Maximizing the contribution doctors make to NHS management

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.

Medical quality management: the case for action learning as a quality initiative

This paper explores how medical quality management has developed in the USA since the 1900s reviewing and summarizing the history of the movement through an extensive literature review. With a particular emphasis on action learning as a theoretical construct, the paper then assesses the extent to which action learning can be applied to the quality process. Using two case studies from the literature, the paper suggests that the action learning process, can in fact overcome some of the problems related to the implementation of quality initiatives in medical settings, and in particular those related to the fear expressed often by physicians that quality procedures emphasize cost cutting at the expense of patient care.