The hierarchy of work pursuits of public health managers

Abstract

How public health is managed in various settings is an important but under-examined issue. We examine themes in the management literature, contextualize issues facing public health managers and investigate the relative importance placed on their various work pursuits using a 14-activity management model empirically derived from studies of clinician-managers in hospitals. Ethnographic case studies of 10 managers in nine diverse public health settings were conducted. The case study accounts of managers' activities were content analysed, and substantive words encapsulating their work were categorized using the model. Managerial activities of the nine public health managers were ranked according to the number of words describing each activity. Kendall's coefficient of concordance yielded W = 0.710, P < 0.000, revealing significant similarity between the activity patterns of the public health managers. A rank order correlation between the activity patterns of the average ranks for the public health sample and for the hospital clinician-managers (n = 52) was R = 0.420, P = 0.131, indicating no significant relationship between relative activity priorities of the two groups. Public health managers put less emphasis on pursuits associated with structure, hierarchy and education, and more on external relations and decision-making. The model of hospital clinician-managers' managerial activities is applicable to public health managers while identifying differences in the way the two groups manage. The findings suggest that public health management work is more managerialist than previously thought.

High performance work systems: the gap between policy and practice in health care reform

“…Clinical management was not identified as a primary pursuit of this group of managers. Instead, process, quality and data management -key components of clinical management -were only found in the secondary pursuits, where the clinician managers reported spending less time and effort (Braithwaite, 2004), and a more recent study found similar results (Braithwaite et al, 2007). We speculate that a large amount of time and effort has been expended on processes mandated by clinical governance which direct the HRM systems to support the mass production hierarchy, but which have little relationship to the on-the-ground relationship between a health care professional and his or her patient.…”