Governmentality and health care networks

Ferlı́e, Ewan; Fitzgerald, Louise F.; McGivern, Gerry; Dopson, Sue; Bennett, Chris

doi:10.1093/acprof:oso/9780199603015.003.0011

Cited by 14 publications

(22 citation statements)

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“…First, we found clinical departmental leadership was heavily affected by taken-for-granted individualized concepts of leadership, top-down authority and medical professional dominance, reflecting other research on leadership in Kenyan health care ( Nzinga et al 2009 ), other LMIC health care systems and global health care more generally ( Freidson, 1970 ; Denis et al 2001 ; Ferlie et al 2013 ). Thus, leadership in such settings cannot be explained in individual terms but ought to be considered in relation to organizational structures and wider (inter)professional norms.…”

Section: Discussionsupporting

confidence: 56%

“…Yet health care delivery involves multiple actors ( Denis et al 2010 ), particularly powerful medical professionals ( Freidson, 1970 ), who often make operational clinical decisions at ward level, in ways influenced more by collegial mechanisms than line management structures ( Ham and Dickinson 2008 ). Accordingly, researchers have shown that leadership in health care usually involves multiple leaders from different professional groups, at the top and middle-levels of organizations, whose actions are enabled and constrained by their organizational contexts ( Denis et al 2001 ; Currie and Lockett 2011 ; Denis et al 2012 ; Fulop and Mark 2013 ; Ferlie et al 2013 ; Fitzgerald et al 2013 ; Nzinga et al 2013 ; Daire and Gilson 2014 ). Addressing this oversight, we the use lens of ‘distributed leadership’ ( Gronn, 2002 ) to examine the messy day-to-day practice of middle-level leadership in Kenyan district hospitals.…”

Section: Introductionmentioning

confidence: 99%

“…While there has been increasing use of distributed leadership as theoretical ‘unit of analysis’ ( Gronn, 2002 ) in analysing health care leadership particularly in HIC settings ( Currie and Lockett 2011 ; Fitzgerald et al 2013 ; Ferlie et al 2013 ), distributed leadership has not been applied in LMICs. Yet using the distributed leadership lens is critical in LMIC health system contexts, because, in the frequent absence of effective standardized processes and accountability mechanisms, its governance is affected by plural and contextually situated modes of professional organization.…”

Section: Introductionmentioning

confidence: 99%

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Examining clinical leadership in Kenyan public hospitals through the distributed leadership lens

Nzinga

McGivern

English

2018

Health Policy and Planning

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Clinical leadership is recognized as a crucial element in health system strengthening and health policy globally yet it has received relatively little attention in low and middle income countries (LMICs). Moreover, analyses of clinical leadership tend to focus on senior-level individual leaders, overlooking a wider constellation of middle-level leaders delivering health care in practice in a way affected by their health care context. Using the theoretical lens of ‘distributed leadership’, this article examines how middle-level leadership is practised and affected by context in Kenyan county hospitals, providing insights relevant to health care in other LMICs. The article is based on empirical qualitative case studies of clinical departmental leadership in two Kenyan public hospitals, drawing on data gathered through ethnographic observation, interviews and focus groups. We inductively and iteratively coded, analysed and theorized our findings. We found the distributed leadership lens useful for the purpose of analysing middle-level leadership in Kenyan hospitals, although clinical departmental leadership was understood locally in more individualized terms. Our distributed lens revealed medical and nursing leadership occurring in parallel and how only doctors in leadership roles were able to directly influence behaviour among their medical colleagues, using inter-personal skills, power and professional expertize. Finally, we found that Kenyan hospital contexts were characterized by cultures, norms and structures that constrained the way leadership was practiced. We make a theoretical contribution by demonstrating the utility of using distributed leadership as a lens for analysing leadership in LIMC health care contexts, revealing how context, power and inter-professional relationships moderate individual leaders’ ability to bring about change. Our findings, have important implications for how leadership is conceptualized and the way leadership development and training are provided in LMICs health systems.

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Section: Discussionsupporting

confidence: 56%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Examining clinical leadership in Kenyan public hospitals through the distributed leadership lens

Nzinga

McGivern

English

2018

Health Policy and Planning

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“…One of the fundamental policy challenges with regard to the role of the medical profession in the evolution of contemporary healthcare systems is the capacity to create an intermediate space in these systems [ 64 ] to mediate and accommodate potentially conflicting forces or pressures to develop transformative and improvement capacities. This implies that governments and healthcare organizations have to search for strategies to locate clinical/medical practice at a more collective level and also to install medical leadership and engagement in so-called less structured systems like networks [ 65 ].…”

Section: Discussion: Lessons From the Two Healthcare Systemsmentioning

confidence: 99%

Medical doctors in healthcare leadership: theoretical and practical challenges

Denis

Gestel

2016

BMC Health Serv Res

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BackgroundWhile healthcare systems vary in their structure and available resources, it is widely recognized that medical doctors play a key role in their adaptation and performance. In this article, we examine recent government and organizational policies in two different health systems that aim to develop clinical leadership among the medical profession. Clinical leadership refers to the engagement and guiding role of physicians in health system improvement. Three dimensions are defined to conduct our analysis of engaging medical doctors in healthcare leadership: the position and status of medical doctors within the system; the broader institutional context of governmental and organizational policies to engage medical doctors in clinical leadership roles; and the main factors that may facilitate or limit achievements.MethodsOur aim in this study is exploratory. We selected two contrasting cases according to their level of institutional pluralism: one national health insurance system, Canada, and one etatist social insurance system, the Netherlands. We documented the institutional dynamics of medical doctors’ engagement and leadership through secondary sources, such as government websites, key policy reports, and scholarly literature on health policies in both countries.ResultsInitiatives across Canadian provinces signal that the medical profession and governments search for alternatives to involve doctors in health system improvement beyond the limitations imposed by their fundamental social contract and formal labour relations. These initiatives suggest an emerging trend toward more joint collaboration between governments and medical associations. In the Dutch system, organizational and legal attempts for integration over the past decades do not yet fit well with the ideas and interests of medical doctors. The engagement of medical doctors requires additional initiatives that are closer to their professional values and interests and that depart from an overly focus on top down performance indicators and competition.ConclusionsDifferent institutional contexts have different policy experiences regarding the engagement and leadership of medical doctors but seem to face similar policy challenges. Achieving alignment between soft (trust, collaboration) and hard (financial incentives) levers may require facilitative conditions at the level of the health system, like clarity and stability of broad policy orientations and openness to local experimentation.

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“…Underpinning the policy of ‘innovation, health and wealth’ is the implicit assumption that pursuit of the first of these goals (innovation) through what has been termed the ‘managed network’ approach [ 24 ] will – if strategic drivers are appropriately aligned – generate the second two [ 25 – 27 ]. The rationale for this policy is that, in order to keep pace with rising expectations and growing demand, especially when innovation generates interventions that are both effective and costly, the health sector needs to become more efficient, embrace innovations that are both effective and cost-effective, and generate additional income.…”

Section: Introductionmentioning

confidence: 99%

Maximising value from a United Kingdom Biomedical Research Centre: study protocol

Greenhalgh

Ovseiko

Fahy

et al. 2017

Health Res Policy Sys

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BackgroundBiomedical Research Centres (BRCs) are partnerships between healthcare organisations and universities in England. Their mission is to generate novel treatments, technologies, diagnostics and other interventions that increase the country’s international competitiveness, to rapidly translate these innovations into benefits for patients, and to improve efficiency and reduce waste in healthcare. As NIHR Oxford BRC (Oxford BRC) enters its third 5-year funding period, we seek to (1) apply the evidence base on how best to support the various partnerships in this large, multi-stakeholder research system and (2) research how these partnerships play out in a new, ambitious programme of translational research.MethodsOrganisational case study, informed by the principles of action research. A cross-cutting theme, ‘Partnerships for Health, Wealth and Innovation’ has been established with multiple sub-themes (drug development, device development, business support and commercialisation, research methodology and statistics, health economics, bioethics, patient and public involvement and engagement, knowledge translation, and education and training) to support individual BRC research themes and generate cross-theme learning.The ‘Partnerships’ theme will support the BRC’s goals by facilitating six types of partnership (with patients and citizens, clinical services, industry, across the NIHR infrastructure, across academic disciplines, and with policymakers and payers) through a range of engagement platforms and activities. We will develop a longitudinal progress narrative centred around exemplar case studies, and apply theoretical models from innovation studies (Triple Helix), sociology of science (Mode 2 knowledge production) and business studies (Value Co-creation). Data sources will be the empirical research studies within individual BRC research themes (who will apply separately for NHS ethics approval), plus documentary analysis and interviews and ethnography with research stakeholders. This study has received ethics clearance through the University of Oxford Central University Research Ethics Committee.DiscussionWe anticipate that this work will add significant value to Oxford BRC. We predict accelerated knowledge translation; closer alignment of the innovation process with patient priorities and the principles of responsible, ethical research; reduction in research waste; new knowledge about the governance and activities of multi-stakeholder research partnerships and the contexts in which they operate; and capacity-building that reflects the future needs of a rapidly-evolving health research system.

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Governmentality and health care networks

Cited by 14 publications

References 0 publications

Examining clinical leadership in Kenyan public hospitals through the distributed leadership lens

Examining clinical leadership in Kenyan public hospitals through the distributed leadership lens

Medical doctors in healthcare leadership: theoretical and practical challenges

Maximising value from a United Kingdom Biomedical Research Centre: study protocol

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