Clinicians and the governance of hospitals: A cross-cultural perspective on relations between profession and management
Section snippets
Overview
The view that there is a conflict between professionalism and organisation employment, particularly state employment, has long been discarded in favour of a more subtle thesis. This recognises how professionals are able to construct a role for themselves in ways that ensure that their interests and conceptions of their tasks are dominant (Johnson, 1972). Within most industrial societies, organisational forms have emerged in which professionals are autonomous from management and accountable
Method
The studies were undertaken in Australia and England (Degeling, Kennedy, Hill, Carnegie, & Holt, 1998), New Zealand (Degeling, Sage, Kennedy, & Perkins, 1999) and in China in 2000. The hospitals included in the study in each country were selected to be comparable in terms of size, type and clinical role. Selection was restricted to not-for-profit teaching hospitals and large general hospitals located in major urban areas. The hospitals in China operated at provincial and county levels. The
Findings
The most striking feature of Fig. 1 is the across-country stability in the patterns of how occupations were positioned on the two dimensions. This finding suggests that the hospital studies, whether in Australia, New Zealand, England or China, are characterised by the underlying consistency in the patterned set of differences between the occupation-based sub-cultures of medicine, nursing and management that populate them.
Notwithstanding this finding, Fig. 1 also describes the extent to which
Discussion
The studies in Commonwealth countries revealed two marked occupational differences that were absent in the Chinese sample. The first referenced occupation-based differences on matters that can affect the standing of medical clinicians in the performance of clinical work. These differences were illustrated in the strong support of the Commonwealth general managers and nurse managers for efforts to strengthen the systematisation and team-based nature of clinical work. Equally, the data showed how
Conclusions
Our starting point was the long-running Western debate on the extent to which the relationship between professionalism and organisations is akin to what Klein (1990) memorably describes as ‘the politics of the double bed’. Here, the interests of clinicians and managers are united in a commitment to the viability of a health service but opposed on how dilemmas about scarce resources, clinical autonomy and accountability might be addressed. Against this background, we examined extraordinary
Acknowledgements
The authors acknowledge their indebtedness to C.K. Wong, Victor Wong, Jonathan Erskine, Andrew Gray and John Kennedy. They also thank the three reviewers for their valuable comments on an earlier draft.
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