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Article
Publication date: 31 August 2012

Chris O'Riordan and Aoife McDermott

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…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Research limitations/implications

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.

Practical implications

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.

Originality/value

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.

Details

Journal of Health Organization and Management, vol. 26 no. 5
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 3 August 2012

Soki Choi, Ingalill Holmberg, Jan Löwstedt and Mats Brommels

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…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Practical implications

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.

Originality/value

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

Details

Journal of Health Organization and Management, vol. 26 no. 4
Type: Research Article
ISSN: 1477-7266

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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…

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

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Article
Publication date: 18 May 2015

Ivan Spehar, Jan C Frich and Lars Erik Kjekshus

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

Abstract

Purpose

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

Design/methodology/approach

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

Findings

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.

Practical implications

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.

Originality/value

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

Details

Journal of Health Organization and Management, vol. 29 no. 3
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 16 March 2012

Inger Johanne Pettersen and Kari Nyland

This paper seeks to explore the legitimacy of budgets as management control processes in hospitals after comprehensive reforms were implemented in the Norwegian hospital…

Abstract

Purpose

This paper seeks to explore the legitimacy of budgets as management control processes in hospitals after comprehensive reforms were implemented in the Norwegian hospital sector in 2002.

Design/methodology/approach

The paper employs qualitative interviews with top level clinical managers in three large hospitals.

Findings

The study shows a variety of practices among the clinical managers as to management control adjustments. The managers use different strategies in order to cope with the budget frames.

Research limitations/implications

This paper contributes to the current debate and research relating to the budgeting and performance management practices in hospital settings.

Practical implications

These findings contribute to contextual knowledge that is relevant in understanding the diverse practices of clinical managers in hospitals as complex service producing organizations.

Social implications

The findings give information to decision makers as to the diversity in management practices within knowledge intensive organizations.

Originality/value

The paper challenges the idea that the strategies used by managers can be understood by the concepts of the means‐end rationality prescribed in most of the reforms introduced into the hospital sector.

Details

Journal of Health Organization and Management, vol. 26 no. 1
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 1 April 1999

Tom Forbes and Neil Prime

Examines a group of radiographers developing management roles within the backdrop of a changing NHS. A comparative study of 25 Scottish and English radiographer managers

Abstract

Examines a group of radiographers developing management roles within the backdrop of a changing NHS. A comparative study of 25 Scottish and English radiographer managers were interviewed using semi‐structured interviews. Interviews were based on a number of issues associated with moving from a clinical professional to a clinical manager and were analysed using domain theory. The interviews formed a number of emerging themes, which included management, professionalism, management style, conflicts between the role of both manager and professional, and role change. Radiographer managers are forming new “hybrid” manager roles, which have been developing within a changing NHS. A definite tension was seen in this role change. This transition was not easy for this group of radiographer managers. However, they have shown resilience in undertaking both operational and strategic management decisions, while using their clinical background to inform their decision making.

Details

Journal of Management in Medicine, vol. 13 no. 2
Type: Research Article
ISSN: 0268-9235

Keywords

Content available
Article
Publication date: 28 March 2019

Jacinta Nzinga, Gerry McGivern and Mike English

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…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Practical implications

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.

Originality/value

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.

Details

Journal of Health Organization and Management, vol. 33 no. 2
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 28 October 2013

Roslyn Sorensen, Glenn Paull, Linda Magann and JanMaree Davis

This paper aims to assess administrative and clinical manager stances on health system reform. Understanding these stances will help to identify cultural differences and…

Abstract

Purpose

This paper aims to assess administrative and clinical manager stances on health system reform. Understanding these stances will help to identify cultural differences and competing agendas between these two key health service stakeholders and contribute to developing strategies to improve organisational performance.

Design/methodology/approach

A qualitative methodology was used comprising in-depth open-ended interviews conducted in 2007 with 26 administrative and clinical managers who managed clinical units.

Findings

This paper provides empirical insights into the ways that administrative and clinical mangers conceive of their managerial roles in relation to health care reform and performance improvement in health services. The findings suggest that developing a hybrid clinical manager culture as a means to bridge the gap between administrative and clinical manager stances on reform objectives, while possible, is not yet being realised.

Research limitations/implications

The research has relevance for health services that are experiencing organisational transformation. However, its location in one health service limits the generalisability of findings to other sites. Further research is needed to assess the opportunities for a hybrid culture to emerge as well as its effect.

Practical implications

While attention is predominantly directed to clinician groups as a key stakeholder in implementing health reform policies, this paper has implications for how administrative managers also structure their roles and responsibilities to create an organisational climate conducive to change. This will include strategies to support clinical managers to make the transition from a predominantly clinical, to a clinical managerial, orientation.

Originality/value

This paper addresses a significant problem in health service governance, namely the divide between the value stances of dual hierarchies. This problem is only now gaining prominence as a significant barrier to health reform.

Details

Journal of Health Organization and Management, vol. 27 no. 6
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 1 September 2000

Anne Harris

Aims to identify awareness of and involvement in risk assessments, training, incident reporting, information giving and consenting in an acute health care context…

Abstract

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.

Details

British Journal of Clinical Governance, vol. 5 no. 3
Type: Research Article
ISSN: 1466-4100

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Article
Publication date: 7 July 2014

Didier Vinot

The perpose of this paper is to analyse recent changes in the management of French public hospitals, following a reform enacted in 2009 and aimed at bolstering the…

Abstract

Purpose

The perpose of this paper is to analyse recent changes in the management of French public hospitals, following a reform enacted in 2009 and aimed at bolstering the managerial roles of doctors.

Design/methodology/approach

The paper is exploratory and is based on both the analysis of French literature dealing with the results of the 2009 reform, and ten semi-directed interviews with clinical managers and top leaders in the public hospital sector.

Findings

The author reports on the major hospital management reforms of 2009 and analyse the implications for the medical profession and management. The author shows that the involvement of the classical clinical leaders has become less regulated as the units no longer have a clear legal basis. The governance of the newly introduced “medical poles” appears to be shaped by various factors: there is high correlation between centrality, prestige and “clan involvement”, which suggests that professionals holding new responsibilities obtain power and legitimacy by consolidating pre-existing networks. While it is often argued that high-quality clinical leadership is a key factor of organisational success, the findings suggest that the performance of clinical managers relies on this network and legitimacy acquired from it.

Originality/value

Drawing on the “sociology of translation” and actor-network theory (Callon and Latour, 1991), this paper provides a new conceptual framework for the analysis of the transformation of the role of clinical leaders, arguing that this transformation depends highly on their abilities to build and use networks. The findings challenge the French tradition of public management that presupposes a clear division of power between doctors and administrative staff.

Details

International Journal of Public Sector Management, vol. 27 no. 5
Type: Research Article
ISSN: 0951-3558

Keywords

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