Abstract
The results of two observational studies of clinical directorates (CDs) are presented. The paper exposes fresh perspectives about the management of hospitals and CDs, and suggests that the most important axis on which hospital decision-making rests continues to be profession rather than the CD, even though CDs are designed at least in part to mitigate professional tribalism and bridge professional divides. In empiricising social structural and cultural theories it seems clear that changes to the prescribed organisational framework, which CDs represent, have had negligible effects on behaviour. This being the case, the paper questions the benefits alleged to have accrued from establishing CDs and calls for more effective, micro-behavioural change strategies than merely altering the structure.
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References
Barley SR (1996) Technicians in the workplace: ethnographic evidence for bringing work into organisation studies. Adm Sci Q 41:404–441
Barley SR, Kunda G (2001) Bringing work back in. Organ Sci 12:76–95
Braithwaite J (1995) Organisational change, patient-focused care: an Australian perspective. Health Serv Manage Res 8(3):172–185
Braithwaite J (1999). Incorporating medical clinicians into management: an examination of clinical directorates. Sydney, Unpublished PhD thesis, University of New South Wales
Braithwaite J (2004) An empirically-based model for clinician-managers’ behavioural routines. J Health Organ Manage 18(4):240–261
Braithwaite J (2006) Analysing social structural and cultural change in acute settings using a Giddens-Weick paradigmatic approach. Health Care Anal 14(2):91–102
Braithwaite J, Finnegan T, Graham E, Degeling P, Hindle D, Westbrook M (2004) How important are safety and quality for clinician-managers? Qualitative evidence from triangulated studies. Clin Governance: An Int J 9(1):34–41
Braithwaite J, Westbrook M (2004) A survey of staff attitudes and comparative managerial and non-managerial views in a clinical directorate. Health Serv Manage Res 17:141–166
Braithwaite J, Westbrook M (2005) Rethinking clinical organisational structures: an attitude survey of doctors, nurses and allied health staff in clinical directorates. J Health Serv Res Policy 10(1):10–17
Carlson S (1951) Executive behavior: a study of the workload and working methods of managing directors. Strombergs, Stockholm
Chantler C (1988) Guy’s Hospital 1985–1988: a case study. King’s Fund College International Fellowship, London
Degeling P (1993) Policy as the accomplishment of an implementation structure: Hospital restructuring in Australia. In: Hill M (ed) New agendas in the study of policy process. Harvester Wheatsheaf, New York, pp 25–56
Disken S, Dixon M, Halpern S, Shocket G (1990) Models of clinical management. Institute of Health Services Management, London
Giddens A (1976) New rules of sociological method. Heinemann, London
Giddens A (1979) Central problems in social theory. Macmillan, London
Giddens A (1984) The constitution of society: outline of a theory of structuration. University of California Press, Berkeley
Goffman E (1971) The presentation of self in everyday life. Penguin, Harmondsworth, Middlesex
Heyssel RM (1981) Faculty role in the competitive academic health center. General meeting of the association of academic health centres, Sept 30–Oct 3. Palm Springs
Heyssel RM, Gaintner JR, Kues, IW, Jones AA, Lipstein SH (1984) Special report: decentralised management in a teaching hospital. N Engl J Med 310:1477–1480
Martin J (2002) Organizational culture: mapping the terrain. Sage, Thousand Oaks, CA
Martin J, Frost P (1996) The organizational culture war games: a struggle for intellectual dominance. In: Clegg SR, Hardy C, Nord WR (eds) Handbook of organization studies. Sage Publications, London, pp 599–621
McDonald P (1991) The Los Angelos Olympic organizing committee: developing organizational culture on the short run. In: Frost P, Moore L, Louis M, Lundberg C, Martin J (eds.) Reframing organizational culture. Sage Publications, Newbury Park, CA, pp 26–38
Ouchi W, Wilkins A (1985) Organizational culture. Ann Rev Sociol 11:457–483
Rae C (1995) Clinical directorates. Brit J Hosp Med 53:231–232
Riordan J, Simpson J (1994) Getting started as a medical manager. Brit Med J 309:1563–1565
Stein L, Watts D, Howell T (1990) The doctor-nurse game revisited. N Engl J Med 322:546–549
Sweet S, Norman I (1995) The doctor-nurse relationship: a selective literature review. J Adv Nurs 22:165–170
Weick K (1979) The social psychology of organizing. Addison-Wesley, Reading
Weick K (1993) Sensemaking in organizations: small structures with large consequences. In: Murnighan J (ed) Social psychology in organizations: advances in theory and research. Prentice Hall, Englewood Cliff, NJ
Weick K (1995) Sensemaking in organizations. Sage, Thousand Oaks
Willcocks S (1993) Managerial effectiveness and the public sector: a health service example. Health Manpow Manage 19(4):14–18
Wolcott H (1995) Making a study ‘more ethnographic.’ In: Van Maanen J (ed) Representation in ethnography. Sage, Thousand Oaks, CA, pp 79–111
Acknowledgements
Jo Travaglia and Christine Jorm provided useful comments on an earlier draft of this paper. Rick Iedema and Mary Westbrook are part of a team which provides a constant flow of ideas. The comments of the Editor and two anonymous referees were helpful and insightful and brought about better shape to the paper and its companion. My appreciation goes to each of them.
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Braithwaite, J. An Empirical Assessment of Social Structural and Cultural Change in Clinical Directorates. Health Care Anal 14, 185–193 (2006). https://doi.org/10.1007/s10728-006-0025-5
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DOI: https://doi.org/10.1007/s10728-006-0025-5