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Reports on a study which explored the views of key stakeholders regarding the meaning and implementation of effective health care and clinical governance in NHS Trusts, and the role for public health professionals. The authors used a national questionnaire survey to derive a sample for qualitative telephone interviews and two area case studies. The authors found that the meaning of effective health care and the means employed for implementation varied. Mergers were seen as hindrances to gaining organisational engagement whilst others, such as the White Paper on quality and the notion of clinical governance, were seen as facilitating. A widespread aspiration was a more integrated and corporate quality culture where quality was central, not marginal. The authors conclude that there is widespread concern among Trusts to change their culture and assert effective health care as a central value. Public health skills, rather than the discipline itself, are seen as important for such culture change.

To date the practice of health sector management has not been sufficiently theorised. An adequate theory should be able to answer the pre‐eminent critique of managerial rationality and ethics mounted by Alasdair MacIntyre in After Virtue and should also offer robust analytical and ethical resources to identify and engage with the social, political, economic and moral issues underlying health sector management. Critical realism with its ontology of generative mechanisms, agency‐structure relationships, valorisation of activity and ideology critique offers such resources in an empirically orientated but adequately theorised realist framework. Rather than negate MacIntyre, critical realism incorporates and transcends his key arguments regarding the rationality and ethics of management. This article introduces the main elements of critical realism and clears a conceptual space for the cumulation of critical realist case‐studies and managerial craft knowledge.

Realism is emerging as a paradigm for research and explanation in the natural and social sciences. A realist framework is elaborated and applied to the four possible situations that may generate the observations of randomised, controlled trials. It is demonstrated that by using two realist concepts “mechanism” and “context” a number of misinterpretations of such trials from within the dominant empiricist paradigm may be rectified. Evidence based medicine should adopt realism to temper a misleading empiricism, this will involve relegating statistical arguments to their proper subsidiary place and adopting an adequate theory of causation.

This commentary surveys the current arguments for and against modifying the work of doctors and nurses by placing the main viewpoints – substitution and diversification – within the policy background, particularly that of the UK. We discuss the forces for modification: cost effectiveness, professional development, quality improvement and pragmatic management and how each provides a stand‐point for evaluation of the issues. Policy makers and managers in the health sector should be aware of the rather fragmented evidence base for doctor‐nurse substitution and should consider skill mix changes only when they are clear about: purpose, evidence base, acceptable risks, accountability and quality assurance. Doctor‐nurse substitution is not necessarily cost effective, nor is it unfailingly a gain in nurse professionalism or in quality of care. Of the management perspectives available – advocacy, skepticism or pragmatism – the current evidence and policy base favours pragmatism over evaluations of the rightness or wrongness of a general policy.

The new public health agenda will require major changes in the way health authorities, local authorities, Trusts and Primary Care Groups organise and manage their activities. The requirement is for inter‐agency co‐ordination and inter‐professional and inter‐sectoral working to a shared agenda, yet the human and resources development planning to achieve these goals has not been done. This paper summarises the key training issues and argues for a collaborative, decentralised and quality assured approach to multidisciplinary public health management education and training. Only with such a joined up human resources plan can Our Healthier Nation succeed where The Health of the Nation signally failed.

This study examines how directors of public health (DsPH) perceive effective leadership. Kelly’s repertory grid technique is used. A total of 13 out of a possible 14 DsPH in one NHS region of England were interviewed. Qualitative and quantitative analysis were carried out. The findings show that male DsPH (n = 8) rate their leadership ability more highly than do female DsPH (n = 5). Qualitative analysis produced a number of categories of constructs, some of which are perceived to be indicative of effective leadership, these being “working for others”, “personal attributes”, “vision and innovation” and “courage and integrity”. Some categories appear to be applicable only to the UK (or to public health) and not to the existing dominant US models of leadership. In general, DsPH perceptions of effective leadership converge with current theories; most specifically the UK‐based theories. This study therefore refutes any simple extrapolation of US theories of leadership to UK health organisations.

This chapter provides a look at the experiences of two Teacher Educators in the Field (TEFs) as they work to shift writing instruction in suburban districts across the Houston metroplex. A review of the literature on most promising practices for literacy educators is provided along with narrative interspersion of restoried enactments of TEFs in public education systems serving students in grades 6–12. Our planned and lived experiences were often dissonant due to the complexity of increasingly diverse demographic populations in fast-growing districts who struggled to shift the focus of instruction in correlation to audience. Our stories present focused reflection on the need for additional supports geared toward teacher development, TEF retention, and consistent engagement from campus and district-level administrators.

Articulation of a vision is commonly held to be a critical component of theories of outstanding leadership – both transformational and charismatic leadership. Although there is reason to suspect that vision contributes to leader performance, less is known about the nature and origin of viable visions. In the present chapter, we argue that leaders’ visions can be viewed as a prescriptive mental model reflecting beliefs about the optimal functioning of an organization. To test this proposition, outstanding leaders possessing two contrasting types of prescriptive mental models were identified: ideologues whose models stress the maintenance of extant standards and charismatics whose models stress adaptive change. These two types of prescriptive mental models were associated with distinct patterns of leader behavior in a sample of notable historic leaders. The implications of these findings are discussed with respect to current theories of outstanding leadership.

In this chapter, we discuss how an outside writing program was able to assist the stakeholders at a local middle school and the story behind the leaders involved in the process. This program was part of a larger system of “interventions” geared toward improving student success and teacher efficacy. Traditional interventions (after-school tutorials, grouping by state assessment scores, test-taking strategies) were viewed as lacking when it came to their impact on the campus's mostly students of color. Knowing the potential impact of a solid reading and writing program on urban youth, the faculty on the campus teamed with a Writers in the Schools (WITS) writer who proposed several promising practices. The contributions of a professional writer, real-world examples, and ongoing teacher professional development with support contributed to creating a knowledge community of writers that, in addition to creating more scholarship for students and staff, manifested itself in more minority students performing at the highest levels on the state accountability assessments.