Polish and UK doctors’ engagement with hospital management

Purpose – The purpose of this paper is to present the findings of a short research project, conducted in 2010 as part of a larger EU funded action investigating the participation and impact of doctors in management. The authors sought to compare the ways in which hospital doctors in the UK and Poland – countries with distinct histories – participate in management; whether they are converging and whether the type of participation found results from changes in the governance and management of these systems. Design/methodology/approach – First, a review of existing evidence and an analysis of policy documents and healthcare statistics were conducted. Identifying a lack of empirical data in the Polish context, and a potentially changing situation in the UK, the authors proceeded to collect some exploratory data in Poland, via interviews with expert informants, and to draw on data collected alongside this study in the UK from qualified doctors participating in research on management and leadership development. Findings – Hospital doctors currently hold similar types of management role in both systems, but there are signs that change is underway. In Poland, different types of medical manager and role are now emerging, whereas in the UK younger doctors appear to be expecting greater management responsibility in the future, and are starting to take up the management training now on offer. Research limitations/implications – The potential implications of these changes for the profession and policymakers in both Poland and the UK are discussed, with opportunities for further research highlighted. Originality/value – The paper provides a comparison of how medical engagement within two systems with different histories is occurring, and also of the changes underway. It provides some much needed initial insight via interviews with expert informants within the polish system, which has been under-researched in relation to the involvement of medicine in management.

Medical Management in Norwegian Hospitals

Hospitals are increasing in size and complexity and hospital manage-ment is being professionalized. This paper aims to investigate how doctors engage in hospital management. Are doctors losing their influence? Based on a review of existing literature and data from a longitudinal study, we show that Norwegian doctors have seemingly lost some of their previous dominance in hospital manage-ment, as other professions have entered traditional areas of medical influence. However, we argue that doctors appear to regain an influential position in formal decision making by entering positions with higher potential for influence. We suggest an analytical approach that illustrates the changing engagement of doctors in management. Our paper contributes to the current and requested research on the relationship between medicine and management in European states.

Being a Clinical Director: First among Equals or Just a Go-Between?

This article explores doctors' experience of the role of clinical director in a large National Health Service (NHS) teaching Trust. The advent of doctors in management, as a relatively new phenomenon in the NHS, is reviewed to provide a contextual setting for the case study. The empirical findings are presented as a ‘clinical diamond’ which emerged as a form that captured the multifaceted nature of the role. The research demonstrates that, for a doctor, being a clinical director potentially threatens the professional identity, collegiality and autonomy of both the individual and the professional group the directorate represents. Moreover, stress that emanates from the structural tension inherent in the role is displaced into personal and professional stress. Clinical directors embody the tensions and conflicts of different managerial and professional cultures, whilst attempting to reconcile the demands of purchasers with the views of disparate and difficult professional colleagues. The argument concludes that there is an urgent need to recognize the demands being placed upon doctors who take on this role, and identifies the benefits and challenges that the role creates in leading health care. The final section identifies the issues that need to be considered to sustain this role in future and the recognition that it has substantially increased the power base of the medical profession, but often at a high price for the individuals involved.