Gerry McGivern

PurposeThe purpose of this paper is to explore the way “hybrid” clinical managers in Kenyan public hospitals interpret and enact hybrid clinical managerial roles in complex healthcare settings affected by professional, managerial and practical norms.Design/methodology/approachThe authors conducted a case study of two Kenyan district hospitals, involving repeated interviews with eight mid-level clinical managers complemented by interviews with 51 frontline workers and 6 senior managers, and 480 h of ethnographic field observations. The authors analysed and theorised data by combining inductive and deductive approaches in an iterative cycle.FindingsKenyan hybrid clinical managers were unprepared for managerial roles and mostly reluctant to do them. Therefore, hybrids’ understandings and enactment of their roles was determined by strong professional norms, official hospital management norms (perceived to be dysfunctional and unsupportive) and local practical norms developed in response...

We explore the argument that a new mode of health care organizing is emerging which moves beyond the established professional dominance versus New Public Management (NPM) debate. We review Foucault's work on 'governmentality', as applied to health care organizations. We specify two specific Foucauldian themes (the power/knowledge nexus in Evidence Based Medicine (EBM); and the technologies of the clinical managerial self) to analyse organizing in the English cancer services field. We introduce two qualitative case studies of Managed Cancer Networks. We suggest their governance can be fruitfully seen through a 'governmentality' lens. We consider implications for developing Foucauldian analysis of health care organizations.

Leadership development and its effectiveness has not been explored in depth across university settings. Few studies link leadership development programmes to organisational outcomes in Higher Education (HE) or performance assessment exercises, such as the UK Research Excellence Framework (REF). This review explores what is known in the area of the impact of leadership development in HE settings and offers a contribution to further thinking in this field.

The Foucauldian concepts of governmentality and pastoral power have been used to explain the way health professionals internalise evidence-based practices in health care generally and clinical networks more specifically. However, we know little about the work, practices and process involved in developing and implementing an ‘evidence-based governmentality’ outside the West, particularly in Low and Middle Income Counties (LMICs), where governmentality often has a different transnational character. We explain the development and implementation of a Western transnational evidence-based governmentality in a clinical network in Kenya, using a decentred analytical approach. We highlight the essential work of medical professional ‘pastors’, with experience of both health care in Kenya and evidence- based medicine in Western High-Income Countries, in transposing this governmentality into health care in a LMIC in a way improving clinical care.

BackgroundCrises, such as the COVID-19 pandemic, risk overwhelming health and social care systems. As part of their responses to a critical situation, healthcare professionals necessarily improvise. Some of these local improvisations have the potential to contribute to important innovations for health and social care systems with relevance beyond the particular service area and crisis in which they were developed.FindingsThis paper explores some key drivers of improvised innovation that may arise in response to a crisis. We highlight how services that are not considered immediate priorities may also emerge as especially fertile areas in this respect.ConclusionHealth managers and policymakers should monitor crisis-induced improvisations to counteract the potential deterioration of non-prioritised services and to identify and share useful innovations. This will be crucial as health and social care systems around the world recover from the COVID-19 pandemic and head into another potent...

This chapter focuses on the importance of the QIPP productivity programme, and the techniques underpinning implementation. It offers a historical analysis of the various phases of QIPP. The chronology indicates that QIPP was originally developed in 2009 under a Labour government following the 2008 global financial crisis. QIPP involved three streams of activity: pay restraint and reduced administration costs; lower national tariffs and increased productivity; and system redesign. We note the involvement of external management consultants brought in to advise government. The chapter reviews existing commentaries on QIPP; however, we note that the nature and effects of QIPP have been badly under-researched, despite its major importance. Think tank-based commentaries suggest QIPP relied on crude cost compression, with little evidence of the productivity-enhancing service transformation initially hoped for. The chapter ends by introducing subsequent chapters that explore the career of Q...

While the implementation of evidence-based medicine guidelines is well studied, there has been little investigation into the extent to which a parallel evidence-based management movement has been influential within health care organizations. This book explores the various management knowledges and associated texts apparent in English health care organizations, and considers how the local reception of these texts was influenced by the macro level political economy of public services reform evident during the period of the politics of austerity. The research outlined in this volume shows that very few evidence-based management texts are apparent within health care organizations, despite the influence of certain knowledge producers, such as national agencies, think tanks, management consultancies, and business schools in the industry. Bringing together the often disconnected academic literature on management knowledge and public policy, the volume addresses the ways in which preferred ...

Leadership development (LD) activity and its effectiveness has not been explored rigorously across changing university settings globally. As Higher Education (HE) settings change radically throughout the world, HE professionals are operating in more uncertain environments, and leaders are taking increasingly complex and diverse approaches to their leadership roles. LD activities therefore become important in supporting this highly complex context, yet little is known in the literature about LD and its impact in HE. We examine peer-reviewed work on LD in HE settings globally to understand what may be learned about its content, processes, outcomes and impact. Our results suggest the current literature is small-scale, fragmented and often theoretically weak, with many different and co-existing models, approaches and methods, and little consensus on what may be suitable and effective in the HE context. We reflect on this state of play and develop a novel theoretical approach for designi...

Clinical leadership is recognised as a crucial element in health system strengthening and health policy globally yet it has received relatively little attention in low and middle income countries (LMICs). Moreover, analyses of clinical leadership tend to focus on senior-level individual leaders, overlooking a wider constellation of middle-level leaders delivering health care in practice in a way affected by their health care context. Using the theoretical lens of 'distributed leadership', this paper examines how middle-level leadership is practised and affected by context in Kenyan county hospitals, providing insights relevant to health care in other LMICs. The paper is based on empirical qualitative case studies of clinical departmental leadership in two Kenyan public hospitals, drawing on data gathered through ethnographic observation, interviews and focus groups. We inductively and iteratively coded, analysed and theorised our findings. We found the distributed leadership...

In this article, we discuss temporal work and temporal politics situated between groups with different temporal orientations, arguing that attention needs to be paid to covert and unarticulated silent politics of temporal work. Drawing on a case study of a management consultancy project to redesign public health care, we explain how unarticulated temporal interests and orientations shape the construction of problems, which, in turn, legitimate tasks and time frames. We also show how task and time frames are temporarily fixed and imposed through boundary objects, and the way these may then be reinterpreted and co-opted to deflect pressure to change. Thus, we argue, unarticulated, covert and political temporal inter-dynamics produce expedient provisional temporal settlements, which resolve conflict in the short-term, while perpetuating it in the longer run.

This article explores contrasting forms of ‘knowledge leadership’ in mobilizing management research into organizational practice. Drawing on a Foucauldian perspective on power–knowledge, we introduce three axes of power–knowledge relations, through which we analyse knowledge leadership practices. We present empirical case study data focused on ‘polar cases’ of managers engaged in mobilizing management research in six research-intensive organizations in the UK healthcare sector. We find that knowledge leadership involves agentic practices through which managers strive to actively become the knowledge object – personally transposing, appropriating or contending management research. This article contributes to the literature by advancing the concept of knowledge leadership in the work of mobilizing management research into organizational practice.

Emotional-affective aspects of risk work are integral to risk management in many fields, particularly in human service organizations; yet rational notions of risk management often obscure these emotional-affective aspects. In this chapter, we discuss the case of high risk mental healthcare (for people with personality disorders), characterised by both formal and informal risk management systems. Drawing on sociomaterial perspectives, we explore empirically how affective dimensions of routine clinical risk work flow between these formal and informal risk management systems, affecting intersubjective relations and experiences. We show how affect can ‘inflame’ incidents, producing heated interactions that escalate and ‘overflow’ through the risk management technologies, devices and systems intended to contain and manage them. The chapter draws conclusions on dynamics of affective flows and overflows that are present – if less visible – in other areas of risk work.

This report is based on a research project funded by the GMC/ESRC Public Services Programme entitled „The Visible and Invisible Performance Effects of Transparency in Professional regulation‟. The research compared the effects of regulation for doctors with developing regulation for psychotherapists and counsellors (as outlined in the 2007 White Paper „Trust, Assurance and Safety: The regulation of health professionals‟). We summarise here some of the key findings in our study focusing on issues that are relevant to the HPC consultation on the regulation of counsellors and psychotherapists. We conducted 50 formal interviews and 22 informal scoping interviews with regulators and other officials, representatives of professional bodies, patient representatives, doctors (GPs and psychiatrists), psychotherapists and counsellors. In addition we observed Health Professionals Council (HPC) Professional Liaison Group (PLG) Meetings for Psychotherapists and Counsellors, as well as for Psychol...

We explain social and organisational processes influencing health professionals in a Kenyan clinical network to implement a form of quality improvement (QI) into clinical practice, using the concept of 'pastoral practices'. Our qualitative empirical case study, conducted in 2015-16, shows the way practices constructing and linking local evidence-based guidelines and data collection processes provided a foundation for QI. Participation in these constructive practices gave network leaders pastoral status to then inscribe use of evidence and data into routine care, through championing, demonstrating, supporting and mentoring, with the support of a constellation of local champions. By arranging network meetings, in which the professional community discussed evidence, data, QI and professionalism, network leaders also facilitated the reconstruction of network members' collective professional identity. This consequently strengthened top-down and lateral accountability and insp...

"Over the last thirty years, scholars of health care organizations have been searching for concepts and images to illuminate their underlying, and shifting, modes of organizing. Nowhere has this controversy been more intense than in the United Kingdom, given the long succession of top down reorganizations within the National Health Service (NHS) over the last thirty years. This book characterises the nature of key reforms - namely managed networks - introduced in the UK National Health Service during the New Labour period (1997-2010), combining rich empirical case material of such managed networks drawn from different health policy arenas (clinical genetics, cancer networks, sexual health networks, and long term care) with a theoretically informed analysis. The book makes three key contributions. Firstly, it argues that New Labour's reforms included an important network element consistent with underlying network governance ideas, specifying conditions of 'success' for these managed networks and exploring how much progress was empirically evident. Secondly, in order to conceptualise many of the complex health policy arenas studied, the book uses the concept of 'wicked problems': problematic situations with no obvious solutions, whose scope goes beyond any one agency, often with conflicting stakeholder interests, where there are major social and behavioural dimensions to be considered alongside clinical considerations. Thirdly, it makes a contribution to the expanding Foucauldian and governmentality-based literature on health care organizations, by retheorising organizational processes and policy developments which do not fit either professional dominance or NPM models from a governmentality perspective. From the empirical evidence gathered, the book argues that managed networks (as opposed to alternative governance modes of hierarchy or markets) may well be the most suitable governance mode in those many and expanding policy arenas characterised by 'wicked problems', and should be given more time to develop and reach their potential."

This article focuses on the pattern and impact of change leadership in complex, pluralistic, public sector settings, and specifically in English healthcare. The argument draws on evidence from ten comparative cases, exploring links between leadership patterns and organizational outcomes. Our analysis builds three themes. First, a pattern of widely distributed change leadership is linked to delivering improvements in service outcomes. Second, professional/managerial hybrids are shown to perform crucial lateral facilitation ...

Abstract: This article uses the stream of literature relating to receptive contexts for change to explore the variations in progress on change implementation between different organisations within healthcare. The aim of the article is to develop our understanding of change processes as they unfold in complex organisations. The article uses empirical data from 11 healthcare sites in the UK to explore how variations can be explained and what impacts on an organisation's capacity to manage changes effectively. Analysis of the data ...

This report is based on a research project funded by the GMC/ESRC Public Services Programme entitled „The Visible and Invisible Performance Effects of Transparency in Professional regulation‟. The research compared the effects of regulation for doctors with developing regulation for psychotherapists and counsellors (as outlined in the 2007 White Paper „Trust, Assurance and Safety: The regulation of health professionals‟). We summarise here some of the key findings in our study focusing on issues that are relevant ...

Abstract: The paper compares two separate studies on GP appraisal and consultant appraisal in the British National Health Service (NHS). Both found potential for appraisal to be a developmental process, which enabled clinicians to reflect on and improve their practice, or to become a'tick box exercise'. We explain the contextual factors leading to appraisal outcomes and suggest that clinical ownership is critical to the success of appraisal. It seems, however, that more often importance is placed upon'ticking the boxes' ...

ABSTRACT: We explore which management texts and associated knowledges are found in a major public services field: English health care. We initially wondered whether Evidence Based Management based texts might be present but we found few such examples. Instead, we found management texts written by authors from American business school and management consultancies. We argue their ready diffusion relates to two macro level forces: (i) the influence of the underlying political economy of public services reform and (ii) a strongly developed Business School/management consulting knowledge nexus. This macro perspective theoretically complements existing explanations operating at the meso or middle level of analysis which examine diffusion processes within the public services field, and also the more micro literature which focusses on agency from individual knowledge leaders.

Network organisations are increasingly common in healthcare. This paper describes an example of clinically led networking, which improved end of life care (EOLC) in care homes, differentiating between a 'network' as a formal entity and the more informal process of 'networking'. The paper begins with a brief discussion of networks and their development in healthcare, then an overview of EOLC policy, the case setting and methods. The paper describes four key features of this networking; (1) how it enabled discussions and implemented processes to help people address difficult taboos about dying; (2) how personal communication and 'distributed leadership' facilitated learning; (3) how EOLC occasionally lapsed during the handover of patient care, where personal relationship and communication were weaker; and (4) how successful learning and sharing of best practice was fragile and could be potentially undermined by wider financial pressures in the NHS.

This paper draws on data from five English primary care trust (PCT) case studies which formed part of a larger research project that explored the roles and relationships of clinical managers and their colleagues in periods of change within different healthcare organisations. This article uses empirical data to further our understanding of how primary care organisations can successfully implement service improvements. Qualitative methods were used to compare across multiple cases. Three methods were utilised comprising semi-structured interviews, document analysis and observation at meetings. Through an iterative process of data coding using the NVivo data analysis software, final conclusions developed and became more explicit. Data were collected between mid-2002 and 2005. Our analysis demonstrates the important influence of context on the change process. The case studies provide evidence of the nature of the relationships between context and progress in organisational change. We id...