Aims: The aim of this study was to determine whether the widely adopted Institute of Medicine's dimensions of quality capture the current meaning of quality in health care literature. Design: An integrative review was utilised as there has been a multitude of published papers defining quality in relation to health care, therefore collective analysis may provide new insight and understanding. Method: Papers offering a definition or conceptual understanding of quality in relation to health care were identified by searching relevant databases. Papers were excluded according to predefined criteria. An integrative review was conducted and the Institute of Medicine's dimensions were used as a framework for data extraction and analysis. Findings: The review identified two important additional dimensions of quality; namely caring and navigating the health care system and argues that they require recognition as dimensions in their own right. Conclusion: In the current climate of constrained finances there is a risk that the allocation of resources is directed to current explicit dimensions to the detriment of others. The result may be a reduction in health care quality, rather than improvement.

Recent literature on hybridity has provided useful insights into how professionals have responded to changing institutional logics. Our focus is on how shifting logics have shaped senior medical professionals’ identity motives and identity work in a qualitative study of hospital consultants in the United Kingdom’s National Health Service. We found a binary divide between a large category of traditionalist doctors who reject shifting logics, and a much smaller category of incorporated consultants who broadly accept shifting logics and advocate change, with little evidence of significant ambivalence or temporary identity ‘fixes’ associated with liminality. By developing a new inductively generated framework, we show how the identity motives and identity work of these two categories of doctors differ significantly. We explore the underlying causes of these differences, and the implications they hold for theory and practice in medical professionalism, medical professional leadership and healthcare reform.

Abstract:Few professionals perform their jobs in an environment as public, as pressurised, as shorttermist and as unforgiving of mistakes, as that which exists for football club managers.

This article addresses the question-can a deterioration in organizational spaces erode a profession's status? It draws on organizational spaces literature to analyse the relationship between design of the physical work setting and senior doctors' experiences of deprofessionalization. Analysis of qualitative data from a study of senior hospital doctors identifies two main themes that link the experience of spaces with perceptions of the erosion of professional status and reduced knowledge sharing. These two themes are: emplacement, which is the application of coercive power both in and through spatial arrangements, and isolation, which refers to physical alienation in the workplace leading to disconnection and a perceived loss of power. Observing the changes in the physical environment over time and mapping them against these processes of deprofessionalization may offer interesting new insights into the sociology of professions.

The third sector is experiencing a radical shift due to social, political and economic changes in Europe. Due to these shifts and their implications, the question of leadership has become significant and needs to be explored. This article contributes to the literature on the challenges of leadership in the sector. It does so by drawing on the personal narratives provided by leaders across the sector. The views expressed by the narratives provide a deeper insight into leadership in the third sector, than has previously existed. The narratives are valuable for a number of reasons including: they help to extend the knowledge and perspectives of leadership in a way that acknowledges the uniqueness of the sector; they contribute to a better understanding of the challenges faced by leaders in the sector; and they serve as an illustration of the benefit of approaching leadership through the eyes of those practising leadership. The article concludes by identifying the impact for leadership across the sector and the implications.