NHS

HS&DR - 08/1808/236: Are We There Yet? Models of Medical Leadership and their effectiveness: An Exploratory Study

Project title Are We There Yet? Models of Medical Leadership and their effectiveness: An Exploratory Study
Research type Primary Research
Status Project complete
Start date March 2009
Publication date

April 2013

Cost £ 248,835.00
Chief Investigator Professor Chris Ham
Co-investigators Mr Robert Cragg, Dr Helen Dickinson (University of Melbourne), Miss Jackie Francis (University of Birmingham), Professor Peter Spurgeon (University Hospitals Coventry & Warwickshire NHS Trust)
Contractor University of Birmingham
Plain English summary The NHS, like a range of other types of organisations, has been historically characterised as a professional bureaucracy in which doctors and other clinicians have a large measure of autonomy in organising their work. However, over the past twenty years the NHS has come under pressures to become more "businesslike" and this has resulted in managerial structures and business values being superimposed on professional structures. The main organisational mechanism for management at the clinical level in hospitals in recent years has been the "Clinical Directorate". Although a range of studies have been conducted into Clinical Directorates, there is no up to date information about the range and types of structures that exist, and how these have been affected by recent innovations, such as service line reporting. There is also a lack of evidence relating different clinical directorate structures to behaviours and relationships, and the effectiveness of team working. This project will map current and emerging structures of medical engagement in management and leadership in NHS Trusts. This will be done through a national questionnaire survey. A number of NHS Trusts will then be identified for more detailed study, in order to explore behaviours and relationships in clinical directorates be identified for more detailed study, in order to explore behaviours and relationships in clinical directorates and related structures. The research will also explore the relationship between different structures and behaviours on the one hand, and organisational and directorate performance on the other. The proposed research will fill a gap in current knowledge about the engagement of doctors in leadership roles by describing the arrangements adopted by NHS Trusts in England, and by providing evidence about the effectiveness of different arrangements. This will enable policy makers and practitioners to review and strengthen medical engagement in management and leadership roles and take forward the reforms to the NHS following The NHS Next Stage Review.
Scientific summary The principal aims of this research are to describe the engagement of doctors in management and leadership roles in the English NHS, to analyse the interaction and functioning of the triumvirate and the effectiveness of team working in clinical directorates and related structures, and to explore the relationship between effectiveness and performance. The research builds on previous empirical and theoretical work on the involvement of doctors and other professionals in management and leadership roles, and addresses an issue of central importance in the NHS in England following the final report of The NHS Next Stage Review. The research will involve a questionnaire survey of NHS Trusts in England to investigate the types of structures that exist for engaging doctors in management and leadership roles. Responses to the survey will be used to develop a typology of structures and this typology will in turn be used to identify a small number of organisations for more detailed analysis. In these case study organisations, the research will examine different patterns of working, and relationships between doctors, nurses, managers and other staff. The nature of medical engagement in the case studies will be assessed using the Medical Engagement Scale and the nature of team working will be assessed using the Aston Team Performance Inventory. The case studies will also be used to analyse the selection, preparation, development and support of clinicians who take on significant management roles, and the effects on their identities. The relationship between different structures and behaviours on the one hand, and organisational and directorate performance on the other, will be studied drawing on data from the Healthcare Commission, Dr Foster and other sources. The research will provide practitioners and policy makers with a better understanding of: 1) The types of structures which exist across England for engaging medical professionals in management and leadership; 2) How different structures are associated with different patterns of working and relationships between doctors, nurses and managers in the triumvirate; and 3) How different structures, roles and behaviours relate to organisational and directorate performance The research will also address issues in the organisational studies literature on the changing nature of professional organisations. Recent reforms to the NHS, building on the Griffiths Report of 1983 and extending through the internal market in the 1990s to New Labour's reforms in the last decade, have superimposed management and business structures and processes on autonomous professionals. The extent to which these reforms have altered health care organisations or resulted in the replication of relationships found in professional bureaucracies will be analysed and the findings related to ongoing debates on the emergence of new organisational forms.
Documents

Protocol (PDF File - 130.2 KB)

Commissioning Brief (PDF File - 142.8 KB)

Executive Summary (PDF File - 109.0 KB)

Final Report (PDF File - 3.8 MB)

Addendum This project was commissioned by the NIHR Service Delivery and Organisation (NIHR SDO) programme under the management of the National Coordinating Centre for the Service Delivery and Organisation (NCCSDO) which was based at the London School of Hygiene and Tropical Medicine (LSHTM). The project was managed by NCCSDO until 31 March 2009. Management of the NIHR Service Delivery and Organisation (SDO) programme and its portfolio of projects transferred to the National Institute for Health Research Evaluations, Trials and Studies Coordinating Centre (NETSCC) based at the University of Southampton from 1 April 2009.

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