For many years middle managers' work, career and future role have been the subject of gloomy descriptions, assertions and predictions. These are described and compared with studies, including our own, that give a more optimistic picture of what is happening to middle management. We also cite survey information about numbers, salaries and job mobility of UK managers, including middle managers. We argue that before generalizations, either optimistic or pessimistic, can justifiably be made, attention needs to be paid to the complexity of changes affecting middle managers' jobs, to the diversity of organizations in which middle management work and the complexity of individual reactions to these changes.
Background Access to dental care is important for overall health, but can remain problematic for those in rural or isolated locations. It can be difficult to encourage clinicians to choose or continue a rural health career. Teledentistry is showing some promise as a strategy to support rural, isolated and new health care workers. This study aims to explore the quantitative and qualitative framework associated with teledentistry in an effort to uncover the interaction of multiple influences on its delivery and sustainability. Methods A systematic search of the literature was undertaken and studies were included if they evaluated consultative teledentistry, reports on implementation of teledentistry in practice or attitudes to teledentistry. Studies were evaluated qualitatively. Results Thirty-nine studies were included focusing on the accuracy, effectiveness or description a teledentistry project in practice. Five main themes were identified in the qualitative analysis: (1) using information and communication technology (ICT), (2) regulatory and system improvements, (3) accuracy of teledentistry, (4) effectiveness, including increasing access to clinical services, efficiencies and acceptability, and (5) building and increasing clinical capacity of the dental workforce. Conclusion Teledentistry provides a viable option for remote screening, diagnosis, consultation, treatment planning and mentoring in the field of dentistry. Rapidly developing information and communication technologies have increasingly shown improving cost effectiveness, accuracy and efficient remote assistance for clinicians. There is high acceptability for teledentistry amongst clinicians and patients alike. Remuneration of advising clinicians is critical to sustainability.
This longitudinal study of the relations between 20 general managers and their chairmen in the UK National Health Service has wider implications despite its distinctive setting. It showed that the two roles are very dependent upon each other, and occupy overlapping domains, so that what each can do is considerably affected by the other's behaviour. The chairman has more power to determine their relative domains so that studies of individual chief executives should take account of this relationship. The ways in which both chairmen and general managers played their roles differed widely. One reason for the differences in the chairmen's roles was the wide variation in the time that they gave to the job. Different types of relationship are described. The most common was that of partners where the two complemented each other. The study crosses different literatures: corporate management, leadership, role theory and managerial work and behaviour. Its main concern is with managerial work and behaviour but it also has some implications for corporate management.
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