The paper is the first to examine the concept of hybridity in the context of clinician leadership. Many approaches to leadership in healthcare fail to address the complexity of leadership within the ranks of clinician managers and thus are unable to deal adequately with the role of leadership in healthcare reform and change.

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Individual clinician leadership is at the forefront of health reforms in Australia as well as overseas with many programs run by health departments (and hospitals) generally focus on the development of individual leaders. This paper argues, along with others, that leadership in the clinician management context cannot be understood from an individualistic approach alone. Clinician managers, especially in the ranks of doctors, are usually described as 'hybrid-professional managers' as well as reluctant leaders for whom most leadership theories do not easily apply. Their experiences of leadership development programs run by health departments both in Australia and internationally are likely to be based on an individual leader-focussed approach that is driving health care reforms. These approaches work from three key assumptions: (1) study and fix the person; (2) give them a position or title; and (3) make them responsible for results. Some would argue that the combination of these three approaches equates to heroic and transformational leadership. Several alternative approaches to leadership development are presented to illustrate how reforms in healthcare, and notably in hospitals, must incorporate alternative approaches, such as those based on collective and relational forms of leadership. This does not mean eschewing individual approaches to leadership but rather, thinking of them differently and making them more relevant to the daily experiences of clinician managers. We conclude by highlighting several significant challenges facing leadership development for clinician managers that arise from these considerations.

Examines popular theories of learning in organizations to highlight their limitations for reform and change. Divides learning approaches here into four general strategiesorganizational learning, learning organization, learning environment, and "learning space". Examines how issues of power, diversity, indeterminacy and hierarchy are treated in each approach and the extent to which multivocal strategies of learning are engendered. These issues have been central to concerns raised in the literature about organizational control. However, much of what is popularly promoted as prescriptions for learning in organizations -on dimensions such as teamwork, leadership, and culture -have significant elements in which there is little evidence of reflection on issues of control. Gives particular attention to Peter Senge's book, The Fifth Discipline, which has become the blueprint for many organizational learning projects and other learning approaches. Also gives attention to a popular account of learning, an address by the CEO of the Australian telecommunications firm, Telstra. The analysis provides a basis for raising questions about popular learning strategies and underlines the need for managers to reflect on the complex, contextualized, and contentious nature of learning and its macro-level constraints and its micro-level impacts.

Using POSH, this paper examines what consumers and practitioners value about health services; it also illustrates how brilliance can be theorized into health service management research and practice.