Evolving Perceptions of Clinical Management in Acute Hospitals in England

AuthorBie Nio Ong
Publication Date01 Sep 1998
The involvement of clinicians in management has
undergone many transformations and is currently
one of the key topical issues in the British health
service reforms. While clinicians have always man-
aged clinical services, the changes in the structure
and functioning of the British health service, in
common with many other western countries, places
specific internal and external pressures upon
clinicians and clinical teams. A number of studies
have been carried out since the mid-1980s, directly
or indirectly addressing the perceived tensions
between medicine and management (Flynn, 1992;
Harrison, Hunter and Pollitt, 1992) and the de-
bate about professions and professional power
has been revisited (Elston, 1991; Gabe, Calnan
and Bury, 1991) leading to reformulation of key
theoretical concepts.
It is becoming increasingly clear that the
modern clinician does not work in isolation, and
that the relationship with clinical teams, managers
and the external environment are central to the
practice of modern medicine. There is much
discussion about the changing face of medical
management, and empirical material about new
roles such as medical and clinical directors in
Trusts is emerging (Fitzgerald, 1995). This paper
aims to contribute to this growing body of re-
search by focusing on the way in which clinicians
and their clinical teams are developing their
understanding of the new order. It uses business
planning as a crucial organizational process from
which empirical material is derived. The business
plan is central to modern health-services man-
agement, and symbolizes a major shift in thinking.
By tracing two years of business planning activity
in one Trust, and documenting the evolving per-
ceptions of key players in clinical teams, insight
can be gained into changing roles, relationships
and ideas about professions and their domains.
The paper starts with a brief overview of the
key changes in the British health service since
the mid-1980s which pertain to the issue of
clinical management. (For a more general and
wide-ranging discussion the reader is referred to
Robinson and LeGrand, 1994.) We will also ad-
dress questions about professional identity and
power, specifically related to the interface between
medicine and management. We will then move on
British Journal of Management, Vol. 9, 199–210 (1998)
Evolving Perceptions of Clinical
Management in Acute Hospitals
in England
Bie Nio Ong
Centre for Health Planning and Management, Darwin Building, Keele University, Keele ST5 5BG, UK
Clinical management is at the centre of organizational change in the contemporary British
hospital sector, and throws up important questions about the relationship between
medicine and management. Through the analysis of business planning as a key organ-
izational process the interpretative frameworks which guide the perceptions of the
roles of clinical directors and directorate managers can be understood. This paper
presents empirical material from a study of an acute hospital trust going through a full
business planning cycle, and traces the evolving interpretations of the nature, content
and form of clinical management. It also provides insights into the changing face of the
medical profession and its place within the health services domain.
© 1998 British Academy of Management

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