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The purpose of this paper is to investigate in an Anglo and a Confucian‐Asian nation how pressure is exerted on middle managers by their subordinate staff, and the managerial activities affected.

In a survey, Australian (n=251) and Singaporean (n=340) health managers rated the degree of pressure exerted on them by subordinate staff to devote additional time to various managerial activities. They described the influence strategies employed.

Ratings of the average pressure experienced regarding nine managerial activities were identical in both cultures. Australian managers reported significantly greater pressure affecting people and general organisational management. Singaporeans experienced more pressure affecting their quality and data management tasks. Australian subordinates used more direct‐assertive and direct‐persuasive influence strategies. Singaporeans employed more indirect‐assertive tactics, particularly poor work performance.

The generalisability of the findings may be limited by having convenience samples from one occupational sector.

The cultural differences found are relevant to the increasing numbers of multinational organisations and expatriate and migrant workers. The information will inform discussions on factors affecting the assignment of managers' priorities, which can be at variance with their aspirations.

Managers' experiences of pressure from subordinates and how pressure is conveyed have been under‐researched, particularly cross‐culturally.

This paper discusses video ethnography as part of a multimethod study of the introduction of information technology to streamline pathology test order entry in hospitals and its effect on the work of pathology laboratory scientists. The paper opens with an overview of video research in health care settings. After acknowledging the limitations inherent in video data, the paper offers a description of how video footage served to enhance insight in three ways. First, the footage enhanced the researchers’ own appreciation of the significance of particular facets of the data, which led them to reassess information collected through interviewing, focus groups and research field notes. Second, the footage enhanced the pathology laboratory scientists’ appreciation of the problems they experienced when incorporating the new information technology into their daily work practice, by enabling them to articulate these problems to outside researchers. Third, by being watched (by the video camera) and by watching themselves perform their work they were enabled to redesign their practices. The paper suggests that, as a result of interactively performing their work in front of the camera, the scientists came to apprehend their practices ‘from under a different aspect’. The paper concludes that by allowing video ethnography as a research method to remain underdefined and emergent, the modality of engagement and uptake shown by participants in the video research can be considered as a further enriching aspect of video ethnography as a research process.

Australian states have embraced clinical networking as a mechanism for managing, organising and improving the quality of care. Using these individualised state approaches to clinical networks, in this paper the authors aim to examine this Australasian “experimentation” and present lessons for other health systems.

The paper draws on current knowledge from the literature on clinical networks. The 2010 Inaugural Australasian Clinical Networks Conference also serves as a primary resource, as well as the authors' extensive discussions with policy‐makers, managers and clinicians in Australasian systems.

Key themes from the literature include: network type (mandated or natural, and hybrids); network purpose; the importance of network objectives; drivers of network success and barriers; the need for consumer engagement; and the difficulty of evaluating network effectiveness. Policy challenges include the establishment of networks for some specialty areas and not others; how to develop common standards across networks; and the need for performance metrics to assess network impact on patient outcomes. Australian networks report difficulties with achieving greater involvement of rural clinicians and indigenous populations, and with private sector clinical engagement. There are challenges too with implementation, at service level, of models of care and recommendations.

Clinical networks are becoming a fundamental vehicle for clinical improvement and change across complex organisational and professional boundaries. How to nurture and sustain effective clinical networks is of import to every health system and the authors invite stakeholders in health systems to network and share their empirical research on clinical networks to assist with distinguishing the evidence from the rhetoric.

The purpose of this paper is to investigate how, and the degree to which, superior and peer managers exerted pressure on middle managers' work cross‐culturally.

Australian (n=251) and Singaporean (n=340) health managers, respectively of Anglo and Confucian‐Asian cultures, rated the pressures exerted on them by managers, superior and peer (managers at the same level), regarding nine work pursuits, and described the nature of this pressure.

Singaporeans reported greater pressure from superiors regarding people, customer, process and quality management. Australians and Singaporeans experienced similar pressure from superiors concerning financial, organisational, data, planning and external relations management. Singaporeans reported more pressure from peers in all work domains. In Singapore superior and peer managers applied pressure to similar activities but areas targeted by Australian peer and superior managers were not significantly related. Singaporean superiors were more likely to apply pressure through deadlines and appraisals.

Convenience samples from one occupational sector may limit the generalisability of the results.

Knowledge of the degree and sources of stress encountered by middle managers in an Anglo and a Confucian‐Asian culture may enhance organisational communication both within and between these cultures.

Although it is a crucial issue, pressures exerted on managers by superior and particularly peer managers regarding specific managerial work pursuits has received little attention, particularly from a cross‐cultural perspective.

The purpose of this paper is to draw on scientific models in conceptualising the evolutionary bases of contemporary behaviours, and make cross‐species comparisons, to account for male managerial activities in situ in health organizations.

In the animal world, males of many species display in order to induce females to mate. Such lekking behaviour involves inter alia, strutting, puffing out, catching attention via the use of ornamental physical characteristics, exhibiting gaudily‐coloured body parts, singing or splashing, and other courting and wooing strategies. The paper applies these behavioural repertoires as an explanatory device for male‐dominant organizational lekking in a set of contemporary settings. It draws on six studies of managerial talk, appearance and behaviour in order to do so.

Within the organizational lek male managers display mainly by power dressing, positioning, and exercising power and influence via verbal and behavioural means. Social and religious mores prohibit overt sexual coupling in organizations but lekking for other rewards is nevertheless pursued by male managers. The paper explores this managerial patterning, compares it to the lekking behaviour of other species, and discusses points of comparison and departure. It shows how male managers display within various sub‐habitats, and discusses the central issues of appearance, tasks and work assignment, physical interaction structure, and talk and physiognomy.

Understanding what makes people tick via deep explanations than are customarily rendered is a vital contribution of scholarship to the practical world of management.

The evolutionary bases of contemporary behaviours, and cross‐species accounts, may prove useful paradigms for other theorists and empiricists in organizational studies, and could encourage the development of a new field that might be labeled evolutionary organizational behaviour.

This paper aims to analyse the development of patient safety as a field within which patients are peripheral stakeholders.

The authors examined the patient safety movement from the perspective of a field in which agents struggle for control over various forms of capital, including economic, social, cultural and symbolic capital. In order to undertake this analysis the authors drew on the literature on errors and patient safety, key inquiries into patient safety, and research conducted with health professionals in New South Wales, Australia.

The patient safety movement has created a heightened sense of awareness of errors and risk across health systems, thereby attracting and creating significant amounts of capital. The authors argue that in the process of struggle to constitute and contain a new field of health, patients and their narratives are rendered vulnerable to appropriation and incorporation.

By considering patient safety from a sociological rather than a technical framework, it is possible to gain new insights into why reducing the levels of medical errors have proven so difficult.

Improved knowledge of how patient safety operates as a field may contribute to more effective strategies in reducing those types of errors.

Despite the growth in the number of publications in patient safety there has been only minimal analysis of the field itself, rather than its technical or organisational components. This paper contributes to a new way of conceptualising and enacting patient safety, one that acknowledges the vulnerability of the parties involved, particularly patients.

The purpose of the paper is to examine the deep conceptual underpinnings of trust and communication breakdowns via selected health inquiries into things that go wrong using evolutionary psychology.

This paper explains how this is carried out, and explores some of the adverse consequences for patient care. Evolutionary psychology provides a means of explaining important mental capacities and constructs including theory of mind and the social brain hypothesis. To have a theory of mind is to be able to read others' behaviours, linguistic and non‐verbal cues, and analyse their intentions. To have a social (or Machiavellian) brain means being able to assess, compete with and, where necessary, outwit others. In the tough and complex environment of the contemporary health setting, not too different from the Pleistocene, humans display a well‐developed theory of mind and social brains and, using mental attributes and behavioural repertoires evolved for the deep past in hunter‐gatherer bands, survive and thrive in difficult circumstances.

The paper finds that, while such behaviours cannot be justified, armed with an evolutionary approach one can predict survival mechanisms such as turf protection, competitive strategies, sending transgressors and whistleblowers to Coventry, self‐interest, and politics and tribal behaviours.

The paper shows that few studies examine contemporary health sector behaviours through an evolutionary psychology lens or via such deep accounts of human nature.

This paper aims to explore the development of the concept of clinical governance as an international approach to addressing quality and safety issues in healthcare.

The authors reviewed and analysed published clinical governance abstracts from 1966 to 2009. Citations were identified through a systematic search of Medline, Embase and CINAHL databases. A time series analysis was undertaken on the citations. The contents of the abstracts were then examined using an automated data‐mining software package in order to identify underlying concepts.

A total of 2,000 publications which made direct mention of clinical governance were identified across the 43‐year search period. All were produced after 1998. This was when the concept was first seriously mobilised. Of the 2,000 citations, 2.3 per cent were published in 1998 and 6.3 per cent in 2008 (the last complete year available). The peak was reached in 2003, when 12.7 per cent of all clinical governance citations were published. The years 1998 to 2003 accounted for 59.2 per cent of all citations (to September 2009). There has been a steady decrease in the number of citations making direct reference to clinical governance since 2003.

This paper maps the development and peak of clinical governance as a mobilising concept in healthcare in the late twentieth and early twenty‐first centuries and shows how its conceptual underpinnings have been taken up by wider quality and safety agendas. Fads and fashions rise and fall in healthcare, as in other areas of life.

The purpose of this paper is to examine the case that health service leadership is more than the sum total of all the health service management activity observed; and to advocate for improved leadership in health services through an examination of top‐down management structures and processes which “crowd out” leadership behaviours.

Application of historical and contemporary contexts to health service management and health service leadership approaches.

The neglect of leadership is discussed and the case is put for a tightly‐crafted position on how leadership should be emphasised and raised to greater prominence. Formulae for conceptualising leadership are presented in order to show the constituent elements underpinning clear descriptions of leadership.

Further research on leadership, and more targeted education for leaders, is needed.

One way to build leadership capacity is to create a sustainable partnership between health service academics and leaders in the field.

Developing formulae for framing leadership is not reductionist per se but specifies with precision the essential elements needed to express health services leadership success.

Patient safety has been addressed since 2002 in the health system of New South Wales, Australia via a Safety Improvement Programme (SIP), which took a system‐wide approach. The programme involved two‐day courses to educate healthcare professionals to monitor and report incidents and analyse adverse events by conducting root cause analysis (RCA). This paper aims to predict that all professions would favour SIP but that their work and educational histories would result in doctors holding the least and nurses the most positive attitudes. Alternative hypotheses were that doctors' relative power and other professions' team‐working skills would advantage the respective groups when conducting RCAs.

Responses to a 2005 follow‐up questionnaire survey of doctors (n=53), nurses (209) and allied health staff (59), who had participated in SIP courses, were analysed to compare: their attitudes toward the course; safety skills acquired and applied; perceived benefits of SIP and RCAs; and their experiences conducting RCAs.

Significant differences existed between professions' responses with nurses being the most and doctors the least affirming. Allied health responses resembled those of nurses more than those of doctors. The professions' experiences conducting RCAs (number conducted, leadership, barriers encountered, findings implemented) were similar.

Observational studies are needed to determine possible professional differences in the conduct of RCAs and any ensuing culture change that this may be eliciting.

There is strong professional support for SIPs but less endorsement from doctors, who tend not to prefer the knowledge content and multidisciplinary teaching environment considered optimal for safety improvement education. This is a dilemma that needs to be addressed.

Few longer‐term SIPs' assessments have been realised and the differences between professional groups have not been well quantified. As a result of this paper, benefits of and barriers to conducting RCAs are now more clearly understood.