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The purpose of this paper is to explore the various ways in which clinical executive directors and non‐clinical executive directors are interpreting and responding to the extensive reforms and restructuring in the UK health service.

The paper draws upon detailed research in two very large teaching hospital organizations in order to understand how actors crucial to the delivery of this vision are responding. Schedule‐structured interviews with executive directors were conducted, recorded, transcribed and coded.

The clinical and non‐clinical directors of these organizations engaged in a process of active sense‐making are found, which is leading to significant changes to the service and also changes to identity. The clinical directors are revealing a willingness to assume accountability for devolved profit centres in their service lines. The non‐clinical directors are supportive of this idea in broad terms but are cautious about releasing “too much” central control.

The paper is based on just two case studies and the analyses are made through the perspectives of the executive teams in each case.

Changes to healthcare environments of this kind are occurring in many countries, but such is the extent and intensity of these changes in the UK that the government's aspiration is high – it sees this set of reforms leading to a peerless world class health service. The way in which the actors make sense of and navigate their way through the cross cutting principles and the layered reforms is a critical issue.

There have been few systematic studies of the practical reality involved in the enactment of profit centre and service line management initiatives in acute hospital settings and the ways these are understood and negotiated at executive team level.

This article examines and comments on the role of clinical directors in the NHS (UK), with specific reference to the relevance of a strategic marketing emphasis. It utilises qualitative methodologies to collect data from stakeholders ‐ in particular, clinical directors and other managers ‐ from two NHS trust hospitals. It examines the extent to which a marketing approach is applicable to clinical managers working in these two hospitals. It utilises a conceptual framework devised by Kottler and Andreason, to highlight whether a marketing approach is, in fact, utilised by these managers. It suggests that a strategic marketing approach (based upon relationships), remains relevant to clinical management, notwithstanding recent changes in government policy.

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.

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.

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.

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.

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.

Reviews the role of clinical directors from outside the usual managerial framework to challenge the managerial myth applied to professionals who take on these roles. Defines management, managing, managerialism and leadership and develops an empirical framework to compare the roles of doctors and managers. Uses the framework to identify the cognitive map that clinical directors use and how they perceive their role. An emergent model illustrates how clinical directors combine a new cognitive map with their existing professional behaviours to undertake their role. Clinical directors both perceived and described their role in terms of leadership rather than management reinforcing the inappropriateness of using managerial frameworks. Instead clinical directors should be developed and evaluated as professional leaders. This raises wider questions of whether management and the language of management are either useful or appropriate for professionals in the NHS or whether their value is really a myth.

As a consequence of new public management reforms, leading professionals in public service organizations have increasingly been involved in management roles. The phenomenon of clinical directors in the healthcare sector is particularly representative of this, as this medical manager role has been adopted in many countries around the world. However, professionals’ managerial role taking still falls quite short of expectations. While most research has searched for the causes of this gap at the individual level by exploring the clash between management and professionalism, the purpose of the paper is to argue that a contextualized understanding of the antecedents at the organizational level, and particularly the existing medical management roles, provides a more thorough picture of the reality.

The paper adopts an institutional perspective to study the development of existing medical management roles and the rise of new ones (clinical directors). The analysis focuses on the case of Italy, a country with a tradition in medical management where, following the example of other countries, clinical director roles were introduced by law; yet they were not incisive. The paper is based on a review of the existing literature and extensive field research on Italian clinical directorates.

The paper shows how in contexts in which doctors in management roles exist and are provided with legitimacy deriving from legal norms, historical settlements between professions and taken for granted arrangements, medical management becomes institutionalized, stability prevails and change towards new doctor-in-management roles is seriously hampered.

The paper contributes to existing knowledge on professionals’ managerial role taking, underlining the relevance of contextual and nation-specific factors on this process. It provides implications for research and for policy making in healthcare and other professional public services.

Examines managerial effectiveness in the NHS, in particular the effectiveness of the clinical director. Based on a qualitative study of an NHS Trust hospital case study, utilizes a social cognitive perspective to analyse the data and draw conclusions. Uses the data to suggest a possible framework for examining the effectiveness of individual directors. The framework may be relevant to other messages, particularly those in professional service organizations. It may also be used as a diagnostic tool to assess these managers. The framework is grounded in the perceptions of the interviewees at the Trust: both clinical directors and managers.

The article examines and comments on the development of clinical management at an NHS hospital Trust. It utilises a qualitative case study methodology to collect data from key stakeholders at this Trust. The data suggest some of the reasons why doctors may be receptive or non‐receptive to the notion of clinical management. It recommends that attention is focused on the specialty context as a key factor in influencing the development of clinical management. It also suggests there may be other important factors, for example: training; the role of change agents; structure of clinical directorates; and individual factors such as cognition, attitudes and motivation.

The purpose of this paper is to explore issues of medical engagement in the management and leadership of health services in the English National Health Service (NHS). The literature suggests that this is an important component of high performing health systems, although the NHS has traditionally struggled to engage doctors and has been characterised as a professional bureaucracy. This study explored the ways in which health care organisations structure and operate medical leadership processes to assess the degree to which professional bureaucracies still exist in the English NHS.

Drawing on the qualitative component of a research into medical leadership in nine case study sites, this paper reports on findings from over 150 interviews with doctors, general managers and nurses. In doing so, the authors focus specifically on the operation of medical leadership in nine different NHS hospitals.

Concerted attention has been focussed on medical leadership and this has led to significant changes to organisational structures and the recruitment and training processes of doctors for leadership roles. There is a cadre of doctors that are substantially more engaged in the leadership of their organisations than previous research has found. Yet, this engagement has tended to only involve a small section of the overall medical workforce in practice, raising questions about the nature of medical engagement more broadly.

There are only a limited number of studies that have sought to explore issues of medical leadership on this scale in the English context. This represents the first significant study of this kind in over a decade.

Purpose – The chapter describes how teacher preparation programs can design effective off-campus clinical programs. Information provided is applicable to clinical practicums, capstone experiences, and to individual course assignments at the undergraduate and graduate levels.

Methodology/Approach – The author describes the foundational components involved in designing a high-quality off-campus clinical-based program. These components include selecting and building a partnership with an off-campus site, using forms, fees, space, and materials, engaging families, aligning assignments to course content, grading, supervision, and acquiring funding.

Practical implications – In addition to the foundational components involved in designing an effective off-campus clinic, the chapters describes a university-based model that uses two different off-campus clinical-based experiences that support community-based programs and local area schools.

Social implications – The chapter addresses the need for teacher preparation programs to build partnerships with off-campus community-based programs to better prepare teachers to meet the literacy demands of all students, particularly students living and learning in urban communities.