across the NHS. Since there…

2965

Abstract

The implementation of effective frameworks which support the clinical governance agenda is proving to be a significant challenge for management teams across the NHS. Since there is no recognised ideal model or gold standard for such frameworks, it is not surprising that many organisations remain in a state of “trial and error” with their clinical governance arrangements. This article provides an insight into the ongoing developments of the clinical governance “infrastructure” at Southampton University Hospitals NHS Trust. A model of delivery for clinical governance within a large acute teaching hospital is proposed and it is hoped that it may prove useful to colleagues across the country, who may well be facing difficulties in their structural arrangements to deliver the clinical governance agenda.

Details

British Journal of Clinical Governance, vol. 7 no. 3
Type: Research Article
ISSN: 1466-4100

Keywords

Article
Publication date: 16 May 2016

Nicky Stanley-Clarke, Jackie Sanders and Robyn Munford

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…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Practical implications

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.

Originality/value

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.

Details

Journal of Health Organization and Management, vol. 30 no. 3
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 1 June 1997

Dave Buchanan, Simone Jordan, Diane Preston and Alison Smith

Aims to examine medical involvement in hospital management processes, and to consider the implications of current experience for the next generation of clinical directors. Doctors…

1785

Abstract

Aims to examine medical involvement in hospital management processes, and to consider the implications of current experience for the next generation of clinical directors. Doctors who move into a formal management role often find themselves unprepared for their new responsibilities. Research has thus concentrated on identifying the management competences which doctors lack, and with designing ways to remedy the deficit. Seeks to move beyond this deficit model by adopting a perspective which focuses on the engagement of doctors in the management process. Draws data from in‐depth interviews with six clinical directors and 19 other members of the hospital management team at Leicester General Hospital NHS Trust (LGH). Content analysis of interviews suggests that the engagement of clinical directors in the hospital management process at this site can be described as reluctant, transient, service‐driven, power‐pulled and pressured. This negative portrayal of the role, however, must be set in the context of the “management expectation” held of clinical directors by other hospital managers and staff ‐ an expectation that is not currently fulfilled.

Details

Journal of Management in Medicine, vol. 11 no. 3
Type: Research Article
ISSN: 0268-9235

Keywords

Article
Publication date: 24 June 2019

Christos Begkos, Sue Llewellyn and Kieran Walshe

The purpose of this paper is to investigate the intricate ways in which accounting is implicated in the unfolding of strategizing in a pluralistic setting. The authors treat…

1920

Abstract

Purpose

The purpose of this paper is to investigate the intricate ways in which accounting is implicated in the unfolding of strategizing in a pluralistic setting. The authors treat strategizing as a practical coping mechanism which begins in response to a problem and unfolds over time into an episode. This approach enables the authors to explore strategizing pathways and the ways they can mobilise accounting to advance from practical coping to explicit strategic intent.

Design/methodology/approach

The authors conducted semi-structured interviews with Clinical Directors, Business Managers and Finance personnel at three NHS hospitals. Documents were also collected, such as business cases and financial reports. The authors employed theories on strategizing agency, episodes and practical coping to select examples of strategizing and indicate how strategizing is constructed and performed. The authors present the results of this qualitative analysis in three strategizing narratives.

Findings

The analysis highlights how Clinical Directors’ strategizing with accounting, in response to their financial problems, can take on contesting, conforming and circumventing modes. As the strategizing pathway unfolds, accounting acts as an obligatory passage point through which Clinical Directors pursue their strategic intent. Along each pathway the authors identify, first, where practical coping takes on a clear strategic intent and, second, whether this emergent strategy proves efficacious.

Originality/value

The authors contribute to the nascent body of accounting and strategizing studies through seeing strategizing with accounting, not as the formulation of explicit organisational strategy as “done” in board rooms and strategy meetings, but as an impromptu response to a critical financial problem within a localised organisational setting. In response to a problem, actors may realise their immanent strategizing through their engagement with accounting practices.

Details

Accounting, Auditing & Accountability Journal, vol. 32 no. 5
Type: Research Article
ISSN: 0951-3574

Keywords

Article
Publication date: 30 September 2014

Eilish McAuliffe

The purpose of this paper is to explain the path that the Irish health system has taken towards achieving good clinical governance, exploring the historical influences on its’…

9515

Abstract

Purpose

The purpose of this paper is to explain the path that the Irish health system has taken towards achieving good clinical governance, exploring the historical influences on its’ development, some of the major initiatives that have been implemented and the obstacles that have been encountered.

Design/methodology/approach

The paper draws on the author's experience researching and teaching in health systems and healthcare management.

Findings

The paper offers some explanations for why earlier attempts failed to change the system as well as why recent attempts have met with more success. Greater efforts need to be made to progress clinical governance in the primary care services. In addition it is argued that there is a need to institute systems that enable learning form errors, to involve the public and patient groups and to invest in research that enables answers to the how and why questions that are so often neglected in the reform process.

Originality/value

The paper discusses clinical governance in the Irish Health system and identifies some of the challenges yet to be addressed, many of which are common to clinical governance efforts in other jurisdictions.

Details

Clinical Governance: An International Journal, vol. 19 no. 4
Type: Research Article
ISSN: 1477-7274

Keywords

Article
Publication date: 31 August 2021

Christos Begkos and Katerina Antonopoulou

This study aims to investigate the hybridization practices that medical managers engage with to promote accounting and performance measurement in the hybrid setting of healthcare…

Abstract

Purpose

This study aims to investigate the hybridization practices that medical managers engage with to promote accounting and performance measurement in the hybrid setting of healthcare. In doing so, the authors explore how medical managers enact and become practitioners of hybridity.

Design/methodology/approach

The authors adopt a practice lens to conceptualize hybridization as an emergent, situated practice and capture the micro-activities that medical managers engage with when they enact hybridity. The authors conducted semi-structured interviews with medical managers, business managers and coding professionals and collected documents at an English National Health Service (NHS) hospital over the course of five years.

Findings

The findings accentuate two emergent practices through which medical managers instill hybridity to individuals who are hesitant or resistant to hybridization. Medical managers engage in equivocalizing and de-stigmatizing practices to broaden the understandings, further diversify or reconcile the teleologies of clinicians in non-managerial roles. In doing so, the authors signal the merits of accounting in improving care outcomes and remove the stigma associated to clinical engagement with costs.

Originality/value

The study contributes to hybridization and practice theory literature via capturing how hybridity is enacted in practice in a healthcare setting. As medical managers engage with and promote accounting information and performance measurement technologies in their practice environment, they transcend professional boundaries and hybridize the professional spaces that surround them.

Details

Accounting, Auditing & Accountability Journal, vol. 35 no. 3
Type: Research Article
ISSN: 0951-3574

Keywords

Article
Publication date: 1 June 1991

H.C.H. Koch and E.J. Chapman

An organisational framework for capturing the essential components of total quality management at hospital and directorate level is presented and discussed, based on work carried…

Abstract

An organisational framework for capturing the essential components of total quality management at hospital and directorate level is presented and discussed, based on work carried out at Northwich Park Hospital, near London. Examples of quality plans and monitoring formats are provided.

Details

International Journal of Health Care Quality Assurance, vol. 4 no. 6
Type: Research Article
ISSN: 0952-6862

Keywords

Article
Publication date: 1 May 1999

C. Stuart Jones

The pursuit of cost efficiency in the British National Health Service has resulted in increased emphasis on devolved financial accountability and the introduction of an internal…

3019

Abstract

The pursuit of cost efficiency in the British National Health Service has resulted in increased emphasis on devolved financial accountability and the introduction of an internal market. With the aid of a case study, this paper examines alternative forms of governance and proposes that aspects of the internal market and functioning within acute hospital units, are suited to network‐style organisation. The implications of hierarchies and networks for the design and use of management accounting information (MAI) are identified. These are used to analyse the case evidence concerning the roles, intended and unintended, of MAI in the context of organisational change and where multiple, and sometimes conflicting, goals and priorities existed. It concludes that a network approach to the design of MAI is more consistent with the desirable culture, at operational level, in acute units. However, this will only be achieved through deliberate intervention by those who design MAI systems and senior managers, who by their attitudes towards the interpretation and response to MAI, shape overall organisational culture.

Details

Accounting, Auditing & Accountability Journal, vol. 12 no. 2
Type: Research Article
ISSN: 0951-3574

Keywords

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