Getting started as a medical manager

The doctor-manager relationship

The different cultures of doctors and managers and the impact of these on their working relationships are described. A historical resumé tracks organisational change, the evolving nature of the relationship and the stresses it engenders. The phenomenon of scapegoating and an approach to managing risk is explored. Vignettes describing familiar problems, with suggested strategies for analysing them and resolving difficulties, are presented.

Clinical managers in the primary care sector: do the benefits stack up?

PURPOSE

The purpose of this paper is to explore the nature and value of the clinical management role undertaken by primary care doctors in Ireland. To date, a majority of research has focused on clinical management roles in the acute sector.

DESIGN/METHODOLOGY/APPROACH

The paper presents a sub-set of data from a mixed methods study. In total, 14 semi-structured interviews are drawn upon to identify the nature and value of the clinical management role in primary care.

FINDINGS

Comparison with acute sector research identifies considerable differences in the nature of the clinical management role across sectors--and in the associated value proposition. Structural and role-related contingencies affecting the potential value of clinical management roles in Irish primary care are discussed. Structural influences include the private ownership structure, low complexity and limited requirement for cross-professional coordination. Role-related influences include the primacy of the clinical identity, time constraints and lack of managerial training.

RESEARCH LIMITATIONS/IMPLICATIONS

The findings provide a limited basis for generalisation, premised on 14 interviews in one national context. However, given the international shift towards the provision of health services in primary care, they provide a research agenda for an important healthcare context.

PRACTICAL IMPLICATIONS

The findings draw attention to the need for policy consideration of the value of the clinical manager role in primary care; how policy can support effective primary care management; and the need for specialised management training, which takes account of the small-firm context.

ORIGINALITY/VALUE

The paper identifies that primary-care clinical-management roles focus on operational management and oversight and discusses the structural and role-related factors which affect their efficacy.

An empirical assessment of social structural and cultural change in clinical directorates

The results of two observational studies of clinical directorates (CDs) are presented. The paper exposes fresh perspectives about the management of hospitals and CDs, and suggests that the most important axis on which hospital decision-making rests continues to be profession rather than the CD, even though CDs are designed at least in part to mitigate professional tribalism and bridge professional divides. In empiricising social structural and cultural theories it seems clear that changes to the prescribed organisational framework, which CDs represent, have had negligible effects on behaviour. This being the case, the paper questions the benefits alleged to have accrued from establishing CDs and calls for more effective, micro-behavioural change strategies than merely altering the structure.

The surgeon for the future and implications for training

Clinical and technical skill may not be sufficient to fulfil society's expectations of surgeons. Other skills, which have been well defined in the published literature, include those of the professional, communicator, collaborator, manager, scholar and health advocate. It is the purpose of this review to explore the current understanding of these different domains and make comment about ways to improve training that will ensure that the surgeon of the future has the opportunity to develop broader expertize.