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The purpose of this paper is to consider the ways in which certain occupational, organizational and political positions become active sites of leadership construction. Taking as their example the introduction of the Modern Matron in the English National Health Service (NHS) this paper considers how new forms of gender transcending leadership are constituted relationally through a dynamic interplay of historical, nostalgic, social, political and organizational forces.

The research was conducted within an interpretive paradigm of social constructivism and draws on data from semi‐structured interviews with a purposive sample of 16 Modern Matrons working in a single English NHS Trust. In keeping with inductive, qualitative research practice, data has been analysed thematically and ordered using descriptive, hierarchical and relational coding.

Their contention is that the Modern Matron presents as a site for relational leadership in respect of both self and other. This paper argues that the construction of Modern Matron usefully points to the ways in which multiple discourses, practices and relations may be intertwined in defining what it is to lead in contemporary organizations. This paper highlights the extent to which leadership is an on‐going relational co‐construction based – in this instance – in the interplay of four factors: nostalgic authority, visibility, praxis and order negotiation. Together, these produce a mode of leading that is neither heroic nor popularist.

Further research might consider how competing temporal, political and organizational imperatives encourage the development of particular sites for leadership, and how such leadership is then re‐performed in practice, as well as the affects/effect on individual and organisational performance.

The data provides opportunity to consider the “lived experience” of leaders in sites that are traditionally gendered female in non‐standard/public sector settings. Moreover, this paper presents empirical evidence in support of leadership as socially constructed and relational, borne of tension between different temporal, spatial and experiential factors, the on‐going negotiation of which both utilises and transcends masculinized and feminized gender performances. The result is a form of “leading” which is often subtle, difficult to identify and self‐effacing.

This article demonstrates how the role of the community matron has developed in Cornwall over the past three years, and how this role can be understood as the lynchpin of an integrated approach to the care and management of patients with complex needs and multiple long‐term conditions. In recent years there has been growing recognition that current models of care delivery would be likely to struggle to meet the future demands of an ageing population. Cornwall's approach is to build on the introduction of the community matron service, and to support a new model of care delivery which will encompass use of assistive technology as an additional tool to support those with long‐term conditions. The article will demonstrate the current effectiveness of the service in terms of savings for the health and social care community, and presents a case study to show how integrated working can be used to facilitate improved outcomes for patients.

As social and nutritional conditions have improved over the last century, there has been a dramatic improvement in health. Communicable diseases have almost been eradicated and mortality rates in childhood have dropped. Consequently, people are now living longer and dying has become an experience of the elderly and often as a result of degenerative diseases such as cancer. The hospice movement was set up to care for patients, such as those with cancer, who could not realistically expect to be cured, and whose needs were primarly for comfort and relief for the remaining period of life. Wheatfields is a hospice in Leeds at which great care is taken over the patients' diets, as Linda Auty, BSc, SRD, senior lecturer at the Department of Dietetics, Leeds Polytechnic, Maire O'Donnell, SRN, ONC matron at Wheatfields and Jackie Evans, SRN, RCNT assistant matron explain.

Against a background of an ageing population, rising emergency admissions and a policy direction moving towards providing care in the least intensive setting, this paper presents the dramatic results achieved in a 22‐week pilot of undivided health and social care replicating the Castlefields study and using Unique Care principles. In the context of practice‐based commissioning, where GP practices develop and commission services that represent the best model of care and use of resources for their patients, the potential for creating savings from this approach are discussed.

The public image of a profession is an important barometer of the group’s status in society. Media images play a key role in this respect, projecting the ideas and values of the group and negotiating shifts in public perception of their identity. This paper focuses on two periods in Britain when shifts in managerial culture resulted in changes in the core values of the group; the introduction of the National Health Service in 1948 and the introduction of the internal market within the NHS in the late 1980s. In both periods, nursing leaders sought to change the public image of the profession through altering their relationship with their patients/clients and reconceptualising notions of service. The focus of analysis is the role of popular film and television images in negotiating these shifts in professional values.

This paper aims to examine the policy and guidance that was issued, either as a direct result of the NHS Plan, or part of a subsequent initiative, surrounding cleaning in the NHS.

A literature review of the Department of Health and related agency web sites was completed. In addition there was a literature review of the relevant academic journals.

There is a growing evidence base on environmental cleaning in the NHS and more specifically the relationship between environmental cleaning and infection control. This paper has examined the contradiction in the evidence in the suspected correlation between infection control and environmental cleaning. However, one thing that does appear to be consistent is that a performance measure based on an observation (visual) assessment is not a sufficient tool to evaluate the environmental cleanliness of a hospital ward.

While the clinical community recognise the contribution of environmental cleaning and the impact on healthcare, more needs to be done to have the relevant studies published in the FM domain. Conversely there also needs to be work done to allow the FM community to have a “voice” in the infection control journals. The literature reviewed suggests that a usable technological solution is required to confirm satisfactory cleaning standards in healthcare facilities.

There is relatively little published work on the importance of cleaning to operations in the NHS, particularly in the FM domain.

This study sought to evaluate the impact and sustainability of the Leading Empowered Organisations (LEO) programme on the role of G Grade Nurse Managers, their colleagues and therefore on patient care at CHS.

A qualitative, inductive research methodology, which employed 360‐degree research evaluation, was used. A purposive sample of four G Grade Nurse Managers was included. Each G Grade and eight of each of their colleagues were interviewed. Data were analysed according to the principles of thematic analysis.

There was evidence of a sustained impact of the LEO programme on G Grade Nurse Managers in relation to competence, action plans, delegation, communication strategies, problem solving, risk taking, leadership and management. The study also revealed a number of significant personal and contextual factors that affected the implementation of the LEO principles. Empowerment, or a lack of it, underpinned much of what occurred in the implementation of the LEO principles by the G Grades into practice.

The findings indicated that both organisational and individual action is necessary to achieve leadership development. Organisations need to ensure that investment in leadership is not restricted to the LEO programme, but that it becomes a strategic priority.

The current focus on psychological well‐being and the treatment of people experiencing common mental disorder in primary care is of interest to health professionals and economists alike (Centre for Economic Performance Mental Health Policy Group, 2006). This brings with it an important opportunity to consider how services for people living with long term medical conditions may benefit from developments in widening access to psychological therapies. The National Service Framework for Longterm Conditions (DoH, 2005a) aims to improve the quality of life for people living with chronic medical conditions. Further to this, NICE Guidelines for the Management of Chronic Obstructive Pulmonary Disease (COPD) (NICE, 2004a) specifically focuses attention on quality of life issues for COPD sufferers and the influence of co‐morbid mental disorder on the ability of individuals to optimise selfmanagement of their condition. By examining issues relating to co‐morbidity of common mental disorders within the long‐term condition of COPD this paper concerns itself with how the agenda for widening access to psychological therapies delivered through a stepped model of care and the introduction of new mental health workforce roles such as community matrons, case managers and primary care graduate mental health workers (PCGMHWs) provides an opportunity for primary care services to integrate mental health care into chronic disease management for COPD, which in turn may provide a model for the development of services for other long‐term medical conditions.

The purpose of this paper is to illustrate how workplace interventions may benefit from a simultaneous focus on individuals’ learning and knowledge and on the situatedness of workplaces in the wider world of changing professional knowledge regimes. This is illustrated by the demand for evidence-based practice in health care.

The paper is based on a case study in a public post-natal ward in a hospital in Denmark in which one of the authors acted as both a consultant initiating and leading interventions and a researcher using ethnographic methods. The guiding question was: How to incorporate the dynamics of the workplace when doing intervention in professionals’ work and learning?

The findings of the paper show how workplace interventions consist of heterogeneous alliances between politics, discourse and technologies rather than something that can be traced back to a single plan or agency. Furthermore, the paper proposes, a road down the middle, made up by both an intentional and a performative model for intervention.

Intervention in workplaces is often directed towards changing humans, their behaviour, their ways of communicating and their attitudes. This is often furthered through reflection, making the success of intervention depend on individuals’ abilities to learn and change. In this paper, it is shown how intervention may benefit from bringing in workplace issues like different professional knowledge regimes, hierarchical structures, materiality, politics and power.

The purpose of this paper is to explore the incidence of “extreme jobs” among middle managers in acute hospitals, and to identify individual and organizational implications.

The paper is based on interviews and focus groups with managers at six hospitals, a “proof of concept” pilot with an operations management team, and a survey administered at five hospitals.

Six of the original dimensions of extreme jobs, identified in commercial settings, apply to hospital management: long hours, unpredictable work patterns, tight deadlines with fast pace, broad responsibility, “24/7 availability”, mentoring and coaching. Six healthcare-specific dimensions were identified: making life or death decisions, conflicting priorities, being required to do more with fewer resources, responding to regulatory bodies, the need to involve many people before introducing improvements, fighting a negative climate. Around 75 per cent of hospital middle managers have extreme jobs.

This extreme healthcare management job model was derived inductively from a qualitative study involving a small number of respondents. While the evidence suggests that extreme jobs are common, further research is required to assess the antecedents, incidence, and implications of these working practices.

A varied, intense, fast-paced role with responsibility and long hours can be rewarding, for some. However, multi-tasking across complex roles can lead to fatigue, burnout, and mistakes, patient care may be compromised, and family life may be adversely affected.

As far as the authors can ascertain, there are no other studies exploring acute sector management roles through an extreme jobs lens.