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A summary of the project examining the impact of general management on the NHS, based on field work in England and Scotland between 1986‐1989. Implications of further change and clinical audit are discussed.

This paper focuses on the strategic role of elites in managing institutional and organizational change within English public services, framed by the wider ideological and political context of neo-liberalism and its pervasive impact on the social and economic order over recent decades. It also highlights the unintended consequences of this elite-driven programme of institutional reform as realized in the emergence of hybridized regimes of ‘polyarchic governance’ and the innovative discursive and organizational technologies on which they depend. Within the latter, ‘leaderism’ is identified as a hegemonic ‘discursive imaginary’ that has the potential to connect selected marketization and market control elements of new public management (NPM), network governance, and visionary and shared leadership practices that ‘make the hybrid happen’ in public services reform.

The role of doctors in hospitals continues to change due to both external (policy) and internal (organisational change) pressures. Comparisons between The Netherlands and the UK highlight that several models of medical management are formulated and exist alongside each other, leading to more flexibility in the roles of both doctors and managers. In particular, the agendas concerning the quality of clinical care and cost‐effectiveness are converging, emphasising the increasingly important role of medical managers.

Summarises the impact of challenges of reorganization faced by the UK medical profession over a 30‐year period up to the arrival in government of New Labour in 1997 in order to provide a historical context for the appearance of clinical governance. Investigates the NHS manager as a “diplomat”, the era of “general management” and the National Health Service quasi‐market. States that: managerial supremacy has increased over a long period; managerial control over medicine seemed uncertain in 1997; and a good deal of secular change has arisen from government imposing macro‐level reorganization. Concludes that it remains to be seen whether these elements are capable of allowing the development of local clinical governance arrangements that carry the support of the medical profession.

The organization of the corporate marketing function has attracted increasing attention from marketers in the 1990s. This reflects both the significant conceptual developments in marketing theory and a questioning of the role of the centralized marketing department to organizations operating in post‐industrial service economies. Drawing on data from a broader research project into marketing activity in the acute health care sector in the United Kingdom, the paper examines the organizational solutions adopted by self‐governing hospitals in managing the marketing function. The core theme to emerge from the research is the imperative for such professional service organizations to facilitate the development of flexible, project focused marketing teams, effectively mirroring the notion of the buying centre, capable of integrating core technical professionals directly into the marketing process. Coupled to this is the notion of marketing professionals having to abdicate ownership, and even dominance, of the corporate marketing process.

The purpose of this paper is to review the current literature and summarises the benefits and limitations of having doctors in health management roles in today’s complex health environment.

This paper reviews the current literature on this topic.

Hospitals have evolved from being professional bureaucracies to being managed professional business with clinical directorates in place that are medically led.

Limitations include the difficulty doctors have balancing clinical duties and management, restricted profession-specific view and the lack of management competencies and/or training.

The benefits of having doctors in health management include bottom-up leadership, specialised knowledge of the profession, expert knowledge of clinical care, greater political influence, effective change champions to have on-side, frontline leadership and management, improved communication between doctors and senior management, advocacy for patient safety and quality, greater credibility with public and peers and the perception that doctors have more power and influence compared to other health professionals can be leveraged.

Overall, there are more benefits than there are limitations to having doctors in health management but there is a need for more management training for doctors.

British public administration has endured radical antistate reforms since 1979. This essay outlines the three phases of these administrative reforms, their sources of support, underlying rationales, basic institutional elements as well as their limitations. As a result of profound administrative changes, UK academic administrative sciences have undergone a redefinition and relabelling. Yet, there is still not a distinctive British School of public administration, nor a pronounced shift to Continental European thinking. Indeed, the author concludes, “UK academic public administration is still more that of a North American satellite than a core European State.”

Research has shown that a key issue for prisoners using healthcare services during their sentence is that of patient confidentiality. Maintaining prisoners’ medical confidentiality has been shown to be difficult in the prison setting as many treatments, especially those considered to be out of the ordinary, are more likely to result in a breach of medical confidence. This can include treating infectious diseases, such as HIV/AIDS, Hepatitis or tuberculosis, which can often include long term and regular contact with healthcare staff, and which, in some cases, may require referrals to specialists outside the prison setting. In addition, institutional factors unique to prisons may impact on healthcare staffs’ ability to maintain prisoners’ confidentiality, such as security or health and safety concerns. Drawing on research carried out by the author on healthcare and people with problematic drug use in prisons in a range of European countries, this paper considers the factors that impact on maintaining prisoners’ medical confidentiality and some of the attempts to address this issue.

The purpose of this paper is to explore issues of medical engagement in the management and leadership of health services in the English National Health Service (NHS). The literature suggests that this is an important component of high performing health systems, although the NHS has traditionally struggled to engage doctors and has been characterised as a professional bureaucracy. This study explored the ways in which health care organisations structure and operate medical leadership processes to assess the degree to which professional bureaucracies still exist in the English NHS.

Drawing on the qualitative component of a research into medical leadership in nine case study sites, this paper reports on findings from over 150 interviews with doctors, general managers and nurses. In doing so, the authors focus specifically on the operation of medical leadership in nine different NHS hospitals.

Concerted attention has been focussed on medical leadership and this has led to significant changes to organisational structures and the recruitment and training processes of doctors for leadership roles. There is a cadre of doctors that are substantially more engaged in the leadership of their organisations than previous research has found. Yet, this engagement has tended to only involve a small section of the overall medical workforce in practice, raising questions about the nature of medical engagement more broadly.

There are only a limited number of studies that have sought to explore issues of medical leadership on this scale in the English context. This represents the first significant study of this kind in over a decade.

Numerous past articles, many of which consist of idealised prescriptions for success or the occasional case study or practitioner's contribution, have commented on the role of hospital clinician‐managers. Prior work is circumscribed, however, in that it tends to be normative and a priori (how clinician‐managers in principle should manage) rather than descriptive and a posteriori (how clinician‐managers in situ do manage). In addition, it is apparent that an empirically‐grounded, testable model is lacking for the way clinician‐managers work. This paper sets out to balance past normative‐prescriptive accounts with a descriptive‐analytic one, and presents an empirically‐based conceptual model of the behavioural routines of hospital clinician‐managers. The model, based on multiple studies of clinician‐managers' activities, conjectures five major modes of operating and four primary and five secondary pursuits. The paper advances accounts of how clinician‐management work is conducted and the time frames for it, and hypothesises about clinician‐managers' relationships, and how power and control is experienced and exercised. It also briefly discusses some of the implications of both the research program and the findings. However, following Popper, researchers ought to invite attempts to improve rigor through a systematic critique of their findings. Critical analysis of this work under falsification processes is consequently welcomed.