Clinical Management and Professionalism

Kirkpatrick, Ian; Hartley, Kathy; Kuhlmann, Ellen; Veronesi, Gianluca

doi:10.1057/9781137384935.0028

Cited by 2 publications

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“…The need of improving the governance of healthcare services has brought health professionals into management positions, thereby performing hybrid management roles [ 1 , 2 ]. Professional and managerial knowledge is growingly perceived as complementary [ 3 ], and more evidence has showed that hybrid managers enhance clinical and management outcomes [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Hybrid management, organizational configuration, and medical professionalism: evidence from the establishment of a clinical directorate in Portugal

Correia

Denis

2016

BMC Health Serv Res

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Background: The need of improving the governance of healthcare services has brought health professionals into management positions. However, both the processes and outcomes of this policy change highlight differences among the European countries. This article provides in-depth evidence that neither quantitative data nor crosscountry comparisons have been able to provide regarding the influence of hybrids in the functioning of hospital organizations and impact on clinicians' autonomy and exposure to hybridization. Methods: The study was designed to witness the process of institutional change from the inside and while that process was underway. It reports a case study carried out in a public hospital in Portugal when the establishment of a clinical directorate was being negotiated. Data collection comprises semi-structured interviews with general managers and surgeons complemented with observations.

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Section: Introductionmentioning

confidence: 99%

Hybrid management, organizational configuration, and medical professionalism: evidence from the establishment of a clinical directorate in Portugal

Correia

Denis

2016

BMC Health Serv Res

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“…The reforms have created a qualitatively new demand for collaboration and coordination between clinicians and managers and introduced new medical manager roles in hospitals. Following an initial debate of either positive or negative effects, often based on dichotomous concepts of management and medical professionalism, research is getting increasingly more complex (for an overview see, [ 4 – 6 ]). One important strand of scholarly work has highlighted organizational and managerial connections and an emergent ‘hybridization’ of medicine and management [ 7 – 16 ], while other studies have primarily explored how doctors respond to the new managerial tasks [ 17 – 21 ].…”

Section: Introductionmentioning

confidence: 99%

“…One important strand of scholarly work has highlighted organizational and managerial connections and an emergent ‘hybridization’ of medicine and management [ 7 – 16 ], while other studies have primarily explored how doctors respond to the new managerial tasks [ 17 – 21 ]. Few authors have applied a cross-country comparative perspective [ 2 – 4 , 22 – 26 ] or explored connections between professions in management and service outcomes [ 27 – 29 ]. However, there is still little research into the dynamics and effects of the new connections between medicine and management in every-day work of hospital doctors and how these changes impact and create novel demand for management to support doctors in their new roles.…”

Section: Introductionmentioning

confidence: 99%

“…The micro-level approach includes the perspectives of the ‘managed doctors’ (rank-and-file doctors working in patient care), and the ‘managing’ doctors (the doctors with management responsibilities). The aim is two-fold: to contribute to the development of theory-led approaches and assessment tools in clinical management research [ 4 , 5 , 30 , 31 ] and to apply the Hospital Control Assessment Framework tool [ 26 ] to the Swedish case in order to explore gaps and organizational weaknesses that may constrain new forms of more integrated (or hybrid) clinical management.…”

Section: Introductionmentioning

confidence: 99%

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Medicine and management: looking inside the box of changing hospital governance

Kuhlmann

Rangnitt

Knorring

2016

BMC Health Serv Res

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BackgroundHealth policy has strengthened the demand for coordination between clinicians and managers and introduced new medical manager roles in hospitals to better connect medicine and management. These developments have created a scholarly debate of concepts and an increasing ‘hybridization’ of tasks and roles, yet the organizational effects are not well researched. This research introduces a multi-level governance approach and aims to explore the organizational needs of doctors using Sweden as a case study.MethodsWe apply an assessment framework focusing on macro-meso levels and managerial-professional modes of hospital governance (using document analysis, secondary sources, and expert information) and expand the analysis towards the micro-level. Qualitative explorative empirical material gathered in two different studies in Swedish hospitals serves to pilot research into actor-centred perceptions of clinical management from the viewpoint of the ‘managed’ and the ‘managing’ doctors in an organization.Results Sweden has developed a model of integrated hospital governance with complex structural coordination between medicine and management on the level of the organization. In terms of formal requirements, the professional background is less relevant for many management positions but in everyday work, medical managers are perceived primarily as colleagues and not as experts advising on managerial problems. The managers themselves seem to rely more on personal strength and medical knowledge than on management tools. Bringing doctors into management may hybridize formal roles and concepts, but it does not necessarily change the perceptions of doctors and improve managerial–professional coordination at the micro-level of the organization.ConclusionThis study brings gaps in hospital governance into view that may create organizational weaknesses and unmet management needs, thereby constraining more coordinated and integrated medical management.

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Clinical Management and Professionalism

Cited by 2 publications

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Hybrid management, organizational configuration, and medical professionalism: evidence from the establishment of a clinical directorate in Portugal

Hybrid management, organizational configuration, and medical professionalism: evidence from the establishment of a clinical directorate in Portugal

Medicine and management: looking inside the box of changing hospital governance

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