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Uses an empirical investigation based on a survey of junior doctors in five NHS trust hospitals, to examine their attitudes towards both the general principle of clinical involvement in hospital management and the particular prospect of exercising such a role themselves. Finds that junior doctors, with few exceptions and irrespective of grade, were very positive towards clinical management roles in NHS trusts and were almost universally keen to assume management responsibilities when they were more senior. At the same time, finds junior doctors to have little concept of the doctor‐ manager role or the recognized and demanded specific preparation for assuming management responsibilities.

Objective — On the basis of previous research funded by the NHS Executive into management education for clinicians it seemed possible that a gap existed between the house officers' perceptions or experience of the pre‐registration year and the educational objectives of the GMC. This study explores the nature of the gap between house officers' perceptions and the GMCs expectations. Design — Observation through job‐shadowing of two individual housemen covering surgery and medicine and in‐depth semi‐structured interviews. Setting — Five hospitals in five regions of which three are teaching hospitals. Subjects — Twenty houseman comprising ten from medicine and ten from surgery, four ward nurses, a Trust Hospital Chief Executive, two Medical Directors, one clinical tutor and a clinical sub dean. Conclusions —The picture of haphazard training and education opportunities of pre‐registration house officers suggests that there are two fundamental problems to be addressed. One is, how best to generate a sense of ‘ownership’ by and ‘affinity’ to a corporate organisation. The second is even more fundamental and requires a strategic review of the purpose of the pre‐registration year and strongly suggests the desirability of re‐profiling the house officers job in order to close the gap between expectations and the reality of current experience and produce better medicine.

Based on a national evaluation of a £2 million Government‐sponsored programme to send some 260 consultants from the 14 Regional Health Authorities in England to attend Business School management programmes during 1992‐3. Reports on a 20‐month tracking study to assess changes in the level and breadth of knowledge, attitudes and behaviour as acknowledged by course participants, their UGMs, line managers and where possible their chief executives. Over 2,000 course participants were interviewed and some 106 completed both pre‐ and post‐course attendance “self‐efficacy” questionnaires. Most consultants emerged from the courses feeling more confident to handle their current and prospective management roles and the tangible returns to the organization suggest that advanced management development should continue for consultants being appointed to senior management roles such as clinical and medical directors.

Features a case study of a major bank which aimed to achieve corporate transformation and a dramatic improvement in service quality. The links between service quality, customer satisfaction and corporate profitability in UK banking are outlined in order to set in context the many quality improvement initiatives undertaken by UK retail banks in recent years. Business process re‐engineering has proved to be the most popular of service quality initiatives but most have been limited to single processes rather than corporate transformation as portrayed in the case study. The five‐year corporate transformation programme focuses on employee communications, the redesign of work, recruitment and reward processes and the introduction of consumer research‐based national quality standards. The bank was rewarded for its efforts, coming top for three consecutive years in the Which? service quality surveys and, according to its own data, which contributed to a rise in customer satisfaction and customer retention at a time of declining employee satisfaction. Future developments in service quality segmentation and a working definition of service quality are proposed.

This paper proposes a diagnostic framework useful to Trust managers who are faced with the task of devising and implementing strategies for improvements in clinical effectiveness, and is based on a recent study incorporating clinicians, managers, and professional staff in four NHS Trusts in the North Thames Region. The gap framework is inspired by the gap model developed by Zeithaml, Parasuraman and Berry from their research into service quality and incorporates Dave Sackett’s schema as well as a personal competency profile needed for the practice of evidence based health‐care (EBHC). The paper highlights the four organisational and personal failures (gaps) which contribute to the fifth gap, namely the discrepancy between clinically relevant research evidence and its implement‐ation in health care. To close the gaps, Trusts need to set the goal and tackle the cultural, organisational, attitudinal and more material aspects such as investment in the information infrastructure, education and training of doctors. Doctors need to go through a process from awareness to action facilitated through a combination of personal and organisational incentives and rewards as well as training in the requisite skills. Researchers should take steps to improve the quality of the evidence and its accessibility and purchasers should reinforce the use of EBHC by withdrawing funding for care which has proved to be ineffective, inappropriate or inferior.

The statistics and associated literature reveal a chronic shortage of nurses and midwives and difficulties in recruiting and retaining D and E grades, the main providers of hands‐on patient care. This qualitative exploratory study of nurse satisfaction, dissatisfaction and reasons for staying provides empirical support for a conceptual model “the nurse satisfaction, quality of care and patient satisfaction chain”. The in‐depth interviews reveal a spontaneous and explicit linking of organisational resources to nurses’ ability to provide the level of patient care commensurate with their desire and patients’ needs. Nurse job satisfaction derives from knowing that they have provided good care as well as the attributes of the job such as a career, skill acquisition and the “people I work with”. Job dissatisfaction stems primarily from staff shortages, the behaviour of patients and negative media comment. The interviews demonstrate the critical role of the “ability to give quality care” and the satisfaction derived from patients’ demonstration of their appreciation and the influence of this on nurse retention.

The pre‐registration house officers′ year has a dual purpose. On the one hand, there is the basic service requirement for long hours of routine assistance to senior medical staff. On the other hand, there is the educational component of the job as seen in the GMC and post‐graduate deans′ objectives. Reports on a study which shows there is considerable tension between these two objectives. Examines the extent and nature of this divergence. Suggests that there are two problems to be addressed: how best to generate a sense of ownership and affinity to the trust hospital, and even more fundamental, requires a strategic audit and reappraisal of the purpose of the pre‐registration year and strongly suggests the desirability of reprofiling it in order to provide a rich working experience and learning environment.

Seeks to throw light on both strategic and managerial aspects of the post of medical director. The medical director is a key executive member of the Trust Board, yet the role remains ill‐defined. The existing published guidance gives some indication of what medical directors should be doing but gives limited information about “best practice” or how to cope with the demands being made on them. A survey of medical directors in 1994 revealed the diversity of the tasks that they can be called on to perform, often with inadequate managerial and secretarial support. The survey also indicated that problems have occurred as a result of the heavy workload and unexpected multiple facets of the role. Concludes that, to make the job somewhat easier, there should be a clear core job specification which is tailored to suit the individual circumstances. This should be combined with generous support and training, together with a suitable reward package.

Presents the results of an empirical study of junior doctors’ views on quality and clinical audit in health care. Claims that the requirement for annual efficiency gains and rising patient expectations, together with the realization that the “costs of quality” can consume between 30 and 50 per cent of costs, has brought quality in health care to the forefront. In this context, and because much of the medical care is delivered by junior doctors, studies their perceptions on dimensions of quality in health care, their knowledge of, and participation in, clinical audit and the obstacles to providing quality care. Makes a striking finding ‐ the low priority given to patient satisfaction ‐ a perspective which is out of alignment with the priorities of government policy, and the whole philosophy of “quality in service”. Asserts that the role, significance and outcome of clinical audit as a quality improvement tool is cast into doubt by these consultants of tomorrow.

This paper focuses on the practice of evidence‐based healthcare by doctors, nurses, midwives and the professions allied to medicine in four NHS Trusts in and around London. This qualitative study, based on interviews and self‐efficiency ratings uncovered the extent of evidence based practice between different groups and between acute and community Trusts, the perceived obstacles to the adoption and implementation of EBHC, and throws light on the knowledge, skills and attitudes required for such practice. Five clusters of competencies were identified – personal attributes, interpersonal, self‐management, information management and technical knowledge skills – and these form the basis of a competency framework of measurable criteria to assess proficiency as well as staff training needs which it is hoped will enable NHS Trusts to devise strategies to meet the requirements and challenges of clinical governance from April 1999.