1,721,034 research outputs found
Management reforms, re-stratification and the adaptation of professional status hierarchies: The case of medicine in publicly owned hospitals
Full text linkPublic management reforms worldwide have triggered processes of re-stratification in professions leading to the emergence of ‘administrative elites’ and potential changes in the nature of social status hierarchies. We investigate the nature of these adjustments and their supporting conditions in the context of English publicly owned hospitals. Applying fsQCA, our analysis shows a form of adaptation of the social status hierarchy of medicine to management demands. However, the emergence of a management criterion for seniority is only apparent under certain conditions. This suggests a form of path-dependent adaptation which reinforces, rather than challenges, the status position of elite doctors
Researching Health Care Management Using Secondary Data
Full text linkAimsa) To highlight gaps in the extant research on the characteristics and impact of managers in healthcare.b) To define and provide a taxonomy of administrative data sources relevant to researching healthcare management.c) To review the range of statistical techniques used to analyse administrative data.d) To illustrate how the analysis of administrative data sources can advance knowledge both with regard to the characteristics of managers in healthcare and their impact.e) To discuss the limitations of administrative data and avenues for future research. <br/
Clinical management and professionalism
No full textA distinctive feature of new public management (NPM) reforms over the last two decades has been the drive to co-opt professionals such as clinicians, social workers, and teachers into the management of services. Profession- als taking on these roles have been considered ‘hybrids’, owing to the fact that they straddle both professional and managerial domains, often bridg- ing the gap between two occupational groups with different interests and priorities. In health services this trend has been especially pronounced with doctors becoming far more active in the strategic management of hospitals and other organizations, through membership of boards, but also at lower levels, working as clinical directors or general practitioners responsible for budgets to commission services. More recently there have been calls to encourage a wider constituency of clinical professionals, even those who do not become managers, to perform leadership roles. With many professional bodies them- selves now supporting these changes, it would seem that clinical leadership has moved from ‘the dark side to centre stage’ (Ham et al., 2011). Indeed, it may be increasingly problematic to view management and professionalism as opposing forces, as deeper connections emerge which are, arguably, leading to entirely new forms of ‘hybrid professionalism’ (Brommels, 2008; Kuhlmann et al, 2013)
Clinicians on the board : what difference does it make?
Full text linkAround the world clinical professionals have increased their involvement in the management of health services. However the evidence to suggest that these changes will lead to improved performance remains fragmented. In this paper we address this matter focussing on the impact of clinicians appointed to the boards of directors of English NHS hospital trusts. Although the number of clinicians involved in the strategic governance of hospital trusts is relatively low by international standards, they do appear to have an impact on overall performance. Drawing on published information from hospital trust annual reports, publicly available performance measures from the Healthcare Commission and data gathered by Dr Foster over a three year period (2006-9), the paper reports two main findings. First, the analysis reveals a significant and positive association between a higher percentage of clinicians on boards and the quality ratings of service providers, especially where doctors are concerned. This positive influence is also confirmed in relation to lower morbidity rates and tests to exclude the possibility of reverse causality (doctors joining boards of already successful organisations). Second, we do not find the same level of support for clinical professions such as nurses and other allied health professions turned directors. © 2012 Elsevier Ltd
Governing public sector use of external management consultancy:beyond client procurement and consultant professionalisation
Full text linkIMPACTEfforts to improve the governance of external management consulting have a mixed record. Attention has focused on either procurement (and insourcing) and/or raising standards through professionalization. The persistence of critiques and public scandals suggests that more is needed from the industry, policy-makers, clients/purchasers and other stakeholders. In this article, the authors highlight how systemic problems with consulting arise from the nature of its reward and value systems and the resulting lack of openness of consultants and their clients—none of which have been adequately addressed through traditional governance mechanisms. The authors explain why these neglected areas need attention. This can be done, in part, by drawing on new trends and classic dilemmas. Is the rise of purpose-led or alternative organizational forms, as well as moves to facilitate transparency and the speaking of ‘truth to power’, improving the governance and outcomes of external management consultancy?ABSTRACTMost research on the use of external management consultancy in the public sector focuses on critique, with less attention given to improving governance. Where governance has been considered, a longstanding concern has been with client procurement and consultant professionalization. However, the persistence of malpractice and critique suggests a need for complementary approaches. In this review article, the authors explore three such options which are linked to core problems in the practice and use of consulting: reward systems and values in consulting firms and spaces where both clients and consultants can openly challenge and speak ‘truth to power’. These are examined in the wider context of an apparent move towards ‘purpose-led’ consulting where profit is held to be less important. This is seen to present an opportunity for reform, but is insufficient on its own without other actors and activists intervening and traditional approaches being strengthened or radicalized
Are public sector managers a "bureaucratic burden"? The case of English public hospitals
Full text linkAlthough managers are, globally, a central part of the new public management reform agenda, in recent years policy makers, the media and the general public have raised concerns about their effectiveness and contribution. In some countries, notably the UK and the US, this debate has been heavily influenced by Public Choice Theory (PCT), which depicts ‘bureaucrats’ as rent seeking, self-serving individuals. In this study, focusing on the case of acute care hospital trusts in the English National Health Service, we formally test whether public sector managers represent a ‘bureaucratic burden’. Using a longitudinal database spanning six years (2007-2012) and employing a dynamic panel data model, the findings reveal that, contrary to PCT assumptions, managers do not engage, in the main, in rent seeking behaviour and, crucially, appear to have a positive impact on organisational performance. Implications for theory, policy and practice are discussed
Does clinical management improve efficiency? Evidence from the English National Health Service
Full text linkThe paper investigates the presence and impact of clinicians on the boards of National Health Service (NHS) acute care trusts on efficiency over a three-year period (2006-2009). The analysis shows an increase, albeit marginal, in the number of clinically qualified directors in the period under investigation. Furthermore, it reveals that the percentage of clinicians-and, more specifically, doctors-at the board level is positively associated to the rating achieved for the financial management of resources. Although the results need to be treated cautiously, they do lend support to the argument that increased clinical involvement in management decision-making will have benefits for the performance of hospital services. © 2014 © 2014 CIPFA
Clinical leadership and the changing governance of public hospitals: Implications for patient experience
Full text linkA growing evidence base suggests that increasing the involvement of clinical professionals on governing boards of hospitals has a positive impact on organizational performance. However, less is known about the wider conditions that influence this process and whether recent moves to restructure the governance of public hospitals, extending their formal autonomy, has made any difference to the outcome of clinical involvement on patient experience. Using four years of data and concentrating on the acute hospital sector in the English National Health Service, this study shows that clinical participation on hospital governing boards can significantly improve the patient experience of the care provided. Yet, whereas a more autonomous organizational form (Foundation Trust status) does not seem to produce positive effects on its own, patient experience appears to markedly improve in those organizations that have both higher levels of clinical involvement in their strategic apex and greater flexibility in decision-making
Corporatisation and the emergence of (under-managered) managed organisations: The case of English public hospitals
Full text linkAn enduring feature of new public management (NPM) in many countries has been the move to create more autonomous, ‘complete’ organisations such as universities, hospitals and social service agencies. Often referred to as ‘corporatisation’, this process is assumed to be leading to the emergence of new organisational forms with dedicated management functions and a greater focus on strategy. However, these assumptions remain largely untested and rely heavily on ‘technical’ accounts of organisational restructuring, ignoring the potential influence of institutional pressures and internal political dynamics. In this paper, we address this concern focusing on the case of acute care public hospitals that have undergone corporatisation (to become Foundation Trusts) in the English National Health Service. Using administrative data spanning six years (2007-2012), the analysis shows that corporatisation is having mixed effects. While it is associated with a shift in the focus of managers to strategic concerns, it has not led to an expansion of management functions overall. Both tendencies are found to be mediated by institutional pressures, in the form of media scrutiny, and, indirectly, by the involvement of clinical professions in management. These results advance ongoing debates about the emergence of new organisational forms in the public sector, highlighting the limitations of technical accounts of change and raising the possibility that corporatisation is leading to organisations that are both more managed and undermanagered at the same time
Business Experts on Public Sector Boards: What Do They Contribute?
Full text linkAlthough public management reforms around the world have given business experts an enhanced role in the governance of public sector organizations, the impact of this change is poorly understood. Drawing from the literature on board human capital as a theoretical framework and focusing on the case of hospital boards in the English National Health Service, this concern is addressed by investigating whether increasing the presence of individuals with business expertise has any significant relationship with organizational performance. The findings show that while business expertise appears to have no influence on service quality, it does have a positive effect on financial performance. However, this only applies to governing boards that are less experienced in terms of their collective tenure. The findings lend partial support to board capital theory but also show that in certain conditions generic business expertise can be a valuable asset for public sector organizations
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