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Article
Publication date: 1 April 1997

Susie Leigh and Karin Newman

Seeks to throw light on both strategic and managerial aspects of the post of medical director. The medical director is a key executive member of the Trust Board, yet the…

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1385

Abstract

Seeks to throw light on both strategic and managerial aspects of the post of medical director. The medical director is a key executive member of the Trust Board, yet the role remains ill‐defined. The existing published guidance gives some indication of what medical directors should be doing but gives limited information about “best practice” or how to cope with the demands being made on them. A survey of medical directors in 1994 revealed the diversity of the tasks that they can be called on to perform, often with inadequate managerial and secretarial support. The survey also indicated that problems have occurred as a result of the heavy workload and unexpected multiple facets of the role. Concludes that, to make the job somewhat easier, there should be a clear core job specification which is tailored to suit the individual circumstances. This should be combined with generous support and training, together with a suitable reward package.

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Health Manpower Management, vol. 23 no. 2
Type: Research Article
ISSN: 0955-2065

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Article
Publication date: 10 August 2012

Megan Joffe and Kate MacKenzie‐Davey

This article is drawn from doctoral research exploring the identity struggles faced by professionals who take on management and leadership roles. The research focused on…

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344

Abstract

Purpose

This article is drawn from doctoral research exploring the identity struggles faced by professionals who take on management and leadership roles. The research focused on the experience of medical directors – the most senior doctor‐manager with board responsibility for medical affairs. Based on the fact that a medical director is a hybrid manager this research has implications for any professional who takes on a managerial or leadership role while continuing to practice their profession. Some challenges of working as a hybrid are associated with the difference in orientations between professionals and managers. While the notion of who and what a professional is has changed and new forms of accommodation have been forged the hybrid identity remains a site of potential conflict for the individual and those they work with. The purpose of this paper is to explore the experience of the hybrid identity.

Design/methodology/approach

The experience of the hybrid identity is explored through social identity theory (Tajfel and Turner).

Findings

The analysis reveals that the medical director role is ambiguous, that medical identity is robust and that medical management is difficult compared to clinical work. Managerial identity in general is constructed negatively and from the perspective of doctors. The importance of maintaining clinical credibility is both embraced as a resource which bolsters and maintains medical identity and so distinguishes medical directors from the taint associated with the pejorative managerial identity that doctors construct of managers.

Originality/value

The implications for the selection, training and development of doctors and medical directors are raised as are those for the relationship between doctors and patients, and doctors and the organisation. Some implications identified, specifically for leadership in practice are as follows: leadership/management is challenging and difficult compared to professional work; language use is significant for how leaders are perceived; language use has implications for leader effectiveness; early exposure to leadership for professionals is important; and leadership role definition is important for consistency and role credibility.

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International Journal of Leadership in Public Services, vol. 8 no. 3
Type: Research Article
ISSN: 1747-9886

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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…

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344

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

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Book part
Publication date: 12 October 2011

Ayse Dayi

With an aim to investigate the recent state of the feminist clinics and their negotiation of medical authority in a time of increased technoscientific biomedicalization…

Abstract

With an aim to investigate the recent state of the feminist clinics and their negotiation of medical authority in a time of increased technoscientific biomedicalization, and capitalistic health-care system, I conducted a study of two feminist health centers in the Northeast of the United States in 2001–2002. In this chapter, I discuss how the two centers (a nonprofit collective and a for-profit center with a more hierarchical structure) negotiated medical authority in organizational terms as impacted by the larger context of medicine and its interaction with the state, capitalist health-care system, and antiabortion forces. The chapter concludes with a discussion of demedicalization as a multilevel process and implications for feminist care (service delivery) and U.S. Women's Health Movement.

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Access to Care and Factors that Impact Access, Patients as Partners in Care and Changing Roles of Health Providers
Type: Book
ISBN: 978-0-85724-716-2

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Article
Publication date: 19 June 2017

Helen Dickinson, Iain Snelling, Chris Ham and Peter C. Spurgeon

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…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Originality/value

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.

Details

Journal of Health Organization and Management, vol. 31 no. 4
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 1 June 1997

Dave Buchanan, Simone Jordan, Diane Preston and Alison Smith

Aims to examine medical involvement in hospital management processes, and to consider the implications of current experience for the next generation of clinical directors

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1709

Abstract

Aims to examine medical involvement in hospital management processes, and to consider the implications of current experience for the next generation of clinical directors. Doctors who move into a formal management role often find themselves unprepared for their new responsibilities. Research has thus concentrated on identifying the management competences which doctors lack, and with designing ways to remedy the deficit. Seeks to move beyond this deficit model by adopting a perspective which focuses on the engagement of doctors in the management process. Draws data from in‐depth interviews with six clinical directors and 19 other members of the hospital management team at Leicester General Hospital NHS Trust (LGH). Content analysis of interviews suggests that the engagement of clinical directors in the hospital management process at this site can be described as reluctant, transient, service‐driven, power‐pulled and pressured. This negative portrayal of the role, however, must be set in the context of the “management expectation” held of clinical directors by other hospital managers and staff ‐ an expectation that is not currently fulfilled.

Details

Journal of Management in Medicine, vol. 11 no. 3
Type: Research Article
ISSN: 0268-9235

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Article
Publication date: 1 October 1994

Allan Bruce and Sandra Hill

Based upon empirical research conducted in 1993, attempts to illustratethe implications of efforts to bring doctors into management. Itaddresses in particular the role of…

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478

Abstract

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.

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Journal of Management in Medicine, vol. 8 no. 5
Type: Research Article
ISSN: 0268-9235

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Article
Publication date: 9 October 2017

Rachel Canaway, Marie Bismark, David Dunt and Margaret Kelaher

The purpose of this paper is to understand the concerns and factors that impact on hospital quality and safety, particularly related to use of performance data, within a…

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1040

Abstract

Purpose

The purpose of this paper is to understand the concerns and factors that impact on hospital quality and safety, particularly related to use of performance data, within a setting of devolved governance.

Design/methodology/approach

This qualitative study used thematic analysis of interviews with public hospital medical directors. For additional context, findings were framed by themes from a review of hospital safety and quality in the same jurisdiction.

Findings

Varying approaches and levels of complexity were described about what and how performance data are reviewed, prioritised, and quality improvements implemented. Although no consistent narrative emerged, facilitators of improvement were suggested relating to organisational culture, governance, resources, education, and technologies. These hospital-level perspectives articulate with and expand on the system-level themes in a state-wide review of hospital safety and quality.

Research limitations/implications

The findings are not generalisable, but point to an underlying absence of system-wide agreement on how to perceive, retrieve, analyse, prioritise and action hospital performance data.

Practical implications

Lack of electronic medical records and an inefficient incident reporting system limits the extent to which performance and incident data can be analysed, linked and shared, thus limiting hospital performance improvement, oversight and learning.

Social implications

Variable approaches to quality and safety, standards of care, and hospital record keeping and reporting, mean that healthcare consumers might expect inconsistency across Victorian hospitals.

Originality/value

The views of medical directors have been little researched. This work uses their voice to better understand contextual factors that situate and impact on hospital quality and safety towards understanding the mixed effectiveness of hospital quality improvement strategies.

Details

Journal of Health Organization and Management, vol. 31 no. 7/8
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 1 February 1996

Richard Walker and Philip Morgan

Reports the results of a survey of 209 senior registrars and 269 consultants throughout Wales to identify the management development needs of doctors and ascertain their…

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566

Abstract

Reports the results of a survey of 209 senior registrars and 269 consultants throughout Wales to identify the management development needs of doctors and ascertain their views of the value and utility of current management development course offerings in Wales. Finds that, currently, management development for doctors in Wales is unstructured and unco‐ordinated but, despite this, many doctors, especially senior registrars, appeared keen to increase their future involvement in management and held positive views regarding management and management development. The questionnaire also required doctors to rank order six managerial topics and their elements: financial, human resource, strategic, operational, service quality and self‐management. Of these, self‐management issues were rated highest and there was some congruity in the rankings of the six topics by senior registrars and the other three consultant categories. Overall, managing a budget, medical and clinical audit, negotiating skills and leadership skills were ranked highest for inclusion in management development while project management, quality circles and equal opportunities received the lowest ratings.

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Journal of Management in Medicine, vol. 10 no. 1
Type: Research Article
ISSN: 0268-9235

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Article
Publication date: 1 June 1999

Elizabeth A. Scott

The regulation of the medical profession has recently been the subject of considerable debate. This paper describes a survey of the views of Trust medical directors and…

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124

Abstract

The regulation of the medical profession has recently been the subject of considerable debate. This paper describes a survey of the views of Trust medical directors and health authority directors of public health in the Northern and Yorkshire region on the way the GMC operates. A total of 46 out of 50 (92 per cent) gave a substantive response to the survey, of whom 16 (35 per cent) had not had cause to contact the GMC during the previous year, nine (20 per cent) were happy with their contact with the GMC and 21 (46 per cent) expressed some concern. The most commonly cited causes for concern were the length of time taken to process a complaint and lack of communication. While the individual opinions expressed are entirely subjective, it is argued that collectively they identify issues which the GMC and executive directors need to address.

Details

Journal of Management in Medicine, vol. 13 no. 3
Type: Research Article
ISSN: 0268-9235

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