Mediating the Cultural Boundaries between Medicine, Nursing and Management—the Central Challenge in Hospital Reform

Abstract

This paper documents the resilience of medical and nursing profession-based subcultures and the extent of the differences between them. Against this background, we assess the capacity and willingness of medical and nursing managers to promote changes that will extend the accountability of clinicians and engender more evidence-based, financially driven and output-oriented approaches to service delivery.

Doctors and managers: poor relationships may be damaging patients--what can be done?

“…Their work also starts to shed light on why relationships with managers can be difficult. Doctors, managers, and nurses differ in their views on five key dimensions: [15][16][17] N Accountability v autonomy: whether they ascribe to accountability to others or personal autonomy. N Power: doctors tend to reject the idea that the power sharing implied by team working is appropriate, nurses and managers tend to be more positive.…”

Clinical leadership development in postgraduate medical education and training: policy, strategy and delivery in the UK National Health Service

“…Bohmer 74 states, leadership is not only about the big "L" (senior leadership roles in organizations), but is also the very important "leading of the micro-systems that have such an effect on care outcomes" (p 483). Leadership in highperforming organizations is not reliant on a charismatic leader; instead it is distributed in nature, where senior leaders define strategy, support execution of strategic initiatives, and engage individuals within the organization to lead on improvement activities.…”

“…Clinicians function in an era of evidence-based practice and can have entrenched views about the credibility and value of leadership. Degeling et al 74 accept that clinical leaders are well placed to take forward NHS reforms, but find reluctance among medical managers to question the perceived dominance of medicine in clinical settings, thus making collective working difficult. On the other side, a culture of "antimanagerialism" exists where clinical leader colleagues are described as having gone "over to the dark side".…”

Treatment of myasthenia gravis

“…Professional boundaries and competition, among health professionals and between health practitioners and managers, need to be dissolved. 43 In hospitals, practitioners work largely in multidisciplinary teams. However, in primary care, and at the interface between primary and specialist or secondary care, this level of collaboration and trust is often more difficult to initiate and sustain.…”