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Based upon empirical research conducted in 1993, attempts to illustrate the implications of efforts to bring doctors into management. It addresses in particular the role of key appointments such as the medical director and clinical directors and the perceptions of these roles. Doctors continue to demonstrate themselves to be reluctant managers and this continues to pose problems for the aspirations contained in Working for Patients. Crucial questions must be asked about whether management represents a productive use of doctors′ time and whether the NHS can afford premium rates for largely inexperienced managers. Identifies changes that have taken place to date and indicates that doctors are, for the most part, still lukewarm about a career in medical management.

To explore theoretically the reasons for the modest uptake of clinical governance practices by taking the literature on the origin of tensions between doctors and managers as the starting‐point.

The approaches of doctors and managers to the division and coordination of medical work are analysed theoretically from a twofold perspective that combines insights from sociologists' theories on “professionalism” and administrative scientists' theories on “management science”.

The combined perspective theoretically explains the problems between doctors and managers that frustrate the uptake of clinical governance practices. By inference from this theoretical analysis, a twofold agenda for a constructive dialogue is proposed. Doctors and managers must develop a shared vision of the division and coordination of medical work as well as discussing the values, norms and goals underlying patient care. It is questionable, however, whether this agenda is currently adequately addressed.

This paper provides a theoretical underpinning for the dialogue between doctors and managers. It may be enlightening for all doctors and managers working in the field.

This paper describes factors influencing doctor‐managers' decision making in specialised health care, health centres and at different levels of management.

Data were collected as part of a survey on physicians graduating in 1977‐1991 as drawn from the register of the Finnish Medical Association. The study sample was formed by selecting all physicians born on odd days (n=4,144) from the baseline group (n=8,232). The category of doctor‐managers comprised physicians reporting as their main occupation: principal or assistant principal physician of hospital, medical director or principal physician of health centre, senior ward physician of hospital, and health centre physician in charge of a population area.

Independent of gender, all doctor‐managers responding to the survey reported that the most important base for decision making was personal professional experience. Position in organisation (first‐line manager, principal physician) had no impact on the base of decision making. Doctor‐managers in primary health care utilised knowledge on norms and knowledge available from their organisation in support of their decision making to a greater degree compared with doctor‐managers in specialised health care.

Evolution discourse from public administration is not yet receiving much response in Finnish doctor‐managers' activities, instead, they still act as clinicians.

Facing the growing challenges of the future, the paper shows that doctor‐managers should reconstruct their orientation and to act more like managers.

The purpose of this paper is to explore whether unitary managers with different professional backgrounds carry out and reflect differently upon their roles as unitary managers.

This paper presents findings from two different studies, comprising both data from qualitative interviews and a nationwide survey.

Doctors and nurses in many respects perform their roles as unitary managers differently. They hold the same position but carry out their roles differently. Doctors are very committed to clinical tasks and stress to a great extent that clinical tasks should be integrated in management at the department level. The opposite is true for the nurses, where leadership first and foremost should be understood as management.

Even though doctors and nurses are in the same position they manage differently, being committed to different tasks within the unit. This is not the intention of the reform. However, the question is thus, will this have (severe) consequences for the organization? Or does it represent a healthy diversity in the health organisation?

This paper explores whether different professions carry out their managerial tasks differently and what practical implications this could have. It brings to the fore substantial empirical data on how one of the major reforms in Norwegian (and international) health care has been adopted and carried out by major professional groups.

Examining the self-identification of physician managers with their manager and clinician roles, and its impact on the state and professional powers in healthcare governance.

With purposive sampling, a total of 15 frontline clinical department managers (mainly principal consultants) and directorial managers (mainly Hospital Chief Executives) were recruited to elite interviews. The themes for data collection and analysis were based on a systematic scoping review of previous empirical studies.

Physician managers maintained respective jurisdictions in policymaking and clinical governance, as well as their primary self-identification as rationalizers or protectors of medicine, according to their managerial roles at a directorial or departmental level. However, a two-way hybridization of physician managers allowed the exchange of clinical and managerial authority, resulting in cooperation alongside struggles among medical elites; while some frontline managers were exposed to managerial values with the awareness of budget and organizational administration, some directorial managers remained aligned to a traditional mode of professional communication, such as persuasion through informal personal networks and by using clinician language and maintaining symbolic contact with the clinical field.

This study identifies the inconsistency in physician managers’ identity work, as well as its patterns. It goes beyond a dichotomized framework of professionalism versus managerialism or an arbitrarily blurred identity.

Current government policy places great emphasis on increased collaboration between disciplines and professions within health care, as in public services across the board. To date, analyses of doctor‐manager relations have tended to focus on equipping doctors with management skills, once they have reached consultant level. In contrast, this paper evaluates a new management development initiative, designed to involve doctors and managers at an earlier career stage, and on an inter‐disciplinary basis. Interview and questionnaire responses indicate that specialist registrars and young managers share common values; however, they also acknowledge a high degree of mutual ignorance. Evaluation suggests that inter‐disciplinary programmes can provide a starting‐point for closer collaboration in practice; in conclusion, some options for sustaining this in the long term are identified.

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

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

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.

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.

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

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.

The purpose of this paper is to review the current literature and summarises the benefits and limitations of having doctors in health management roles in today’s complex health environment.

This paper reviews the current literature on this topic.

Hospitals have evolved from being professional bureaucracies to being managed professional business with clinical directorates in place that are medically led.

Limitations include the difficulty doctors have balancing clinical duties and management, restricted profession-specific view and the lack of management competencies and/or training.

The benefits of having doctors in health management include bottom-up leadership, specialised knowledge of the profession, expert knowledge of clinical care, greater political influence, effective change champions to have on-side, frontline leadership and management, improved communication between doctors and senior management, advocacy for patient safety and quality, greater credibility with public and peers and the perception that doctors have more power and influence compared to other health professionals can be leveraged.

Overall, there are more benefits than there are limitations to having doctors in health management but there is a need for more management training for doctors.

The role of doctors in hospitals continues to change due to both external (policy) and internal (organisational change) pressures. Comparisons between The Netherlands and the UK highlight that several models of medical management are formulated and exist alongside each other, leading to more flexibility in the roles of both doctors and managers. In particular, the agendas concerning the quality of clinical care and cost‐effectiveness are converging, emphasising the increasingly important role of medical managers.