Appreciating managers in the NHS

The redefined roles within the NHS, and the changed organisational structures required to meet the challenges of the purchaser/provider environment, are bringing an unprecedented state of flux between organisations and their staff. New roles and altered responsibilities, more fluid organisational structures, all increase the risk of individuals being placed in inappropriate positions. Each one of these mismatches, argue Michael Church and Derek Houghton, represents a misuse of our most valuable resource--people, and is a cost or waste for the organisation.     

Specialty location decisions in the reformed NHS: a case study.

A soft systems approach, largely based on soft systems methodology, was used to steer a study (completed in 1996) of the National Health Service contracting process. It led to action research projects on a number of related issues. One such area that emerged very strongly concerns service rationalization and service planning, and in particular the location of 'small' specialties. A Trust-based study involving patient flow modelling demonstrates the form these problems can take within the internal market and highlights the challenge they make to the contracting process or the new primary care group based commissioning process if they are to be resolved in a rational manner.     

Changing domains in the management process. Radiographers as managers in the NHS

Examines a group of radiographers developing management roles within the backdrop of a changing NHS. A comparative study of 25 Scottish and English radiographer managers were interviewed using semi-structured interviews. Interviews were based on a number of issues associated with moving from a clinical professional to a clinical manager and were analysed using domain theory. The interviews formed a number of emerging themes, which included management, professionalism, management style, conflicts between the role of both manager and professional, and role change. Radiographer managers are forming new "hybrid" manager roles, which have been developing within a changing NHS. A definite tension was seen in this role change. This transition was not easy for this group of radiographer managers. However, they have shown resilience in undertaking both operational and strategic management decisions, while using their clinical background to inform their decision making.     

The role of health information managers in hospital financial management

One area of internal analysis that has attracted increasing attention from healthcare managers is product line management. The coded data produced by the health information management professional is integrated with financial data to provide decision makers with valuable information about service quality and profitability.     

Limits to employee empowerment in the UK NHS. Locality managers in a community health trust

The concern of this paper lies with empowerment of middle managers in a community health trust. It considers the impact of traditional structures and cultures upon the level of decision which middle managers are empowered to make. The conclusion reached is one which suggests that the level of discretion available to middle managers was one of making task-oriented decisions rather than decisions about strategic change. However, even this was compromised by financial constraints and by "best practices" imposed by the personnel function.     

Subordinate appraisal of managers: a useful tool for the NHS

Problems in recruiting and retaining professional staff are an ongoing concern to many NHS Trusts and professional heads of service. There is evidence from a wide variety of sources that direct line managers are frequently cited as a source of worker's stress and a cause of staff turnover. Reviews these issues and suggests subordinate appraisal of managers as one possible response.     

英国全民医疗系统财务体系及其借鉴

目的:提高中国全民医疗系统的财务运作水平.方法:比照英国的全民医疗系统(NHS)的财务体系.结果:我国全民医疗系统的财务体系尚未成熟,在审计,主要财务信息公开,卫生系统区域规划,终端医疗单位上级评价方法等多个方面尚有待提高.结论:在不断完善我国全民医疗系统的过程中,建议对其财务系统进行全面优化,做到政审分离,主要财务信息社会监督,明确卫生规划部门的区域及职责范围,上级单位需要对终端医疗单位进行全面评价及与之相配合的外部审计.     

Developing an explicit strategy towards social responsibility in the NHS: a case for including NHS managers in this strategy

PURPOSE: To explore the concept of corporate social responsibility (CSR) within the UK National Health Service (NHS) and to examine how it may be developed to positively influence the psyche, behaviour and performance of NHS managers. DESIGN/METHODOLOGY/APPROACH: Primary research based upon semi-structured individual face to face interviews with 20 NHS managers. Theoretical frameworks and concepts relating to organisational culture and CSR are drawn upon to discuss the findings. FINDINGS: The NHS managers see themselves as being driven by altruistic core values. However, they feel that the public does not believe that they share the altruistic NHS value system. RESEARCH LIMITATIONS/IMPLICATIONS: The study is based on a relatively small sample of NHS managers working exclusively in London and may not necessarily represent the views of managers either London-wide or nation-wide. PRACTICAL IMPLICATIONS: It is suggested that an explicit recognition by the NHS of the socially responsible commitment of its managers within its CSR strategy would help challenge the existing negative public image of NHS managers and in turn improve the managers' self esteem and morale. ORIGINALITY/VALUE: This paper addresses the relative lacunae in research relating to public sector organisations (such as the NHS) explicitly including the role and commitment of its staff within the way it publicises its CSR strategy. This paper would be of interest to a wide readership including public sector and NHS policy formulators, NHS practitioners, academics and students.     

Professionals' awareness of operational antibiotic prescribing controls in UK NHS hospitals

In recent years, there have been increasing recommendations for multidisciplinary collaboration between clinical pharmacists and medical microbiologists in an attempt to control the quality (and quantity) of antibiotic prescribing. A questionnaire addressing the utilization of antibiotic prescribing controls was sent to the chief pharmacist and medical microbiologist in UK NHS hospitals. Responses were received from both the chief pharmacist and the medical microbiologist employed in the same hospital from 83 hospitals (a 30% response rate from two independent studies). A high level of disagreement and poor awareness was identified between the interprofessional staff groups regarding the existence of antibiotic formulary (with disagreement between the two groups, or not known by one or both respondents, in 46% of the paired hospitals, N = 38) and guideline documents (13%, N = 11), performance of antibiotic prescribing audits (40%, N = 33), and whether pharmacists (52%, N = 43) and medical microbiologists (77%, N = 64) monitored physician compliance with antibiotic prescribing control documents. This study has identified poor knowledge of the existence of basic antibiotic prescribing control mechanisms and the role of professional colleagues. It is suggested that there is some way to go before 'Agenda for Change' principles of flexible and collaborative roles are met.     

NHS managers as rhetoricians: a case of culture management?

In the wake of Peters and Waterman's In Search of Excellence few NHS managers are unaware of culture management as a tool for shaping organisational change. Yet the first wave of post-Griffiths studies found little evidence of ‘culture management’ in action. This paper draws on data from an ethnographic study carried out in 1988–90 to suggest that the symbolic facet of management action is an important, though neglected, element in the 1991 NHS reforms. It argues that rhetorical skills Iwere a valuable resource for general managers overseeing the change process, and explores some of the ways in which rhetoric may have influenced cultural adaptation. However, many of the specific claims of the ‘excellence genre’, including ideas about the importance of strong, homogeneous cultures, are rejected. Rhetoric is an aspect of micro-political struggles over meaning, which rarely result in straightforward cultural ‘manipulation’, and are more likely to re-shape organisations through pragmatic accommodation than to win the hearts and minds of members.     

Perception of risk: a study of A&E nurses and NHS managers

This exploratory study investigates perceptions of two groups of NHS staff, of a range of risks, topical and relevant to accident and emergency (A&E). Literature suggests that the effectiveness of a risk management strategy is lessened if staff exposed to risk, and managers, have different perceptions of the nature and severity of the risk. A self-administered questionnaire was distributed to registered A&E nurses and to Trust managers at directorate level and above, working in five large inner-city NHS Trusts. Managers and nurses were asked to quantify their perceptions of nine defined adverse events. They were also asked to identify the jobholder with day-to-day responsibility for managing four specific risks. Completed forms were obtained from 38 per cent of managers and nurses. Results showed broadly that managers tended to quantify risks of violence and stress to A&E nurses less highly than did nurses. By contrast, they tended to quantify risks to patients more highly than did nurses. Overall, a coherent pattern of difference in risk perception between the two groups was identified. It is argued that identification of differences of perception is an essential part of the risk management process. Illustrations are given of ways in which these differences can undermine the effectiveness of a risk management strategy.     

The use of smart cards in the NHS.

The majority of doctors have experienced the frustration of the loss of a patient's medical records. A new development in technology may help alleviate this problem and indeed facilitate patient care. This development is the smart card. This article describes the types of smart cards and their use within the NHS.     

Exploring HRD in two Welsh NHS Trusts: analysing the discursive resources used by senior managers

PURPOSE: The purpose of this paper is to examine human resource development (HRD) in the UK National Health Service (NHS), and particularly in two Welsh NHS Trusts, to help illuminate the various ways in which learning, training and development are talked about. The NHS is a complex organisation, not least with its recent devolution and separation into the four distinct countries of the UK. Within this, there are multiple and often conflicting approaches to human resource development associated with the various forms of employee, professional (nursing, medical etc.), managerial and organisational development. How people are developed is crucial to developing a modern health service, and yet, with the diverse range of health workers, HRD is a complex process, and one which receives little attention. Managers have a key role and their perceptions of HRD can be analysed through the discursive resources they employ. DESIGN/METHODOLOGY/APPROACH: From an interpretivist stance, the paper employs semi-structured interviews with seven Directorate-General Managers, and adopts discourse analysis to explore how HRD is talked about in two Welsh NHS Trusts. FINDINGS: The paper finds some of the different discourses used by different managers, including those with a nursing background and those without. It examines how they talk about HRD, and also explores their own (management) development and the impact this has had on their sense of identity. ORIGINALITY/VALUE: The paper highlights some of the tensions associated with HRD in the NHS, including ambiguities between professional and managerial development, the functional and physical fragmentation of HRD, conflict between a focus on performance/service delivery and the need to learn, discursive dissonance between the use of the terms training and learning, a delicate balance between "going on courses" and informal, work-related learning, inequities regarding "protected time" and discourses shifting between competition and cooperation. These tensions are exposed to help develop a shared understanding of the complexities of HRD within the NHS. The paper concludes with a summary of the different discursive resources employed by senior managers to articulate and accomplish HRD. These are "surfaced" to enable managers and HRD practitioners, amongst others, to construct common repertoires and shared meaning.