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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.

In the OECD countries, hospitals face increased financial restrictions and competition. Process orientation is an essential means of remaining competitive. A wide range of theories and concepts relating to clinical process management already exists. When it comes to practical implementation, however, a comprehensive approach for the target‐oriented and consistent introduction of clinical process management throughout an entire hospital is missing. The purpose of this paper is to document the case of a German hospital that has realised a project of this kind and demonstrate the impacts on cooperation and on operational efficiency, which is understood as the degree to which a hospital is capable of steadily realising short lengths of stay.

The case shows the approach to implementing theories and concepts for managing clinical processes in practice as a consistent management system in the day‐to‐day use of process management and its impacts.

The effect of using clinical processes shown in the case is an additional net profit of several million euros a year – without a reduction in quality.

While the impacts of clinical pathways on hospitals are not country‐specific, the reasons are nonetheless subject to the political and economic conditions. Therefore, some findings are only valid for hospitals in German‐speaking countries. However, major effects (e.g. reduction in the length of stay) may exist everywhere.

The paper shows how process orientation in a medium‐sized hospital can be systematically implemented.

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.

Aims to identify awareness of and involvement in risk assessments, training, incident reporting, information giving and consenting in an acute health care context. Explores how nurse managers perceived risk management as a concept and if they saw advanced neonatal nurse practitioners having a role to play in this activity. The method used was a postal survey of 62 nurse managers or clinical specialists responsible for neonatal nursing care services within NHS Trusts in the UK. Results show that while the nurse managers studies understood the definition of risk management in general, they were more vague about certain aspects of that definition. The nurse managers appeared to be passive in their dissemination and taking forward of risk management strategies, rather than proactively “promoting and helping them forward” as may be expected in facilitative managerial behaviour. Concludes that the challenges of clinical governance demand more proactive approaches to effect and demonstrate change, and support ongoing clinical quality improvements.

The authors explored clinical staff perceptions of their interactions with middle management and their experiences of the uncongeniality of their working environment.

Semi-structured interviews of clinical staff from an Australian public health service's Emergency, Surgery and Psychiatry departments. Volunteer interview transcripts were inductively coded using a reflexive thematic content analysis.

Of 73 interviews, 66 participants discussed their interactions with management. Most clinicians considered their interactions with middle management to be negative based on a violation of their expectations of support in the workplace. Collectively, these interactions formed the basis of clinical staff perceptions of management's lack of capacity and fit for the needs of staff to perform their roles.

Strategies to improve management's fit with clinicians' needs may be beneficial for reducing uncongenial workplaces for healthcare staff and enhanced patient care.

This article is among the few papers that discuss interactions with management from the perspective of clinical staff in healthcare. How these perspectives inform the perception of workplace uncongeniality for clinicians contributes greater understanding of the factors contributing to adversarial relationships between clinicians and managers.

This paper seeks to explore critical factors that may obstruct or advance integration efforts initiated by the clinical management following a hospital merger. The aim is to increase the understanding of why clinical integration succeeds or fails.

The authors compare two cases of clinical integration efforts following the Karolinska University Hospital merger in Sweden. Each case represents two merged clinical departments of the same specialty from each hospital site. In total, 53 interviews were conducted with individuals representing various staff categories and documents were collected to check data consistency.

The study identifies three critical factors that seem to be instrumental for the process and outcome of integration efforts and these are clinical management's interpretation of the mandate; design of the management constellation; and approach to integration. Obstructive factors are: a sole focus on the formal assignment from the top; individual leadership; and the use of a classic, planned, top‐down management approach. Supportive factors are: paying attention to multiple stakeholders; shared leadership; and the use of an emergent, bottom‐up management approach within planned boundaries. These findings are basically consistent with the literature's prescriptions for managing professional organisations.

Managers need to understand that public healthcare organisations are based on competing institutional logics that need to be handled in a balanced way if clinical integration is to be achieved – especially the tension between managerialism and professionalism.

By focusing on the merger consequences for clinical units, this paper addresses an important gap in the healthcare merger literature.

Aims to illustrate how the use of a social identity approach can help to refine our understanding of how organizational professionals experience the introduction of managerialism and the incorporation of managing specialist roles.

Draws on theories of social identity and social categorization to examine the process by which clinical directors tackle and assign meaning to their managing roles. Interviews were conducted with a sample of current and previous clinical directors over a five year period. Variations in doctors’ responses were explained by a range of self enhancement strategies that emerged to deal with tensions between prepared management identities and actual role experiences.

Reveals the importance of multiple self‐enhancement strategies as a way for doctors to protect self definitions in failing identity situations where immediate exit from a new role is not feasible. Concludes that a greater use of social identity and social categorization theory may add much to general explanations of how varied stances towards management interventions emerge and develop among professional workers.

Points to how we might achieve a deeper understanding of the diverse ways that the organizational professionals experience the introduction of managerialism and the incorporation of managing the specialist roles.

This paper seeks to review prior definitions of the umbrella term “clinical governance”. The research question is: do clinical governance definitions adequately distinguish between governance, management and practice functions? Three definitions are introduced to replace that umbrella term.

Content analysis is applied to analyse 29 definitions of clinical governance from the perspective of the roles and responsibilities of those charged with governance, management and practice.

The analysis indicates that definitions of the umbrella term “clinical governance” comprise a mixture of activities relating to governance, management and practice which is confusing for those expected to execute those roles.

Consistent with concepts from corporate governance, the paper distinguishes between governance, management and practice. For effective governance, it is important that there be division of duties between governance roles and management and practice roles. These distinctions will help to clarify roles and responsibilities in the execution of clinical activities.

Drawing on insights from corporate governance, in particular, the importance of a division of functions between governance roles, and management and practice roles, the paper proposes three new definitions to replace the umbrella term “clinical governance”.

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.

The purpose of this paper is to explore the nature and value of the clinical management role undertaken by primary care doctors in Ireland. To date, a majority of research has focused on clinical management roles in the acute sector.

The paper presents a sub‐set of data from a mixed methods study. In total, 14 semi‐structured interviews are drawn upon to identify the nature and value of the clinical management role in primary care.

Comparison with acute sector research identifies considerable differences in the nature of the clinical management role across sectors – and in the associated value proposition. Structural and role‐related contingencies affecting the potential value of clinical management roles in Irish primary care are discussed. Structural influences include the private ownership structure, low complexity and limited requirement for cross‐professional coordination. Role‐related influences include the primacy of the clinical identity, time constraints and lack of managerial training.

The findings provide a limited basis for generalisation, premised on 14 interviews in one national context. However, given the international shift towards the provision of health services in primary care, they provide a research agenda for an important healthcare context.

The findings draw attention to the need for policy consideration of the value of the clinical manager role in primary care; how policy can support effective primary care management; and the need for specialised management training, which takes account of the small‐firm context.

The paper identifies that primary‐care clinical‐management roles focus on operational management and oversight and discusses the structural and role‐related factors which affect their efficacy.