The paper presents a robust model for comparative research. The findings may well be useful not only to researchers but also to policy makers and analysts.

In health systems around the world the current trend has been for doctors to increase their participation in management. This has been taken to imply a common process of re-stratification with new divisions emerging between medical elites and the rank and file. However, our understanding of this change remains limited and it is open to question just how far one can generalise. In this paper we investigate this matter drawing on path dependency theory and ideas from the sociology of professions. Focusing on public management reforms in the hospital sectors of two European countries -Denmark and England -we note similarities in the timing and objectives of reforms, but also differences in the response of the medical profession. While in both countries new hybrid clinical management roles have been created, this process has advanced much further and has been more strongly supported by the medical profession in Denmark than in England. These findings suggest that processes of re-stratification are more path dependent than is frequently acknowledged. They also highlight the importance of national institutions that have shaped professional development and differences in the way reforms have been implemented in each country for explaining variation.

In this paper we develop a framework for comparing changes in the management of public hospitals across different national health systems, drawing on insights from institutional theory. Using a range of secondary sources we show how one particular form of hospital management, pioneered originally at the Johns Hopkins Hospital in Baltimore, has been translated differently in four health systems: England, Denmark, Italy and France. This analysis builds on the notion of editing rules, which derive from the institutional context, and illustrates how these rules broaden our understanding of variable translations of global templates for hospital management. The paper concludes by highlighting wider implications for theory and policy.

This article examines the changing configuration of professional-management relations within the English health service, focusing on hospital doctors and managers. It draws on a case study of a hospital apparently under threat of closure during a period when management is pursuing a policy of attempting to rationalize medical work, for example, by expanding day surgery. At the same time, the strategies of medical staff for the defence of their professional interests are also explored. The usefulness of rhetoric, irony and actor-network theory for the analysis of the threatened hospital closure and the implications for professional-managerial relations is explored within the broader context of `governmentality' (Foucault).

ObjectivesCalls for major reconfigurations of health services have been accompanied by recommendations that wide ranging stakeholders be involved. In particular, patients and the wider public are seen as critical contributors as both funders and beneficiaries of public health care. But public involvement is fraught with challenges, and little research has focused on involvement in the health service transformation initiatives. This paper examines the design and function of public involvement in reconfiguration of health services within the English NHS.MethodsQualitative data including interviews, observation and documents were collected in two health service ‘transformation’ programmes; interviews include involved public and professional participants. Data were analysed using parallel deductive and inductive approaches.ResultsPublic involvement in the programmes was extensive but its terms of reference, and the individuals involved, were restricted by policy pressures and programme objectives. The degree to which participants descriptively or substantively represented the wider public was limited; participants sought to ‘speak for’ this public but their views on what was ‘acceptable’ and likely to influence decision-making led them to constrain their contributions.ConclusionsPublic involvement in two major service reconfiguration programmes in England was seen as important and functional, and could not be characterized as tokenistic. Yet involvement in these programmes fell short of normative ideals, and could inadvertently reduce, rather than enlarge, public influence on health service reconfiguration decisions.

This article examines the degree to which doctors, as members of an autonomous profession, function as organic intellectuals within capitalist society (Abercrombie and Urry, 1983) and, more generally, the complex and ambivalent relations that sustain their role within a ‘service class'. It is in this context that the organization of medical care and its delivery in Britain will be addressed. In particular, the current and intended changes in the organization and control of hospital medicine within the NHS, notably the issues of medical audit, clinical budgeting and the role of the ‘internal market’.

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Although much has been written on the changing management of professional services organizations, only limited attention has been given to the way in which management itself might represent a contested terrain. Drawing on concepts from the sociology of professions, this article develops this idea in relation to the Danish hospital sector. The analysis of secondary sources reveals how, from the mid-1980s, both the nursing and medical professions in Denmark actively sought to lay claim to the jurisdiction of hospital management. The result of this struggle was to further reinforce the dominant position of doctors in the clinical division of labour although the position of nurses has also been enhanced. Such findings point to the need to give more attention to the way broader changes in hospital governance are mediated by interprofessional struggles and rivalries. Such struggles, in turn, have implications not only for the division of labour and status order between professions but also for the way management work itself is enacted.