Dynamics between doctors and managers in the Italian National Health Care System

Abstract

This article focuses on the changes in the Italian NHS by concentrating on patterns in the managerialisation of doctors. It addresses a series of shortcomings in studies on the response by doctors to managerialisation. The first is a shortcoming of theoretical and analytical nature. It is necessary to adopt a broader perspective whereby analysis considers not only the interaction between doctors and managers, but also the public control and regulation agencies that operate in that field. The second shortcoming is a methodological one. The literature on managerialisation is more theoretical than applied. It is necessary to adopt a strategy based on a plurality of methodologies and sources in order to focus attention on a national case (Italy in the present study), discussing the changes over time (from the beginning of managerialisation until today) and considering different groups within the medical profession. The outcome is a complex picture of the dynamics between doctors and managers which foregrounds the managerial co-optation processes of a small group of national health service doctors, the transition from strategic adaptation to forms of resistance against managerialisation by the majority of Italian NHS doctors, and the emergence of restratification processes among self-employed doctors working with the NHS.

New public management, physicians and populism: Turkey's experience with health reforms

“…, McDonald et al . , Vicarelli and Pavolini ). As a result, boundaries between professionalism and managerialism and between professions and organisations are ‘blurring’ and new forms of more hybrid, integrated or transformative professionalism are emerging (Denis and van Gestel , Kuhlmann and Burau , Martin et al .…”

“…One important issue is a stronger role of the health professions and more complex forms of governing through performance alongside the improved participation of patients and representatives of other health professions. New modes of governing focused on physicians not only as objects but also as actors directly involved in governance (Kuhlmann et al 2013, McDonald et al 2008, Vicarelli and Pavolini 2017. As a result, boundaries between professionalism and managerialism and between professions and organisations are 'blurring' and new forms of more hybrid, integrated or transformative professionalism are emerging (Denis and van Gestel 2016, Kuhlmann and Burau 2015, Martin et al 2017, Noordegraaf 2015, Waring and Currie 2009).…”

Healthcare governance, professions and populism: Is there a relationship? An explorative comparison of five European countries

“…Specifically, the capacity of the health professions to act as 'trusted' policy experts and the importance of stakeholder participation are well known [12][13][14][15][16]. Research has also highlighted the transformative powers of new public management (NPM) policies and the changing involvement of doctors in clinical management and leadership [17][18][19][20][21]. These developments have not been previously analysed in relation to populist political parties and movements, but there are two obvious connections.…”

“…There has also been significant recent reforms of professional regulation and oversight, including more extensive methods of measuring and assessing organisational and individual performance, tighter clinical governance arrangements and the use of financial incentives to drive performance improvements. This has led to a range of market, corporate and professional logics ([47] for the UK;[21] for Italy) and also to new forms of involving doctors in management[18].…”

A Phenomenological Study of Italian Students’ Responses to Professional Dilemmas: A Cross-Cultural Comparison

“…This is in contrast with the ongoing change in organizational culture in medicine, which asks for more focus on teamwork and patient-centeredness. 40 In addition, there has been an increased focus on the issue of burnout in Italy 41 and internationally. 42 This may be another reason why our students were often hesitant when faced with a dilemma and why they looked for a solution that prioritized personal and social wellbeing, a sense of inclusion and protection.…”