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The purpose of this paper is to explore the way “hybrid” clinical managers in Kenyan public hospitals interpret and enact hybrid clinical managerial roles in complex healthcare settings affected by professional, managerial and practical norms.

The authors conducted a case study of two Kenyan district hospitals, involving repeated interviews with eight mid-level clinical managers complemented by interviews with 51 frontline workers and 6 senior managers, and 480 h of ethnographic field observations. The authors analysed and theorised data by combining inductive and deductive approaches in an iterative cycle.

Kenyan hybrid clinical managers were unprepared for managerial roles and mostly reluctant to do them. Therefore, hybrids’ understandings and enactment of their roles was determined by strong professional norms, official hospital management norms (perceived to be dysfunctional and unsupportive) and local practical norms developed in response to this context. To navigate the tensions between managerial and clinical roles in the absence of management skills and effective structures, hybrids drew meaning from clinical roles, navigating tensions using prevailing routines and unofficial practical norms.

Understanding hybrids’ interpretation and enactment of their roles is shaped by context and social norms and this is vital in determining the future development of health system’s leadership and governance. Thus, healthcare reforms or efforts aimed towards increasing compliance of public servants have little influence on behaviour of key actors because they fail to address or acknowledge the norms affecting behaviours in practice. The authors suggest that a key skill for clinical managers in managers in low- and middle-income country (LMIC) is learning how to read, navigate and when opportune use local practical norms to improve service delivery when possible and to help them operate in these new roles.

The authors believe that this paper is the first to empirically examine and discuss hybrid clinical healthcare in the LMICs context. The authors make a novel theoretical contribution by describing the important role of practical norms in LMIC healthcare contexts, alongside managerial and professional norms, and ways in which these provide hybrids with considerable agency which has not been previously discussed in the relevant literature.

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.

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.

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.

The purpose of this paper is to explore the practical daily work undertaken by middle‐level managers in Primary Care Trusts (PCTs), focusing upon the micro‐processes by which these managers enact sensemaking in their organisations.

The research took a case study approach, undertaking detailed case studies in four PCTs in England. Data collection included shadowing managers, meeting observations and interviews.

The research elucidated two categories of enactment behaviour exhibited by PCT managers: presence/absence; and the production of artefacts. Being “present” in or “absent” from meetings enacted sensemaking over and above any concrete contribution to the meeting made by the actors involved. This paper explores the factors affecting these processes, and describes the situations in which enactment of sense is most likely to occur. Producing artefacts such as meeting minutes or PowerPoint slides also enacted sense in the study sites in addition to the content of the artefact. The factors affecting this are explored.

The study has practical implications for all managers seeking to maximise their influence in their organisations. It also provides specific evidence relevant to managers working in the new Clinical Commissioning Groups currently being formed in England.

The study expands the understanding of sensemaking in organisations in two important ways. Firstly, it moves beyond discourse to explore the ways in which behaviours can enact sense. Secondly, it explores the distinction between active and unconscious sensemaking.

This paper aims to propose that healthcare is dominated by a managerialist ideology, powerfully shaped by business schools and embodied in the Masters in Business Administration. It suggests that there may be unconscious collusion between universities, healthcare employers and student leaders and managers.

Based on a review of relevant literature, the paper examines critiques of managerialism generally and explores the assumptions behind leadership development. It draws upon work which suggests that leading in healthcare organisations is fundamentally different and proposes that leadership development should be more practice-based.

The way forward for higher education institutions is to include work- or practice-based approaches alongside academic approaches.

The paper suggests that there is a challenge for higher education institutions to adopt and integrate practice-based development methods into their programme designs.

The paper provides a challenge to the future role of higher education institutions in developing leadership in healthcare.

The purpose of this paper is to explore leadership in the context of the policy shift to collaborative working and integration currently being pursued in the UK NHS. As ways of integrating care are being explored in other countries it can be argued that this topic may have wider policy significance. This paper is particularly concerned with leadership in Primary Care Networks in the English NHS.

This paper is a conceptual paper using literature relating to the antecedents of shared leadership and relevant policy documents pertaining to the English NHS. The paper is informed, theoretically by the conceptual lens of shared leadership. A conceptual framework is developed identifying the antecedents of shared leadership that help to explain how shared leadership may be developed.

The paper identifies the challenges that may be faced by policymakers and those involved in Primary Care Networks in developing shared leadership. It also reveals the implications for policymakers in developing shared leadership.

The paper is conceptual. It is acknowledged that this is a preliminary study and further work will be required to test the conceptual framework empirically.

The paper discusses the policy implications of developing leadership in primary care networks. This has relevance to both the NHS and other countries.

There is limited research on the antecedents of shared leadership. In addition, the conceptual framework is applied to a new policy initiative.

The purpose of this paper is to offer a personal interpretation of the nature and impact of alternative narratives of public management reform evident in the UK since the 1980s. These reforms are examined through the prism of alternative bodies of public management scholarship. They are applied to the specific case of the health care sector as a concrete focus.

The study is a personal overview of various streams of policy reforms in the UK health care sector and associated public management scholarship. This is an interpretive essay.

The new of public management remains the dominant reform, narrative and highly embedded, even if dysfunctionally so. Network governance reforms have had some enduring influence. Digital era governance has so far had only weak influence. A reprofessionlisation counter narrative shows variable and oscillating influence.

The study contributes to a developing narrative-based stream in public management scholarship. It also provides a “big picture” assessment of reforming in the UK health care sector since the 1980s.

A recurrent theme in medical sociology has been the juxtaposition of emotion with scientific rationality in the delivery of health care services. However, apart from addressing this juxtaposition very little is said about the complex intertwinement of “emotional” and “rational” practices which makes up professionals' own day‐to‐day work experiences – and how these experiences are influenced by present ways of organising health care. This paper aims to explore the ways that hospital doctors relate emotions to their understanding of professional medical work and how they respond to recent organisational changes within the field.

Drawing upon a small series of semi‐structured interviews (n=14) with doctors from a public teaching hospital in Denmark, the paper adopts a constructivist framework to analyse personal biographies of health professionals' working lives.

The doctors represented rich accounts of professional medical work, which includes an understanding of what a doctor should feel and how he/she should make him/herself emotionally available to others. However, the impetus for making this appearance was not left unaffected by recent new public management reforms and attempts to accelerate the delivery of services.

The organisation of cancer services into a work system, which consists of a set of tasks broken down into narrow jobs, underestimates the emotional components of patient‐doctor encounters. This makes the creation and maintenance of a genuine patient‐doctor relationship difficult and the result is feelings of a failed encounter on behalf of the doctor.

The paper suggests that recent rearrangements of cancer services complicate doctors' ability to incorporate emotion into a stream of medical care in a “rational” way. This is shown to challenge their professional ethos and the forms emotional engagement takes in medical practice.

The authors draw selectively on theories of learning and knowledge, which currently have received little attention from knowledge translation (KT) researchers, and suggest how they might usefully inform future development of the KT literature. The purpose of this paper is to provide conceptual tools and strategies for the growing number of managers, clinicians and decision makers navigating this arena.

The authors conducted a narrative review to synthesise two streams of literature and examine evolving conceptual landscape concerning knowledge translation over the previous three decades. Conceptual mapping was used iteratively to develop and synthesise the literature. Iterative feedback from relevant research and practice stakeholder groups was used to focus and strengthen the review.

KT has been conceptualised along three competing frames; one focusing on linear (largely unidirectional) transfer of knowledge; one focusing on KT as a social process; and another that seeks to more fully incorporate contextual issues in understanding research implementation. Three overlapping themes are found in the management literature that inform these debates in the health literature, namely knowledge boundaries, organisational learning and absorptive capacity. Literature on knowledge boundaries problematizes the nature of boundaries and the stickiness of knowledge. Organisational learning conceptualises the need for organisational wide systems to facilitate learning processes; it also draws on a more expansive view of knowledge. Absorptive capacity focuses at the firm level on the role of developing organisational capabilities that enable the identification, assimilation and use of new knowledge to enable innovation.

The paper highlights the need to consider KT processes at multiple levels, including individual, organisational and strategic levels. These are important not only for research but also have practical implications for individuals and organisations involved in KT processes.

This review summarises and integrates two largely separate literature streams on knowledge translation – namely health services research and management scholarship. In addition to outlining and organising the conceptual landscape around knowledge transfer, the paper contributes by highlighting how management literature on knowledge and learning theories might inform health services research on knowledge translation.

This article aims to examine tensions between hybrid clinician managers' professional values and health care organisations' management objectives.

Data are from interviews conducted with, and observation of, 14 managerial participants in a Cancer Therapy Unit set in a large teaching hospital in New South Wales, Australia, who participated in a Clinical Leadership Development Program.

The data indicate that there are tensions experienced by members of the health care organisation when a hybrid clinician manager appears to abandon the managerial role for the clinical role. The data also indicate that when a hybrid clinician manager takes on a managerial role other members of the health care organisation are required concomitantly to increase their clinical roles.

Although the research was represented by a small sample and was limited to one department of a health care organisation, it is possible that other members of health care organisations experience similar situations when they work with hybrid clinician managers. Other research supports the findings. Also, this paper reports on data that emerged from a research project that was evaluating a Clinical Leadership Development Program. The research was not specifically focused on organisational professional conflict in health care organisations.

This paper shows that the role of the hybrid clinician manager may not bring with it the organisational effectiveness that the role was perceived to have. Hybrid clinician managers abandoning their managerial role for their clinical role may mean that some managerial work is not done. Increasing the workload of other clinical members of the health care organisation may not be optimal for the health care organisation.

Organisational professional conflict, as a result of hybridity and divergent managerial and clinical objectives, can cause conflict which affects other organisational members and this conflict may have implications for the efficiency of the health care organisation. The extension or duality of organisational professional conflict that causes interpersonal or group conflict in other members of the organisation, to the authors' knowledge, has not yet been researched.