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While critical approaches have enriched research in proximate fields, their impact has been less marked in studies of healthcare management. In response, the 2016 Organizational Behaviour in Health Care Conference hosted its first-ever session dedicated to the emergent field of critical healthcare management studies (CHMSs). The purpose of this paper is to present five papers selected from that conference.

In this introductory paper, the authors frame the contributions as “green shoots” in a field of CHMS which contains four main furrows of activity: questioning the taken-for-granted; moving beyond instrumentalism; reflexivity and meanings in research; and challenging structures of domination (Kitchener and Thomas, 2016). The authors conclude by presenting an agenda for further cultivating the field of CHMS.

The papers evidence the value of CHMS, and provide insight into the benefits of broadening theoretical and methodological approaches in pursuit of critical insights.

CHMS works to explicate the multiple and competing ideologies and interests inherent in healthcare. As pragmatic imperatives push the provision of health and social care out of the organisational contexts and into private space, there is a particular need to simultaneously understand, and critically interrogate, the implications of new, as well as existing, forms of care.

This paper reviews, frames and details practical next steps in developing CHMS. These include: enhanced engagement with a wider range of actors than is currently the norm in mainstream healthcare management research; a broadening of theoretical and methodological lenses; support for critical approaches among editors and reviewers; and enhanced communication of critical research via its incorporation into education and training programmes.

The paper contributes to an emerging stream of CHMS research, and works to consolidate next steps for the field.

Workplace silence impedes productivity, job satisfaction and retention, key issues for the hospital workforce worldwide. It can have a negative effect on patient outcomes and safety and human resources in healthcare organisations. This study aims to examine factors that influence workplace silence among hospital doctors in Ireland.

A national, cross-sectional, online survey of hospital doctors in Ireland was conducted in October–November 2019; 1,070 hospital doctors responded. This paper focuses on responses to the question “If you had concerns about your working conditions, would you raise them?”. In total, 227 hospital doctor respondents (25%) stated that they would not raise concerns about their working conditions. Qualitative thematic analysis was carried out on free-text responses to explore why these doctors choose to opt for silence regarding their working conditions.

Reputational risk, lack of energy and time, a perceived inability to effect change and cultural norms all discourage doctors from raising concerns about working conditions. Apathy arose as change to working conditions was perceived as highly unlikely. In turn, this had scope to lead to neglect and exit. Voice was seen as risky for some respondents, who feared that complaining could damage their career prospects and workplace relationships.

This study highlights the systemic, cultural and practical issues that pressure hospital doctors in Ireland to opt for silence around working conditions. It adds to the literature on workplace silence and voice within the medical profession and provides a framework for comparative analysis of doctors' silence and voice in other settings.

The purpose of this paper is two-fold. First, it sets the context for the special issue by considering conceptions of patients and their roles in service delivery and improvement. Second, it introduces the contributions to the special issue, and identifies thematic resonance.

The paper utilises a literature synthesis and thematic analysis of the special issue submissions. These emanated from the Ninth International Organisational Behaviour in Healthcare Conference, hosted by Copenhagen Business School on behalf of the Learned Society for Studies in Organizing Healthcare.

The articles evidence a range of perspectives on patients’ roles in healthcare. These range from their being subject to, a mobilising focus for, and active participants in service delivery and improvement. Building upon the potential patient roles identified, this editorial develops five “ideal type” patient positions in healthcare delivery and improvement. These recognise that patients’ engagement with health care services is influenced both by personal characteristics and circumstances, which affect patients’ openness to engaging with health services, as well as the opportunities afforded to patients to engage, by organisations and their employees.

The paper explores the relationally embedded nature of patient involvement in healthcare, inherent in the interdependence between patient and providers’ roles. The typology aims to prompt discussion regarding the conceptualisation patients’ roles in healthcare organisations, and the individual, employee, organisational and contextual factors that may help and hinder their involvement in service delivery and improvement. The authors close by noting four areas meriting further research attention, and potentially useful theoretical lenses.

The purpose of this paper is to explore the nature of industrial relations (IR), and IR conflict in the Irish healthcare sector.

The paper is based on a thematic analysis of Labour Court cases concerning hospitals over a ten‐year period.

The findings of the paper indicate that the nature of IR conflict is changing in healthcare. The paper suggests that alternative manifestations of IR conflict evident in the Irish healthcare sector include: absenteeism as a form of temporary exit; and resistance. The key groups in the sector are discussed in the context of their contrasting disputes. The themes which characterise negotiations are identified as precedent, procedure and partnership.

The research was conducted in the healthcare sector, and thus its transferability is limited. Caution is also required as the research pertains to one national setting, which despite sharing some structural similarities with other health and IR systems, is a unique context. The paper highlights the importance of recognising IR conflict in its various forms. It is further suggested that managing the process of IR conflict may be significant in furthering change agendas.

The value of the paper centres on the investigation of alternative manifestations of IR conflict in the healthcare sector.

The purpose of this paper is to consider the role of the HR function in the management of professional and non‐professional staff in the acute hospital sector.

A qualitative approach was adopted. Empirical data from three hospital case studies is utilised to explore the role of the hospital HR function. Cases were compiled from 45 interviews, observation and secondary data analysis.

The paper finds that in two of the three cases the human resource (HR) function predominantly provides services to non‐professional workforce groups. However, the effective and strategic management of professionals is undertaken in the third case, without a professional HR function.

The findings of this paper require some caution in extrapolation, being based on research in one national context. The authors suggest the delivery of service as a useful lens to explore the enacted practice of HRM in hospitals.

The paper draws attention to a significant deficit in the role of the HR function in managing core professional staff.

The paper applies an existing conceptual framework to explore the role of the HR function in hospitals. It identifies a significant deficit in the management of core professional staff. On this basis the paper suggests alternative research methodologies to investigate the management of all hospital staff.

The purpose of this paper is to explore the nature and value of the clinical management role undertaken by primary care doctors in Ireland. To date, a majority of research has focused on clinical management roles in the acute sector.

The paper presents a sub‐set of data from a mixed methods study. In total, 14 semi‐structured interviews are drawn upon to identify the nature and value of the clinical management role in primary care.

Comparison with acute sector research identifies considerable differences in the nature of the clinical management role across sectors – and in the associated value proposition. Structural and role‐related contingencies affecting the potential value of clinical management roles in Irish primary care are discussed. Structural influences include the private ownership structure, low complexity and limited requirement for cross‐professional coordination. Role‐related influences include the primacy of the clinical identity, time constraints and lack of managerial training.

The findings provide a limited basis for generalisation, premised on 14 interviews in one national context. However, given the international shift towards the provision of health services in primary care, they provide a research agenda for an important healthcare context.

The findings draw attention to the need for policy consideration of the value of the clinical manager role in primary care; how policy can support effective primary care management; and the need for specialised management training, which takes account of the small‐firm context.

The paper identifies that primary‐care clinical‐management roles focus on operational management and oversight and discusses the structural and role‐related factors which affect their efficacy.

The purpose of this paper is to investigate the process and impact of patient involvement in locally defined improvement projects in two hospital clinics. The paper particularly aims to examine how patient narratives, in the form of diaries and radio montage, help to create new insights into patient experience for healthcare professionals, and support professionals’ enrolment and mobilisation in innovation projects.

Two case studies were undertaken. These drew upon qualitative interviews with staff and participant observation during innovation workshops. Patient diaries and a recorded montage of patient voices were also collected.

The findings illuminate translation processes in healthcare innovation and the emergence of meaning making process for staff through the active use of patient narratives. The paper highlights the critical role of meaning making as an enabler of patient-centred change processes in healthcare via: local clinic mangers defining problems and ideas; collecting and sharing patient narratives in innovation workshops; and healthcare professionals’ interpretation of patient narratives supporting new insights into patient experience.

This study demonstrates how healthcare professionals’ meaning making can be supported by articulating, constructing, listening and interpreting patient narratives. The two cases demonstrate how patient narratives serve as reflective devices for healthcare professionals.

This study presents a novel demonstration of the importance of patient narratives for translating healthcare innovation in a clinical practice setting.

The purpose of this paper is to integrate senior managers' personal experiences of leadership development with theory to provide insights into leadership development for aspiring and developing leaders.

A qualitative research design was adopted. Empirical data were gathered from 11 semi‐structured interviews with senior leaders in the Irish public, voluntary (non‐profit) and private sectors.

The analysis led to the identification of development‐oriented themes in the leadership literature, and the provision of insights regarding the developmental influences, core activities (vision and mobilisation) and the contextual influences (sectoral and societal) which affect appropriate leadership behaviour.

Although the study is limited by its small sample it provides a basis for further research and draws attention to personal leader development processes. In particular the importance of formative experiences on leaders' development, their struggle to attain balance, the need for advanced emotional management skills, the capacity to work with collectives of people and to adapt to contextual demands are emphasised. The study suggests that future research investigate how contextual factors influence the adoption of certain leadership styles.

The study explores personal perspectives on fundamental leadership development themes, of pragmatic value to established and aspiring leaders interested in enhancing their capacity to lead.

This paper considers leader development from the viewpoint of front‐line actors. As such it adopts an intrapersonal focus, considering the development journeys of individual leaders. The paper extends the traditional focus on the transactional and relational dimensions of leadership behaviours to incorporate the formative experiences and contextual factors that influence leadership.

The purpose of this paper is to integrate Greenberg's perspective on the connection between injustice and stress in order to clarify the role of organisational justice, burnout and organisational commitment in the understanding of absenteeism.

The study was carried out among 457 workers of a large healthcare establishment in the Canadian public healthcare sector. The model was tested using structural equation methods.

The results reveal that procedural and interactional justices have an indirect effect on exhaustion through distributive injustice. Moreover, it was found that distributive injustice is indirectly linked to short‐term absences through exhaustion. By contrast, the relationship between distributive injustice and long‐term absence can be explained by two mediating variables, namely, exhaustion and psychosomatic complaints.

In spite of the non‐longitudinal nature of this study, the results suggest that the stress model and the medical model best explain the relationship between organisational injustice and absenteeism, while the withdrawal model via organisational commitment is not associated in this study with absenteeism.

Healthcare managers should consider the possibility of better involving employees in the decision‐making process in order to increase their perception of procedural and interactional justice, and indirectly reduce exhaustion and absenteeism through a greater perception of distributive justice.

For the healthcare sector, the need to reduce absenteeism is particularly urgent because of budget restrictions and the shortage of labour around the world.

This is one of the first studies to provide a complete model that analyses the stress process in terms of how organisational justice affects short‐ and long‐term absences, in a bid to understand the specific process and factors that lead to shorter and longer episodes of absence.