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Article
Publication date: 31 January 2024

Sigrid Betzelt, Ingo Bode and Sarina Parschick

Regarding how the public regulation of human services is perceived within welfare organizations and how the latter cope with it, the role of emotions (as mediators between…

Abstract

Purpose

Regarding how the public regulation of human services is perceived within welfare organizations and how the latter cope with it, the role of emotions (as mediators between structure and agency) proves highly relevant while often being hidden beneath the surface. This article shows how a specific approach to such regulation – here: managerialism – may impact on “emotional regimes” at the organizational and individual level, affecting the attainment of organizational goals and workers' health.

Design/methodology/approach

The article primarily draws on multiple qualitative case studies across two welfare sectors (four organizations) in Germany (continuing education/active inclusion; long-term care). The study research was conducted between 2020 and 2022 and based on 36 interviews with caseworkers and managers, focus group interviews and expert dialogues at industry level.

Findings

The results suggest that the managerialist regulation of welfare services breeds complex and ambiguous emotional regimes. Business-like management techniques elicit various emotions, affecting the motivational basis of human service work. While the experience of hard challenges may raise positive feelings, coping patterns often put strain on organizations and staff alike. In the short run, related emotional regimes tend to make service delivery proceed smoothly, yet in the long run they may have corrosive effects and problematic repercussions on macro-level developments.

Originality/value

The study highlights the role of emotions in publicly regulated human service settings by intermingling macro- and micro-level processes and thereby broadens the perspective of welfare state research as it reveals the impact of (managerialist) regulation on the dynamic organizational chemistry of such settings.

Details

International Journal of Sociology and Social Policy, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 0144-333X

Keywords

Article
Publication date: 7 July 2014

Ingo Bode and Markus Maerker

Internationally, management in medicine has become a topical issue in health care research and policy. Against this background, the purpose of this paper is to examine the…

1022

Abstract

Purpose

Internationally, management in medicine has become a topical issue in health care research and policy. Against this background, the purpose of this paper is to examine the changing role of doctors in the management of German hospitals.

Design/methodology/approach

The paper is based on a literature review on the one hand, explorative research drawing on field document and expert interviews, on the other. In the light of basic assumptions of neo-institutionalist and contingency theory, major developments regarding the relationship between medicine and management in Germany are sketched.

Findings

In the German health care sector, the importance of management in medicine is generally increasing, with more managerial (administrative) functions included in the clinicians’ activity. However, the current situation proves complex. On the one hand, there is more management within medicine, materializing, e.g. in further education schemes embracing economic training or in a general expectation that physicians striving for higher ranks within a hospital's hierarchy should exhibit economic knowledge. On the other hand, the authors see a hesitant attitude of the medical profession toward a greater involvement in management. In addition, policies of hospital owners affecting management roles prove diverse. They range from organizing medical departments as autonomous profit centers to ensuring strong hierarchical control by top management, with this entailing different demands regarding a doctor's managerial skills. Due to the advent of powerful non-clinician managers in part of the sector, moreover, medics are losing influence at top level. Altogether, there seems to be a polarization within the hospital system concerning the role of doctors in hospital management. This, to some extent, sits uneasy with key propositions from neo-institutionalist and contingency theory.

Originality/value

The paper retraces general developments concerning the involvement of German hospital doctors in management. Given the paucity of research in this field, it provides preliminary insights on the dynamics that influence the way and degree of this involvement. The major result is that there is structural polarization within an environment which, though streamlining both institutional mind-maps and organizational structures, leaves considerable discretion to the organizational level.

Details

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

Keywords

Content available

Abstract

Details

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

Article
Publication date: 26 April 2011

Ingo Bode, Laurent Gardin and Marthe Nyssens

This paper seeks to explore various types of quasi‐market governance in domiciliary elderly care with an interest in both the institutional variety of these governance…

857

Abstract

Purpose

This paper seeks to explore various types of quasi‐market governance in domiciliary elderly care with an interest in both the institutional variety of these governance arrangements and their assumable consequences, against the twofold background of the EU care policy agenda and the Nordic experience.

Design/methodology/approach

Based on evidence from four Western European countries, the paper examines how recent reforms have changed the provision of domiciliary care, including the shape of vertical and horizontal governance arrangements. Moreover, summarizing results of previous research and drawing on theoretical reflections rooted both in economics and sociology, the paper discusses the wider impact of these reforms.

Findings

The analysis points to country‐specific limitations of the quasi‐market approach regarding issues such as the work‐life balance of carers and the access to adequate services.

Originality/value

By combining different scientific approaches and exploring several institutional contexts, the paper offers new insights both in problems of quasi‐market governance and their cultural colouring.

Details

International Journal of Sociology and Social Policy, vol. 31 no. 3/4
Type: Research Article
ISSN: 0144-333X

Keywords

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 managerial…

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

Article
Publication date: 7 July 2014

Marco Sartirana, Anna Prenestini and Federico Lega

As a consequence of new public management reforms, leading professionals in public service organizations have increasingly been involved in management roles. The phenomenon of…

390

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Originality/value

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.

Details

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

Keywords

Article
Publication date: 7 July 2014

Haldor Byrkjeflot and Peter Kragh Jespersen

The purpose of this paper is to bring the discussion on the relationship between management and medicine a step forward by focussing on: first, how the notion of hybrid and…

1713

Abstract

Purpose

The purpose of this paper is to bring the discussion on the relationship between management and medicine a step forward by focussing on: first, how the notion of hybrid and hybridity has been used in the literature on healthcare management. Second, the authors have mapped the alternative ways that the concept have been used in order to conceptualize a more specific set of possible combinations of managerial and professional roles in healthcare management. Hybrid management is a topic that ought to be important for training, communication among researchers and for identifying areas of future research: in management, in healthcare reforms, in sociology of professions and in theory of organizations.

Design/methodology/approach

The authors provide a systematic literature review in order to map the various conceptualizations of hybrid management. The authors have searched for “hybrid leadership,” “hybrid management” combined with hospitals and health care in a whole range of journals, identified in Google scholar, Academic Search Premier, Academic Research Library and Sage Publication. The authors have also used already existing literature reviews. The search has resulted in more than 60 articles and book titles that have been classified according to whether they make a fit with three alternative ways of conceptualizing hybrid management. The authors are aware that they might have missed some relevant literature but the literature included is quite comprehensive.

Findings

In the literature the authors have found three conceptualizations of management. The clinical manager who combines professional self-governance with a general management logic. The commercialized manager who combines professional self-governance with an enterprise logic. The neo-bureaucratic manager who combines self-governance with a neo-bureaucratic logic.

Originality/value

In most analyses of hybridity in management and organization the notion of hybrid has been used in a rather superficial way. By mapping the various uses of hybrid in the literature and suggest how a professional logic may be combined with a set of alternative logics of management the authors provide a platform for developing the concept of hybrid management into a more useful tool for analyses of changes in healthcare management.

Details

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

Keywords

Article
Publication date: 7 July 2014

Kathy Hartley and Marcin Kautsch

The purpose of this paper is to present the findings of a short research project, conducted in 2010 as part of a larger EU funded action investigating the participation and impact…

477

Abstract

Purpose

The purpose of this paper is to present the findings of a short research project, conducted in 2010 as part of a larger EU funded action investigating the participation and impact of doctors in management. The authors sought to compare the ways in which hospital doctors in the UK and Poland – countries with distinct histories – participate in management; whether they are converging and whether the type of participation found results from changes in the governance and management of these systems.

Design/methodology/approach

First, a review of existing evidence and an analysis of policy documents and healthcare statistics were conducted. Identifying a lack of empirical data in the Polish context, and a potentially changing situation in the UK, the authors proceeded to collect some exploratory data in Poland, via interviews with expert informants, and to draw on data collected alongside this study in the UK from qualified doctors participating in research on management and leadership development.

Findings

Hospital doctors currently hold similar types of management role in both systems, but there are signs that change is underway. In Poland, different types of medical manager and role are now emerging, whereas in the UK younger doctors appear to be expecting greater management responsibility in the future, and are starting to take up the management training now on offer.

Research limitations/implications

The potential implications of these changes for the profession and policymakers in both Poland and the UK are discussed, with opportunities for further research highlighted.

Originality/value

The paper provides a comparison of how medical engagement within two systems with different histories is occurring, and also of the changes underway. It provides some much needed initial insight via interviews with expert informants within the polish system, which has been under-researched in relation to the involvement of medicine in management.

Details

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

Keywords

Article
Publication date: 7 July 2014

Laila Nordstrand Berg and Haldor Byrkjeflot

The hospital sector has expanded in Norway with reforms and a strong demand for better management. The purpose of this paper is to examine: first, how this has affected physicians…

1175

Abstract

Purpose

The hospital sector has expanded in Norway with reforms and a strong demand for better management. The purpose of this paper is to examine: first, how this has affected physicians and nurses in management; second, how management roles in hospitals are changing; and third, how these two professions are tackling their new roles.

Design/methodology/approach

The paper presents a review of the secondary literature and a case study undertaken in the spring, 2012.

Findings

In Norway, two reforms have been introduced aimed at creating stronger management positions with less professional influence. The leader has full responsibility for a particular unit, which means that the jurisdiction of managers has expanded and that management has become more time consuming. Physicians – traditionally those in charge of hospitals – are facing competition from other professions, especially nursing, which has gained representation in top management positions, particularly at middle management level.

Originality/value

The originality of this paper is the comparison of the evolvement of management among physicians and nurses since the reforms. While the medical profession was critical of management to begin with, i.e. viewing management positions as a trap, it is gradually adapting to the new ideas. Physicians are facing competition from nurses, who readily adjust to the new conditions, and perceive management as a new career track.

Details

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

Keywords

Book part
Publication date: 8 November 2011

Anders la Cour and Holger Højlund

Purpose – To analyze the emergence of new organizational forms in the Danish welfare sector.Design/methodology/approach – Drawing on Niklas Luhmann and Gunther Teubner, the…

Abstract

Purpose – To analyze the emergence of new organizational forms in the Danish welfare sector.

Design/methodology/approach – Drawing on Niklas Luhmann and Gunther Teubner, the research analyzes governmental documents, policy programs, action plans, and strategic documents.

Findings – A partnering structure has emerged with a new politics of voluntarism, complex forms of integration and new imaginary distinctions between voluntariness and public care. This can usefully be conceptualized as aspects of the stabilization of a “third-order system.” The research identified a number of different managerial strategies for involvement in the system.

Practical and social implications – Social welfare has become a mix of public and civil society values and norms, and extensive resources have been invested from both governmental and nongovernmental sides to build up shared competences for the new forms of partnering-based organization. However, to act according to the new principles of partnering, at the strategic and managerial level, the voluntary organizations have to behave in a schizophrenic manner – as both individual organizations and cooperational partners within the system.

Research implications – The concept of “third-order system” is especially useful in analyzing mixed forms of management in the welfare sector.

Originality – Different forms of radical organizational analysis are combined to develop a notion of “third-order system” in the welfare sector.

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