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The purpose of this paper is to provide and explain the model that underlies most of the research reported within this special issue on “Patient involvement in health care across Europe”.

This introduction provides a literature review and a conceptual framework for the understanding of patient involvement and its potential development within health care across Europe.

Patient involvement can be characterised in terms of three ideal types: voice, choice and co-production. Policies for developing user involvement in healthcare can have disempowering as well as empowering consequences. The pattern of dissemination of user involvement across Europe varies in form and content largely due to path dependency.

The paper provides a template for future comparative research on user involvement in health care and one that could be extended to social care as well as other varieties of human services. This introduction and the special issue highlights the need for further comparative research in this area.

The paper presents a robust model for comparative research. The findings may well be useful not only to researchers but also to policy makers and analysts.

This article examines the similarities and differences in the professional and work organisation of nursing within two European countries: Italy and Germany. In principle both nursing systems could be expected to share much in common given they are both part of the European Community (EC). In practice the professional and work organisations are rather different. In Italy, the organised profession is currently being “promoted” from collegi to ordini, reflecting an upgrading of nurse education and training. Ordine (and collegi) are state‐sponsored mechanisms for professional registration, a system not to be found in Germany. Instead, German nurses through their professional organisations have been struggling to establish an autonomous role for themselves within the health service division of labour independent of the medical profession.

This study aims to explore the controllability of risk culture, identify and categorize risk culture controls used in firms and explore how industry and ownership structure affect the use of different risk culture controls.

This explorative study is based on 32 semi-structured interviews with 37 participants who are heads of risk management or top managers in German firms from different industries with different ownership structures.

Interviewees perceive risk culture to be largely controllable. The authors identify a wide spectrum of risk culture controls, ranging from leadership and motivational controls to risk competence controls; in each category, the authors find value-, symbol- and clan-based controls. Leadership controls were most extensively discussed by the interviewees. The use of risk culture controls varied based on industry and ownership structure.

Due to the explorative character of the approach, the authors cannot claim representativeness for the results. The study is limited to one point in time and to a German sample. The findings imply that companies should select risk culture controls according to their own context and that implementation requires support by the top and middle management.

The authors respond to the call for more organizational studies on risk management that consider cultural paradigms (Arena et al., 2010; Mikes, 2011; Power, 2009). The study systematically identifies risk culture controls used in corporate practice and categorizes them. It provides tentative evidence of the relevance of context-specific factors for the use of risk culture controls.

The purpose of this paper is to present the findings of a short research project, conducted in 2010 as part of a larger EU funded action investigating the participation and impact of doctors in management. The authors sought to compare the ways in which hospital doctors in the UK and Poland – countries with distinct histories – participate in management; whether they are converging and whether the type of participation found results from changes in the governance and management of these systems.

First, a review of existing evidence and an analysis of policy documents and healthcare statistics were conducted. Identifying a lack of empirical data in the Polish context, and a potentially changing situation in the UK, the authors proceeded to collect some exploratory data in Poland, via interviews with expert informants, and to draw on data collected alongside this study in the UK from qualified doctors participating in research on management and leadership development.

Hospital doctors currently hold similar types of management role in both systems, but there are signs that change is underway. In Poland, different types of medical manager and role are now emerging, whereas in the UK younger doctors appear to be expecting greater management responsibility in the future, and are starting to take up the management training now on offer.

The potential implications of these changes for the profession and policymakers in both Poland and the UK are discussed, with opportunities for further research highlighted.

The paper provides a comparison of how medical engagement within two systems with different histories is occurring, and also of the changes underway. It provides some much needed initial insight via interviews with expert informants within the polish system, which has been under-researched in relation to the involvement of medicine in management.

The purpose of this paper is to compare user involvement in the case of assisted reproductive technologies in England and Portugal through the concepts of voice, choice and co-production, assessing the implications for user empowerment.

This qualitative study draws primarily on policy review and uses exploratory semi-structured interviews with key informants as a way of illustrating points. Data on the following themes was compared: voice (users’ representativeness on licensing bodies and channels of communication between users and doctors); choice (funding and accessibility criteria; choice of fertility centres, doctors and level of care); and co-production (criteria through which users actively engage with health professionals in planning the treatment).

Inter- and intra-healthcare systems variations between the two countries on choice and co-production were identified. Differences between funding and accessibility, regions, public and private sectors and attitudes towards doctor-patient relationship (paternalistic/partnership) were the key issues. Although consumer choice and indicators of co-production are evident in treatment pathways in both countries, user empowerment is not. This is limited by inequalities in accessibility criteria, dependence on doctors’ individual perspectives and lack of genuine and formal hearing of citizens’ voice.

Enhancing users’ involvement claims for individual and organizational cultures reflecting user-centred values. Effective ways to incorporate users’ knowledge in shared decision making and co-design are needed to empower patients and to improve the delivery of care.

The perpose of this paper is to analyse recent changes in the management of French public hospitals, following a reform enacted in 2009 and aimed at bolstering the managerial roles of doctors.

The paper is exploratory and is based on both the analysis of French literature dealing with the results of the 2009 reform, and ten semi-directed interviews with clinical managers and top leaders in the public hospital sector.

The author reports on the major hospital management reforms of 2009 and analyse the implications for the medical profession and management. The author shows that the involvement of the classical clinical leaders has become less regulated as the units no longer have a clear legal basis. The governance of the newly introduced “medical poles” appears to be shaped by various factors: there is high correlation between centrality, prestige and “clan involvement”, which suggests that professionals holding new responsibilities obtain power and legitimacy by consolidating pre-existing networks. While it is often argued that high-quality clinical leadership is a key factor of organisational success, the findings suggest that the performance of clinical managers relies on this network and legitimacy acquired from it.

Drawing on the “sociology of translation” and actor-network theory (Callon and Latour, 1991), this paper provides a new conceptual framework for the analysis of the transformation of the role of clinical leaders, arguing that this transformation depends highly on their abilities to build and use networks. The findings challenge the French tradition of public management that presupposes a clear division of power between doctors and administrative staff.

The purpose of this paper is to introduce an innovative qualitative methodology, the beliefs, barriers and control (BBaC) model. The BBaC model facilitates the understanding of how perceptions are formed through actors' interactions with their environments and each other, enabling targeted solutions for social and organisational questions.

The paper draws on a case study of a sports‐based intervention that addresses the physical activity levels of at risk youths in Stoke‐on‐Trent. It is an account of how the BBaC model was used to provide an understanding of barriers to participation in sport and active recreation amongst the target population. The study involved youth workers utilising the BBaC approach in focus groups with young people (YP) and staff. Moreover, the model was used in this case study in conjunction with the European Foundation for Quality Management (EFQM) framework, which demonstrated how this qualitative methodology can be used with “harder” focused management tools to produce strategies for social and organisational improvement.

The BBaC model was used to collect rich qualitative data from the target YP. This was translated into action points using the EFQM model which were used in strategic and policy decision making; delivering improved results for the target YP.

The paper introduces an innovative and original methodology, the BBaC model, and demonstrates how it can be used to deliver strategies that have positive impacts.

Internationally, management in medicine has become a topical issue in health care research and policy. Against this background, the purpose of this paper is to examine the changing role of doctors in the management of German hospitals.

The paper is based on a literature review on the one hand, explorative research drawing on field document and expert interviews, on the other. In the light of basic assumptions of neo-institutionalist and contingency theory, major developments regarding the relationship between medicine and management in Germany are sketched.

In the German health care sector, the importance of management in medicine is generally increasing, with more managerial (administrative) functions included in the clinicians’ activity. However, the current situation proves complex. On the one hand, there is more management within medicine, materializing, e.g. in further education schemes embracing economic training or in a general expectation that physicians striving for higher ranks within a hospital's hierarchy should exhibit economic knowledge. On the other hand, the authors see a hesitant attitude of the medical profession toward a greater involvement in management. In addition, policies of hospital owners affecting management roles prove diverse. They range from organizing medical departments as autonomous profit centers to ensuring strong hierarchical control by top management, with this entailing different demands regarding a doctor's managerial skills. Due to the advent of powerful non-clinician managers in part of the sector, moreover, medics are losing influence at top level. Altogether, there seems to be a polarization within the hospital system concerning the role of doctors in hospital management. This, to some extent, sits uneasy with key propositions from neo-institutionalist and contingency theory.

The paper retraces general developments concerning the involvement of German hospital doctors in management. Given the paucity of research in this field, it provides preliminary insights on the dynamics that influence the way and degree of this involvement. The major result is that there is structural polarization within an environment which, though streamlining both institutional mind-maps and organizational structures, leaves considerable discretion to the organizational level.

Considers the impact of recent government policy on the organization of primary care in England and Wales. Discusses the notion and practice of “teamworking” currently in vogue, and analyses implications for doctors, nurses and managers working in/attached to general practices. Draws on the findings of a study of primary care team building which took place in a UK health authority (here referred to as “Weston”), and focuses on the experiences of four general practices as they have attempted to develop as multidisciplinary partnerships. Gives consideration to the “new managerialism” evident in the NHS and its attempt to redefine professionalism and professional autonomy.