Search results

The purpose of this paper is to explore whether official inquiries are an effective method for holding the medical profession to account for failings in the quality and safety of care.

Through a review of the theoretical literature on professions and documentary analysis of key public inquiry documents and reports in the UK National Health Service (NHS) the authors examine how the misconduct of doctors can be understood using the metaphor of professional wrongdoing as a product of bad apples, bad barrels or bad cellars.

The wrongdoing literature tends to present an uncritical assumption of increasing sophistication in analysis, as the focus moves from bad apples (individuals) to bad barrels (organisations) and more latterly to bad cellars (the wider system). This evolution in thinking about wrongdoing is also visible in public inquiries, as analysis and recommendations increasingly tend to emphasise cultural and systematic issues. Yet, while organisational and systemic factors are undoubtedly important, there is a need to keep in sight the role of individuals, for two key reasons. First, there is growing evidence that a small number of doctors may be disproportionately responsible for large numbers of complaints and concerns. Second, there is a risk that the role of individual professionals in drawing attention to wrongdoing is being neglected.

To the best of the authors’ knowledge this is the first theoretical and empirical study specifically exploring the role of NHS inquiries in holding the medical profession to account for failings in professional practice.

The health workforce of the 21st century has enormous challenges; health professionals need to be both experts in their field and equipped with leadership and managerial skills. These skills are not part of the regular curriculum, so specific programs bridging this gap are required. Since 2001, FAIMER®, with eight centers across the globe, has worked to create health professions education leaders through transformational learning experiences, developing a global community of practice encompassing over 40 countries. We describe the design, implementation, evaluation, and evolution of the leadership and management curriculum component of the global Institute over 15 years. The curriculum is developed and updated through practices that keep faculty and fellows connected, aligned, and learning together. The article highlights the unique features, challenges faced, and sustainability issues. With a robust mixed methods evaluation, there are substantial reasons to believe that the model works, is adaptable and replicable to meet local needs. The program is playing an important role of answering the call for training positive, strengths-based, collaborative leaders who are socially accountable and embrace the challenges for high quality equitable health care around the globe

In the management world, leadership is a quality associated with business leaders, social entrepreneurs and political figures. Doctors are rarely considered as possessing or requiring leadership skills. With doctors, one thinks of skill and knowledge, but for some strange reason, leadership is hardly associated with doctors. This paper aims to highlight the leadership aspects unique to doctors. This study highlights why leadership training is imperative for doctors, outlines current status of leadership training for doctors in India and sets out proposals for effective leadership building.

Methodology is based on a two-pronged explanatory approach – the first is review of current literature in the context of leadership training of doctors, and the second is review of circumstances unique to the line of work undertaken by doctors that shed light on the need for leadership.

This paper highlights the imperative need for leadership training for doctors in India. It recommends leadership training on a continuous basis in their career life cycle as with the other professions. It also calls for involvement of all stakeholders in the medical community to foster leadership training – medical educational institutions, hospitals, medical councils and members of the medical fraternity.

Akin to leadership training programs conducted for IT and management professionals, this paper recommends that similar programs be conducted for doctors.

There are very few studies conducted in the Indian context on leadership training needs for doctors. This paper explains the importance of leadership training for doctors and suggests ways it can be implemented throughout the medical education life cycle of a doctor’s career.

The global Covid-19 pandemic is posing considerable challenges for governments throughout the world and has and will have a significant influence on the shape of peoples social and economic life and wellbeing in the short and longer term. This opinion paper discusses the current health policy response adopted in England to control or manage the epidemic and identifies the key sociological and political influences which have shaped these policies. Drawing on the theoretical approach set out in his recent book, which emphasises the interplay of powerful structural and economic interest groups, the author will consider the influence of the key players. Government policy has tied itself to scientific and medical evidence and protecting the NHS so the key roles of the medical profession, public health scientific community and NHS management and their respective and relative powerful influences will be discussed. The government needs the support of the public if their policies are to be successful, so how have the government addressed maintaining public trust in this “crisis” and how much trust do the public have in the government and what has influenced it? The strong emphasis on social distancing and social isolation in the national government policy response to Covid-19 has placed an increasing public reliance on the traditional and social media for sources of information so how the media has framed the policy will be considered. One policy aim is for an effective vaccine and the influence of the drug industry in its development is discussed. Finally, the role of the state will be discussed and what has shaped its social and economic policies.

The last decade has seen a significant increase in self-initiated expatriation research across various cohorts; however, limited research exists on the self-initiated expatriation of medical doctors despite their high mobility rates. The purpose of this paper is to investigate the determinants of cross-cultural adjustment among self-initiated medical doctors working and living in a host culture.

A questionnaire was distributed to self-initiated expatriate (SIE) doctors working in Irish hospitals. In total, 193 valid responses were collected. Three linear regression analyses were conducted to explore factors influencing cross-cultural adjustment among SIE medical doctors, along with qualitative insight into their adjustment to working and living in Ireland.

This study found that age, marital status, cultural novelty, previous international work experience, length of time working in the host culture did not influence the cross-cultural adjustment of SIE doctors. However, gender, language ability and perceived fair treatment were found to influence their cross-cultural adjustment in the study. Specifically, female SIE doctors reported higher levels of general adjustment to that of SIE male doctors. SIE doctors' language ability was found to influence their work adjustment, and those who perceived unfair treatment in the host culture reported lower levels of general adjustment.

This paper contributes to the limited knowledge and understanding surrounding the self-initiated expatriation of medical doctors and their cross-cultural adjustment to the host hospital and host culture.

This study aims to explore the calculations and valuations that unfold in everyday practices within social care settings. Specifically, the paper concerns the role of accounting in dealing with multiple calculable and non-calculable spaces within the case management process. The study sheds light on the multiplicity produced in constructing the client as an object through the calculations and valuations embedded in the costing and caring practices in social work.

This is a qualitative case study in a Swedish social care organisation, with a specific focus on the calculations and valuations within the case management process. The data have been gathered from 20 interviews with social workers, team leaders, managers and a management accountant, along with more than 36 h of on-site observations and internal organisational documents, including policy documents, guidelines and procedural lists.

The case management process involves interconnected practices in constructing the client as an object. While monetary calculations and those associated with worth are embedded in costing and caring practices, they interact and proliferate in various ways. Three elements are found: transforming service units into centres of calculation, constructing the accounts of calculation and establishing the cost-value calculations. Calculations and valuations are actuated in these elements in describing the need, matching the case with the unit and caseworker and deciding on the measure. The objectification of the client entails the construction of accounts, for example, ongoing qualifications, categorisations and groupings of units, juridical frameworks, case types, needs and measures. As an object multiple, the client becomes different objects at different stages, challenging the establishment accounts, and thus producing a range of calculations and valuations. Such diversity in calculations concomitantly produces more calculations to represent the present and absent multiple facets of the client, resulting in a multiplicity of costing and caring.

The study might flag up for practitioners the possible risks and unintended consequences of depending too much on fixed guidelines and (performance) indicators since social work involves object multiples, which are always in diversity and changeable in situ. Considering the multiple dimensions within the specific contexts could thus be helpful to mitigate such risks in the evaluation of social care processes and the design of (performance) metrics.

This study contributes to the literature on accountingisation by extending the concept as a part of ongoing organisational practices, materialised within the calculations of money and worth in everyday social care. Besides demonstrating their reconsolidation, this study shows a multiplicity of costing and caring practices depending on the way the client is constructed, resulting in the proliferation of accounting(s) and ultimately accountingisation of social work.

Qualified immigrants (QIs) and their work experiences have been studied using a wide variety of theoretical approaches with divergent characteristics. This paper reviews theoretical progress and proposes directions for future research and practice.

Using relevant keywords, articles indexed by Web of Science in management, business, industrial relations and applied psychology were systematically searched for and analysed. In total, 60 theoretical articles published during 2008–2018 were included. The theoretical progress and future theoretical and practical challenges were organised based on the notions of equality, diversity and inclusion.

Eight theoretical approaches utilised to study QIs' work experiences were recognised: (1) human capital theory, (2) career capital theory, (3) theory of practice, (4) intersectionality, (5) social identity theory, (6) sensemaking, (7) cultural identity transition and (8) the career-centred approach. The contributions and limitations of each theoretical lens were then scrutinised. Overall, research on QIs still lacks a comprehensive theoretical framework. As a step towards that, the paper proposes considering the role of organisations and labour market intermediaries, strategic view over the immigrant workforce, agency–institution play, identity–capital play and host–immigrant play.

The focus is on theory development and empirical papers with no clear theoretical foundation are excluded.

This review is the first attempt to summarise and direct the divergent research on the topic. The main contribution is setting an agenda for future research, particularly by proposing the elements of a comprehensive theoretical framework for studying QIs in the workplace.

In North America, delegated practice “medical direction” models are often used as a proxy for clinical quality and safety in paramedic services. Other developed countries favor a combination of professional regulatory boards and clinical governance frameworks that feature paramedics taking lead clinician roles. The purpose of this paper is to bring together the evidence for medical direction and clinical governance in paramedic services through the prism of paramedic self-regulation.

This narrative synthesis critically examines the long-established North American Emergency Medical Services medical direction model and makes some comparisons with the UK inspired clinical governance approaches that are used to monitor and manage the quality and safety in several other Anglo-American paramedic services. The databases searched were CINAHL and Medline, with Google Scholar used to capture further publications.

Synthesis of the peer-reviewed literature found little high quality evidence supporting the effectiveness of medical direction. The literature on clinical governance within paramedic services described a systems approach with shared responsibility for quality and safety. Contemporary paramedic clinical leadership papers in developed countries focus on paramedic professionalization and the self-regulation of paramedics.

The lack of strong evidence supporting medical direction of the paramedic profession in developed countries challenges the North American model of paramedics practicing as a companion profession to medicine under delegated practice model. This model is inconsistent with the international vision of paramedicine as an autonomous, self-regulated health profession.

The purpose of this paper is to explore different health care professionals’ discourse about privacy – its definition and importance in health care, and its role in their day-to-day work. Professionals’ discourse about privacy reveals how new technologies and laws challenge existing practices of information control within and between professional groups in health care, with implications not only for patient privacy, but also for the role of information control in professions more generally.

The authors conducted in-depth, semi-structured interviews with n=83 doctors, nurses, and health information professionals in two academic medical centers and one veteran’s administration hospital/clinic in the Northeastern USA. Interview responses were qualitatively coded for themes and patterns across groups were identified.

The health care providers and the authors studied actively sought to uphold the protection (and control) of patient information through professional ethics and practices, as well as through the use of technologies and compliance with legal regulations. They used discourses of professionalism, as well as of law and technology, to sometimes accept and sometimes resist changes to practice required in the changing technological and legal context of health care. The authors found differences across professional groups; for some, protection of patient information is part of core professional ethics, while for others it is simply part of their occupational work, aligned with organizational interests.

This qualitative study of physicians, nurses, and health information professionals revealed some differences in views and practices for protecting patient information in the changing technological and legal context of health care that suggest some professional groups (doctors) may be more likely to resist such changes and others (health information professionals) will actively adopt them.

New technologies and regulations are changing how information is used in health care delivery, challenging professional practices for the control of patient information that may change the value or meaning of medical records for different professional groups.

Qualitative findings suggest that professional groups in health care vary in the extent of information control they have, as well in how they view such control. Some groups may be more likely to (be able to) resist changes in the professional control of information that stem from new technologies or regulatory policies. Some professionals recognize that new IT systems and regulations challenge existing social control of information in health care, with the potential to undermine (or possibly bolster) professional self-control for some but not necessarily all occupational groups.

This study seeks to improve the understanding of physician leaders' leadership work challenges.

The subjects of the empirical study were physician leaders (n = 23) in the largest central hospital in Finland.

A total of five largely identity-related, partially paradoxical dilemmas appeared regarding why working as “just a leader” is challenging for physician leaders. First, the dilemma of identity ambiguity between being a physician and a leader. Second, the dilemma of balancing the expected commitment to clinical patient work by various stakeholders and that of physician leadership work. Third, the dilemma of being able to compensate for leadership skill shortcomings by excelling in clinical skills, encouraging physician leaders to commit to patient work. Fourth, the dilemma of “medic discourse”, that is, downplaying leadership work as “non-patient work”, making it inferior to patient work. Fifth, the dilemma of a perceived ethical obligation to commit to patient work even if the physician leadership work would be a full-time job. The first two issues support the findings of earlier research, while the remaining three emerging from the authors’ analysis are novel.

The authors list some of the practical implications that follow from this study and which could help solve some of the challenges.

This study explores physician leaders' leadership work challenges using authentic physician leader data in a context where no prior empirical research has been carried out.