This paper explores the changing patterns of professional power and the struggle for control between doctors and managers in the UK NHS, by examining the role of clinical directors. Located at the nexus of managerial and professional power, clinical directors represent and embody the challenges to medicine through increased managerialism and the profession's response to it. An analysis of the role of clinical directors reveals the changes in power and jurisdiction that have been created through clinical management. A medical model of professional power illustrates how structural and ideological changes threaten medical dominance. However, clinical directors respond to the changes by creating new forms of expertise through managerial assimilation, to extend their jurisdiction and domain within the organization and in the market. This re-professionalization, rather than de-professionalization, by doctors raises questions about the shifting power balance between doctors and managers in the NHS and between doctors within the medical profession.
Reviews the role of clinical directors from outside the usual managerial framework to challenge the managerial myth applied to professionals who take on these roles. Defines management, managing, managerialism and leadership and develops an empirical framework to compare the roles of doctors and managers. Uses the framework to identify the cognitive map that clinical directors use and how they perceive their role. An emergent model illustrates how clinical directors combine a new cognitive map with their existing professional behaviours to undertake their role. Clinical directors both perceived and described their role in terms of leadership rather than management reinforcing the inappropriateness of using managerial frameworks. Instead clinical directors should be developed and evaluated as professional leaders. This raises wider questions of whether management and the language of management are either useful or appropriate for professionals in the NHS or whether their value is really a myth.
This paper uses an empirical case study to present a new way of thinking about the dynamics of multicultural relationships within organizations. The paper initially uses subcultural analysis to identify how doctors became clinical directors and how their culture emerged as they learned to cope with problems of external adaptation and internal integration. Clinical directors were unique in working within and between the medical and managerial cultures, mediating the process of cultural learning and balancing the multicultural dynamics of the organization. They sustained this dynamic by becoming ‘cultural chameleons’ in both the medical and managerial cultures. It is also argued that clinical directors formed a ‘cell culture’ rather than a ‘subculture’ as they developed directly from the medical culture but emerged as different from it. The conclusions reveal how the empirical data describe a complex and dynamic pattern of multicultural relationships that are more interdependent than hierarchical. Consequently an alternative concept of cultural coconstitutionality is used to describe how these three cultures exist alongside each other in a relationship of asymmetric complementarity.
There's no success like failure and failure is no success at all (Bob Dylan).Why write a paper about failure? First tò`o ut'' failure an as organisational taboo and, second, because ignoring failure can limit our understanding of the theory and practice of organisational change. This article confronts these limitations working explicitly with failure to illustrate how adopting this perspective can inform both theory and practice. The relationship between theory and practice is considered at two levels and illustrated through the interpretation of a failed transformation in the construction division of a large multinational company (Alpha). Level one identifies the conditions for organisational transformation and questions whether crisis is the best stimulus for successful transformation, while level two captures the human experiences and dynamics of a management workshop intervention designed to support the top down change.The first section defines and evaluates transformation, the relationship between success and failure, and why transformation efforts fail. This is followed by the Alpha case study describing the context, strategy and change processes adopted by the MD and Board. The second section discusses the common themes that emerged from the change management workshops and the article concludes by identifying what can be learned from working with failure. For example should failure feature more explicitly and frequently in the organisational change literature?
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.