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Article
Publication date: 19 March 2018

James F.B. Houston and Jessica E. Morgan

Close collaboration between NHS clinicians and managers is essential in providing effective healthcare, but relationships between the two groups are often poor. Paired…

Abstract

Purpose

Close collaboration between NHS clinicians and managers is essential in providing effective healthcare, but relationships between the two groups are often poor. Paired learning is a peer-peer buddying tool that can break down barriers, increase knowledge and change attitudes. Paired learning has been used with doctors and managers but not for multi-professional clinicians. The purpose of this paper is to assess whether a paired learning programme (PLP) can improve knowledge and attitudes between multi-professional NHS clinicians and managers.

Design/methodology/approach

A PLP pairing clinicians and managers over a four-month period to participate in four buddy meetings and three group meetings was delivered. A mixed methods study was completed which collected quantitative and qualitative data in the form of pre- and post-course questionnaires and focus group discussions.

Findings

Participants reported increased understanding, changed attitudes and better communication between clinicians and managers following the PLP. Self-rated knowledge increased across all domains but was only statistically significant for ability to engage, ability to establish shared goals and knowledge of decision-making processes.

Research limitations/implications

This paper highlights the value of paired learning in encouraging collaboration between clinicians and managers but is of a small size. The PLP did not provide enough data to examine relationships and interaction between clinicians and managers, this should be considered in any future work.

Originality/value

To the authors’ knowledge, this is the only published paper showing data from a PLP involving multi-disciplinary health professionals.

Details

Journal of Health Organization and Management, vol. 32 no. 1
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 30 October 2009

Louise Kippist and Anneke Fitzgerald

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

Abstract

Purpose

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

Design/methodology/approach

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.

Findings

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.

Research limitations/implications

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.

Practical implications

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.

Originality/value

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.

Details

Journal of Health Organization and Management, vol. 23 no. 6
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 22 April 2020

Chiara Oppi and Emidia Vagnoni

This paper aims to investigate the consequences of the coercive regulations for performance measurement and comparability that strengthened regional health authority’s…

Abstract

Purpose

This paper aims to investigate the consequences of the coercive regulations for performance measurement and comparability that strengthened regional health authority’s control over organizations’ activities on management accountants’ relationship with clinician managers, who are the recipients of accounting information for decisional processes in health-care organizations. To achieve this aim, the research focuses on management accountants’ perception of their role and whether they perceive role conflict and role ambiguity.

Design/methodology/approach

A case study was undertaken in a public university hospital in the Emilia-Romagna region, Italy; 9 management accountants and 11 clinician managers were interviewed and secondary data analyzed.

Findings

Management accountants show low capabilities to support clinician managers’ decisional processes. Following the enactment of regulations, management accountants perform their role with a primary focus on functional responsibility. The focus on the provision of information to address regulations influenced management accountants’ capability to act as business partners in the organization. Because of the conflicting information needs from regulations and clinician managers, management accountants experience role conflict and ambiguity.

Research limitations/implications

The paper has implications for policymakers, underlining the consequences of strict regulations on management accountants’ role. It also emphasizes the importance of revising accounting techniques to satisfy both regional requirements and clinician managers’ needs for decision-making.

Originality/value

The article contributes to knowledge related to the role of management accountants in health care. It explores, in particular, the consequences of coercive regulations in health-care organizations, adding knowledge to a field that remains quite unexplored.

Details

Qualitative Research in Accounting & Management, vol. 17 no. 3
Type: Research Article
ISSN: 1176-6093

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Article
Publication date: 1 August 2004

Jeffrey Braithwaite

Numerous past articles, many of which consist of idealised prescriptions for success or the occasional case study or practitioner's contribution, have commented on the…

Abstract

Numerous past articles, many of which consist of idealised prescriptions for success or the occasional case study or practitioner's contribution, have commented on the role of hospital clinicianmanagers. Prior work is circumscribed, however, in that it tends to be normative and a priori (how clinicianmanagers in principle should manage) rather than descriptive and a posteriori (how clinicianmanagers in situ do manage). In addition, it is apparent that an empirically‐grounded, testable model is lacking for the way clinicianmanagers work. This paper sets out to balance past normative‐prescriptive accounts with a descriptive‐analytic one, and presents an empirically‐based conceptual model of the behavioural routines of hospital clinicianmanagers. The model, based on multiple studies of clinicianmanagers' activities, conjectures five major modes of operating and four primary and five secondary pursuits. The paper advances accounts of how clinician‐management work is conducted and the time frames for it, and hypothesises about clinicianmanagers' relationships, and how power and control is experienced and exercised. It also briefly discusses some of the implications of both the research program and the findings. However, following Popper, researchers ought to invite attempts to improve rigor through a systematic critique of their findings. Critical analysis of this work under falsification processes is consequently welcomed.

Details

Journal of Health Organization and Management, vol. 18 no. 4
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 8 January 2018

Sally Crowe and Frank Deane

The purpose of this paper is to investigate the relationships between clinicians’ and managers’ risk aversion and a range of variables related to the implementation of the…

Abstract

Purpose

The purpose of this paper is to investigate the relationships between clinicians’ and managers’ risk aversion and a range of variables related to the implementation of the Collaborative Recovery Model (CRM). Positive risk taking is an integral component of the recovery process. Clinicians’ risk aversion has the potential to negatively impact on their implementation of recovery-oriented practices. The CRM provides an evidence-based framework to assist consumers to participate in the recovery process. However, there is a need for research to clarify the factors related to recovery that have impact on managers’ and clinicians’ risk aversion, and ultimately on implementation of recovery practices.

Design/methodology/approach

A cross-sectional survey assessed clinicians’ (n=174) and managers’ (n=48) risk aversion and their self-reported learning experiences, commitment to using CRM, goal setting attitudes and CRM implementation behaviour.

Findings

Clinicians who reported more risk aversion were significantly more likely to report positive attitudes towards goal setting. Stepwise regression revealed that training experiences, goal setting attitudes and commitment to CRM significantly predicted an increase in CRM implementation. Over and above this, risk aversion predicted a small but significant increase in the self-reported use of CRM. Managers experienced significantly less risk aversion than clinicians, with a negative relationship between risk aversion and commitment to CRM principles.

Originality/value

This paper suggests that clinicians’ risk aversion impacts upon their implementation of the CRM, with managers less risk averse than clinicians.

Details

The Journal of Mental Health Training, Education and Practice, vol. 13 no. 1
Type: Research Article
ISSN: 1755-6228

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Article
Publication date: 31 August 2012

Liz Fulop

In many countries leadership theories and leadership development programs in healthcare have been dominated by individualistic and heroic approaches that focus on…

Abstract

Purpose

In many countries leadership theories and leadership development programs in healthcare have been dominated by individualistic and heroic approaches that focus on developing the skills and competencies of health professionals. Alternative approaches have been proffered but mainly in the form of post‐heroic and distributed forms of leadership. The notion of “hybridity” has emerged to challenge the assumptions of distributed leadership. The paper seeks to explore how the concept of hybridity can be used to re‐theorize leadership in healthcare as it relates to clinician managers (or hybrid‐professional managers).

Design/methodology/approach

The theoretical developments are explored and empirical material is presented from research in Australian public hospitals to support the case for the existence of hybridized forms of leadership in healthcare. The paper discusses whether hybridity needs re‐theorizing to adequately account for clinician leadership. It contributes to debates surrounding the role of clinician leadership in healthcare reform particularly in relation to those doctors who occupy management positions at the division or unit levels as distinct to CEOs. The study uses qualitative research, i.e. interactive interviews to present accounts of how healthcare professionals describe leadership. It undertakes both deductive and inductive theme analysis of the interview material.

Findings

There is support for hybridized configurations of leadership in interview materials of healthcare professionals but other aspects were also noted that cannot be explained by this approach alone.

Originality/value

The paper is the first to examine the concept of hybridity in the context of clinician leadership. Many approaches to leadership in healthcare fail to address the complexity of leadership within the ranks of clinician managers and thus are unable to deal adequately with the role of leadership in healthcare reform and change.

Details

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

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Article
Publication date: 20 March 2017

Shaozhuang Ma, Xuehu Xu, Virginia Trigo and Nelson J.C. Ramalho

The purpose of this paper is twofold: first, to develop and test theory on how commitment human resource (HR) practices affect hospital professionals’ job satisfaction…

Abstract

Purpose

The purpose of this paper is twofold: first, to develop and test theory on how commitment human resource (HR) practices affect hospital professionals’ job satisfaction that motivates them to generate desirable patient care and subsequently improve doctor-patient relationships (DPR) and second, to examine how commitment HR practices influence hospital managers and clinicians in different ways.

Design/methodology/approach

Using a cross-sectional survey, the authors collected data from 508 clinicians and hospital managers from 33 tertiary public hospitals in China. Structural equation model was employed to test the relationships of the variables in the study.

Findings

Commitment HR practices positively affect the job satisfaction of the healthcare professionals surveyed and a positive relationship is perceived between job satisfaction and DPR. Overall, the model shows a reversal on the strongest path linking job satisfaction and DPR whereby managers’ main association operates through extrinsic job satisfaction while for clinicians it occurs through intrinsic satisfaction only.

Practical implications

DPR might be improved by applying commitment HR practices to increase healthcare professional’s intrinsic and extrinsic satisfaction. In addition, while recognizing the importance of compensation and benefits to address the underpayment issue of Chinese healthcare professionals, empowerment and autonomy in work, and the use of subjects’ expertise and skills may serve as stronger motivators for clinicians rather than hard economic incentives in achieving DPR improvements.

Originality/value

This study contributes to the small but growing body of research on human resource management (HRM) in the healthcare sector with new evidence supporting the link between commitment HR practice and work attitudes, as well as work attitudes and patient care from the perspective of clinicians and hospital managers. This study represents an initial attempt to examine the associations among commitment HR practices, job satisfaction and DPR in the Chinese healthcare sector. The findings provide evidence to support the value of commitment HR practices in Chinese hospital context, and demonstrate the importance of effective HRM in improving both hospital managers and clinicians’ work attitudes.

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Article
Publication date: 8 May 2017

Theresa Maureen Williams and Geoffrey Paul Smith

The purpose of this paper is to describe the impact of a trauma-informed care (TIC) training programme on practice at the individual and workplace level in mental health…

Abstract

Purpose

The purpose of this paper is to describe the impact of a trauma-informed care (TIC) training programme on practice at the individual and workplace level in mental health and drug and alcohol services and to examine the implications of using training alone as a strategy for achieving system-level practice change.

Design/methodology/approach

A total of 271 clinicians and managers from public mental health and drug and alcohol services in Western Australia who had undertaken TIC training were invited to complete an on-line survey 12 months after training. Individual survey items were based on a five-point Likert scale with opportunity being provided for additional comments from respondents.

Findings

One year post-training, both clinicians and managers reported that training had increased their awareness and knowledge and had a positive impact on their attitudes towards TIC. Clinicians reported a moderate impact on their individual practice and both groups reported very limited success in bringing about change in their workplaces. Workforce development and organisational factors were identified by both clinicians and managers as being barriers to implementation.

Research limitations/implications

Only 30 per cent of the training participants responded to the survey and it is not possible to determine whether they differed from non-respondents. Findings were based on a self-report survey with no objective measure of behaviour change.

Originality/value

This “naturalistic” study examines the longer-term impact of training, from the perspective of clinicians and managers, on changing practice at the individual clinician and workplace level. It highlights the critical importance of understanding and addressing contextual factors where collective, coordinated behaviour change is needed in order to effect organisational change.

Details

The Journal of Mental Health Training, Education and Practice, vol. 12 no. 3
Type: Research Article
ISSN: 1755-6228

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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: 1 March 1987

F. Eskin

Since the 1974 reorganisation of the British National Health Service, clinicians have continually voiced concern regarding the threat of encroachment on their clinical…

Abstract

Since the 1974 reorganisation of the British National Health Service, clinicians have continually voiced concern regarding the threat of encroachment on their clinical freedom by lay management, within the context of increasing financial stringency. The introduction of general management has reinforced these fears of interference by what is perceived by the medical profession to be vastly enhanced professional managerial power in relation to resource control in the sphere of direct patient care.

Details

Journal of Management in Medicine, vol. 2 no. 3
Type: Research Article
ISSN: 0268-9235

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