Aims to examine medical involvement in hospital management processes, and to consider the implications of current experience for the next generation of clinical directors. Doctors who move into a formal management role often find themselves unprepared for their new responsibilities. Research has thus concentrated on identifying the management competences which doctors lack, and with designing ways to remedy the deficit. Seeks to move beyond this deficit model by adopting a perspective which focuses on the engagement of doctors in the management process. Draws data from in-depth interviews with six clinical directors and 19 other members of the hospital management team at Leicester General Hospital NHS Trust (LGH). Content analysis of interviews suggest that the engagement of clinical directors in the hospital management process at this site can be described as reluctant, transient, service-driven, power-pulled and pressured. This negative portrayal of the role, however, must be set in the context of the "management expectation" held of clinical directors by other hospital managers and staff--an expectation that is not currently fulfilled.
It is clear that for at least the next decade, funding for many health systems across the world will be challenged by serious uncertainties in country economies. In facing these challenges nurses have to respond positively to innovations in the delivery of care, increases in productivity and the eradication of errors that result in harm to patients. In committing to supporting this necessary change, quality improvement and innovation programmes are now available from national, not-for-profit organisations, such as the Health Foundation (UK) and the Institute for Health Improvement (USA) and the National Health Service Institute for Innovation an Improvement (UK) that specifically address these important issues. Although the targets for these programmes are often health care systems at the macro level, the role of nurses in understanding and delivering innovative practices at a more micro level is vital. Evidence is now available that demonstrates the outputs of such programmes and the impact from making consequent changes to nursing practice. Education programmes and research activity by nurses can also take advantage of this activity and begin to ask questions that focus on those subject areas, as well as adding positive value to people who use health care services. This paper briefly describes background developments during the last decade, offers one example of innovation programme content, describes the results of introducing patient safety, quality improvement and innovation into education curricula and suggests potential areas for future research by clinical academic nurse researchers.
This paper explores the organizational culture of a general hospital from. a symbolic perspective. It is suggested that traditional symbols or stereotypes associated with certain professions within the Health Service may affect the way in which people both within and outside the NHS understand these professional roles. In particular, the hierarchy and power differentiations which exist (or are assumed to exist) between professions may have an effect on any culture change programmes. The paper is based on a study of communications within a large general hospital in the East Midlands. The idea is explored that these symbolic images of different health care groups may constitutean implicit element in the organization culture of any British hospital and thereby influence the communications within it.
This paper outlines and discusses issues arising from a specific evaluation project. The project brief was to conduct a communications audit of a UK National Health Service trust hospital, focusing particularly upon the interface between junior doctors and other professional groups within the hospital. The experience of conducting the research and operating as management evaluators within a medical research environment is also discussed. The stages and mechanics of designing, conducting and reporting the research are outlined. Apart from the political issues, there are several challenges involved in undertaking non-medical research in a medical setting where the work environment is only slowly coming to terms with adapting a more managerial philosophy whilst being, traditionally, hostile to managerialism. These issues are discussed, the perspectives of the team members (both hospital based and university based) are explored and learning points for future projects are outlined.
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