Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-10T15:52:49.291Z Has data issue: false hasContentIssue false
  • English
  • Français

Health managers and health reform

Published online by Cambridge University Press:  02 February 2015

David Briggs ,
Mary Cruickshank  and
Penny Paliadelis
David Briggs*
Affiliation:
Schools of Health and Rural Medicine, Faculty of the Professions, University of New England, Armidale, NSW, Australia
Mary Cruickshank
Affiliation:
Faculty of Health, University of Canberra, Canberra, ACT, Australia
Penny Paliadelis
Affiliation:
Schools of Health and Rural Medicine, Faculty of the Professions, University of New England, Armidale, NSW, Australia
*
E-mail: dbriggs@une.edu.au
Get access Rights & Permissions [Opens in a new window]

Abstract

This qualitative study was undertaken with a diverse sample of Australian health managers to examine their perceptions regarding the health system and to understand how they learned to become health managers. The findings showed that they viewed the health system as one of constant change, mostly non-adaptive, and a system of parts controlled by bureaucrats and political interests. While the respondents enjoyed their managerial role, they see it as contested between the professions. This study concluded that greater emphasis on the education and training of health managers and their continuing professional development is required if they are to manage increasingly complex, dynamic and changing health systems. In Australia, the health debate continues with the recently announced national health reform agenda. The perceptions of health managers in health reform and change management are important given that they are said to be central to the implementation of health reform and the management of change.

Keywords

health caremanagersreformchangemanagerialcontestedprofessionsphenomenology
Type
Healthcare management challenges for nurse managers
Information
Journal of Management & Organization , Volume 18 , Issue 5: Healthcare management: Progress, problems and solutions , September 2012 , pp. 641 - 658
Copyright
Copyright © Cambridge University Press and Australian and New Zealand Academy of Management 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alford, R. (1975). Health care politics. Chicago, IL: The University of Chicago Press.Google Scholar
Amis, J., Slack, T., and Hinings, C. R. (2002). Values and organisational change. The Journal of Applied Behavioural Science, 38(4), 436–465.Google Scholar
Anderson, R. A., & McDaniel, R. R. (2000). Managing health care organisations: Where professionalism meets complexity science. Health Care Management Review, 25(1), 83–92.Google Scholar
Australian Institute of Health and Welfare and Australian Bureau of Statistics. (2003). Health and community services labour force 2001 (National Health Labour Force Series No. 27). Canberra, ACT: Australian Institute of Health and Welfare.Google Scholar
Balogun, J. (2003). From blaming the middle to harnessing its potential: Creating change intermediaries. British Journal of Management, 14, 69–83.Google Scholar
Balogun, J., & Johnson, G. (2004). Organisational restructuring and middle manager sense-making. The Academy of Management Journal, 47(4), 523–549.Google Scholar
Barbour, R. S. (2001). Checklist for improving reliability in qualitative research: A case of the tail wagging the dog? British Medical Journal, 322, 1115–1117.Google Scholar
Bassett, C. C. (2004). ‘Phenomenology’. In Basset, C. (Ed.), Qualitative research in health care (pp. 154–177). London, England: Whurr.Google Scholar
Berg, B. (2004). Qualitative research methods for the social sciences. Boston, MA: Pearson.Google Scholar
Bigelow, B., and Arndt, M. (2000). The more things change, the more they stay the same. Health Care Management Review 25(1), 65–72.Google Scholar
Blendon, R. J., Schoen, C., DesRoches, C., Osborn, R., & Zapert, K. (2003). Common concerns amid diverse systems: Health care experiences in five countries. Health Affairs, 22(3), 106–121.Google Scholar
Bloor, G., and Dawson, P. (1994). Understanding professional culture in organisational context. Organisation Studies 15(2), 275–295.Google Scholar
Boucher, C. (2001). Making the transition from clinician to manager: Describing the first six months. In Boucher, C. & Holihan, R. (Eds.), Emerging forms of representing qualitative data (pp. 3–102). Melbourne, VIC: RMIT University Press.Google Scholar
Braithwaite, J. (1998). Complex systems and the nature of professionalism. Australian Health Review, 21(4), 11–14.Google Scholar
Braithwaite, J. (2004). An empirically-based model for clinician-managers' behavioural routines. Journal of Health Organisation and Management, 18(4), 240–261.Google Scholar
Braithwaite, J., & Goulston, K. (2004). Turning the health system 90° down under. The Lancet, 364(9432), 397–399.Google Scholar
Briggs, D. S. (2008a). SHAPE declaration on the organisation and management of health services: A call for informed debate. Asia Pacific Journal of Health Management, 3(2), 10–13.Google Scholar
Briggs, D. S. (2008b). The lived experience of health service managers, their perceptions of the health system and the health management role (PhD Thesis). University of New England, Armidale, NSW.Google Scholar
Brock, D. (2006). The changing professional organisation: A review of competing archetypes. International Journal of Management Reviews, 8(3), 157–174.Google Scholar
Bruce, A., & Hill, S. (1994). Relationships between doctors and managers: The Scottish experience. Journal of Management in Medicine, 8(5), 49–57.Google Scholar
Cecez-Kecmanovic, D., & Dalmaris, P. (2000). Knowledge mapping as sensemaking in organisations. Penrith, NSW: IS-KOMO Research Group, University of Western Sydney, Faculty of Management.Google Scholar
Clegg, S. R., Hardy, C., & Nord, W. R. (1999). Introduction: Organisational issues. In Clegg, S. R., Hardy, C., & Nord, W. R. (Eds.), Managing organisations: Current issues (pp. 1–10). London, England: Sage.Google Scholar
Colaizzi, P. F. (1978). Psychological research as the phenomenologist views it. In Vale, R. S. & King, M. (Eds.). Existential–phenomenological alternatives for psychology. New York, NY: Oxford University Press.Google Scholar
Council of Australian Governments. (2010). National health and hospitals network agreement. Retrieved from http://www.coag.gov.au/docs/national_reform_agreement.pdfGoogle Scholar
Cunliffe, A., Forray, J. M., & Knights, D. (2002). Considering management education: Insights from critical management studies. Journal of Management Education, 26(5), 489–495.Google Scholar
Dann, Z., & Barclay, L. (2006). Complexity theory and knowledge management application, The Electronic Journal of Knowledge Management, 4(1), 11–20.Google Scholar
Davies, G. (2005). Public hospital commission of inquiry report. Brisbane, QLD: Queensland Health.Google Scholar
Davies, T. O., & Harrison, S. (2003). Trends in doctor–manager relationships. British Medical Journal, 326, 646–649.Google Scholar
Decter, M. B. (2000). Four strong winds: Understanding the growing challenges to health care. Toronto, ON: Stoddart.Google Scholar
Degeling, P., & Carr, A. (2004). Leadership for the systemisation of health care: The unaddressed issue in health care reform. Journal of Health Organisation and Management, 186, 399–414.Google Scholar
Degeling, P., Hunter, D., & Dowdeswell, B. (2001). Changing health care systems. Journal of Integrated Care Pathways, 5, 64–69.Google Scholar
Denis, J. L., Lamothe, L., Langley, A., Breton, M., Gervais, J., Trotter, L. H., … Dubois, C. A. (2009). The reciprocal dynamics of organising and sense-making in the implementation of major public-sector reforms. Canadian Public Administration, 52(2), 225–248.Google Scholar
Denis, J. L., Lamothe, L., Langley, A., & Valette, A. (1999). The struggle to redefine boundaries in health care systems. In Brock, D. M., Powell, M. J., & Hinings, C. R. (Eds.), Restructuring the professional organisation: Accounting, health care and law (pp. 105–130), London, England: Routledge.Google Scholar
Diekelmann, N. (2001). Narrative pedagogy: Heideggerian hermeneutical analyses of lived experiences of students, teachers, and clinicians (teaching and learning). Advances in Nursing Science, 23(3), 53–71. Retrieved from http://find.galegroup.com.ezproxy.une.edu.au/itx/printdoc.do?contentSet = IAC-DocumentGoogle Scholar
DiMaggio, P. J., & Powell, W. W. (1983). The iron cage revisited: Institutional isomorphism and collective rationality in organisational fields. American Sociological Review, 48, 147–160.Google Scholar
Dwyer, J. M. (2004). Australian health system restructuring – What problem is being solved? Australian and New Zealand Health Policy, 1 (6), 19–31.Google Scholar
Eager, K. (2004). The weakest link? Australian Health Review, 28(1), 7–12.Google Scholar
Edmonstone, J. (1997). The continuing development of clinical management. British Journal of Health Care Management, 3(5), 265–267.Google Scholar
Elliott, C., & Reynolds, M. (2002). Manager–educator relations from a critical perspective. Journal of Management Education, 26(5), 512–526.Google Scholar
Eraut, M. (2004). Learn to change and/or changing to learn. Learning in Health and Social Care, 3(3), 111–117.Google Scholar
Fitzgerald, A., & Teal, G. (2003). Health reform, professional identity and sub-cultures: The changing interprofessional relations between doctors. Contemporary Nurse, 16 (1–2), 9–19.Google Scholar
Forbes, T., & Prime, N. (1999). Changing domains in the management process: Radiographers as managers in the NHS Journal of Management in Medicine, 13(2), 105–113.Google Scholar
Forster, P. (2005). Queensland health system review. Brisbane, QLD: Independent Review.Google Scholar
Fournier, V., & Grey, C. (2000). At the critical moment: Conditions and prospects for critical management studies. Human Relations, 53, 7–32.Google Scholar
Garling, P. (2008). Final report of the special commission of inquiry: Acute care services in NSW public hospitals – Overview. Sydney: NSW Government. Retrieved from http://healthactionplan.nsw.gov.au/garling-report.phpGoogle Scholar
Gollop, R., Whitby, E., Buchanan, D., & Ketley, D. (2004). Influencing sceptical staff to become supporters of service improvement: A qualitative study of doctors' and managers'. Quality and Safety in Health Care, 13, 108–114.Google Scholar
Gramsci, A. (1971). Selections from the prison notebooks. London, England: Lawrence and Wishart.Google Scholar
Gray, D. (2002). Top doctor slams health system. Melbourne, VIC: The Age.Google Scholar
Greener, I. (2004). Talking to health managers about change: Heroes, villains and simplification. Journal of Health Organisation and Management, 18(5), 321–335.Google Scholar
Greenwood, R., & Hinings, C. R. (1993). Understanding strategic change: The contribution of archetypes. Academy of Management Journal, 36(5), 1052–1081.Google Scholar
Greenwood, R., & Hinings, C. R. (1996). Understanding radical organisational change: Bringing together new and old institutionalism. Academy of Management Review, 21(4), 1022–1055.Google Scholar
Gummesson, E. (2000). Qualitative methods in management research. Thousand Oaks, CA: Sage.Google Scholar
Harding, N. (2005). The inception of the National Health Service: A daily managerial accomplishment. Journal of Health Organisation and Management, 19(3), 261–272.Google Scholar
Hatch, M. J. (1997). Organisation theory. Oxford, England: Oxford University Press.Google Scholar
Hewison, A. (2001). The modern matron: Reborn or recycled. Journal of Nursing Management, 9, 187–189.Google Scholar
Hewison, A. (2003). Qualitative management research in the NHS: A classic case of counting to one? Journal of Health Organisation and Management, 17(2), 122–137.Google Scholar
Hewison, A. (2004). Evidenced-based management in the NHS: Is it possible? Journal of Health Organisation and Management, 18(4/5), 336–348.Google Scholar
Hill, J. (2007). Hospital management to be trimmed – Minister. Retrieved from http://www.worldwideres.net/core/publications/health/HEALTH-26-7-07.pdfGoogle Scholar
Hood, C. (1991). A public management for all seasons. Public Administration, 69, 3–19.Google Scholar
Isouard, G. (2008). A real opportunity for SHAPE and ACHSE to lead the national debate for health system reform. Asia Pacific Journal of Health Management, 3(2), 4–5.Google Scholar
Kernick, D. (2006). Wanted – new methodologies for health service research. Is complexity theory the answer? Retrieved from http://fampra.oxfordjournals.org/content/23/3/385.longGoogle Scholar
Kippist, L., & Fitzgerald, A. (2009). Organisational professional conflict and hybrid clinician managers: the effect of dual roles in Australian health care organizations. Journal of Health Organisation and Management, 23, 642–655.Google Scholar
Knight, P. T. (2002). Small-scale research–Pragmatic inquiry in social science and the caring professions. London, England: Sage.Google Scholar
Laclau, E., & Mouffe, C. (1985). Hegemony and socialist strategy: Towards a radical democratic politics. London, England: Verso.Google Scholar
Law, D., Boyce, R., Smyth, (2003). Beyond organisational design: Moving from structure to service enhancement. Australian Health Review, 26(1), 181–191.Google Scholar
Learmonth, M. (2005). Guest editorial: Tales of the unexpected? Stirring things up in health care management. Journal of Health Organisation and Management, 19(3), 181–188.Google Scholar
Legge, D., Stanton, P., & Smyth, A. (2006). Learning management (and managing your own learning). In Harris, M. G. & Associates (Eds.), Managing Health Services: Concepts and Practices (2nd ed.). Sydney, NSW: Mosby Elsevier.Google Scholar
Lewis, J. (2004). Health service management: Theory and practice. In Clinton, M. (Ed.), Management in the Australian health care industry. Sydney, NSW: Pearson Prentice Hall.Google Scholar
Liang, Z. M., Short, S. D., Howard, P. F., & Brown, C. R. (2006). Centralised control and devolved responsibilities: Personal experiences of senior health executives on the implementation of the area health management model in New South Wales, 1990– 1999. Asia Pacific Journal of Health Management, 1(2), 44–50.Google Scholar
Liang, Z. M., Short, S. D., & Lawrence, B. (2005). Healthcare reform in New South Wales 1986–1999: Using the literature to predict the impact on senior health executives. Australian Health Review, 293, 285–291.Google Scholar
Llewellyn, G., Sullivan, G., & Minichiello, V. (2004). Sampling in qualitative research. In Minichiello, V., Sullivan, G., Greenwood, K., & Axford, R. (Eds.), Handbook of research methods for nursing and health science (pp. 210–241). Sydney, NSW: Pearson Education.Google Scholar
Lozeau, D., Langley, A., & Denis, J. L. (2002). The corruption of managerial techniques by organisations. Human Relations, 55(5), 537–564.Google Scholar
Mackey, S. (2004). Phenomenological nursing research: Methodological insights from Heidegger's interpretive phenomenology. International Journal of Nursing Studies, 42, 179–186.Google Scholar
Mark, A. (2006). Notes from a small island: Researching organisational behaviour in healthcare from a UK perspective. Journal of Organisational Behaviour, 27, 851–867.Google Scholar
Martins, J. M. (2006). Health challenges in Australia. Asia Pacific Journal of Health Management, 1(1), 17–23.Google Scholar
McConnell, C. R. (2000). The changing face of health care management. The Health Care Manager, 18(3), 1–17.Google Scholar
McConville, T., & Holden, L. (1999). The filling in the sandwich: HRM and middle managers in the health sector. Personnel Review, 28(5/6), 406–424.Google Scholar
McKenna, S., & Richardson, J. (2003). Managing in the New Zealand health service: The interpretation of experience. Journal of Health Organization and Management, 17(2), 74–87.Google Scholar
Menadue, J. (2003). Healthcare reform: Possible ways forward. Medical Journal of Australia, 179(7), 367–369.Google Scholar
Miles, M., & Huberman, A. (1984). Qualitative Data Analysis. London, England: Sage.Google Scholar
Mintzberg, H. (1979). The structuring of organisations. Englewood Cliffs, NJ: Prentice Hall.Google Scholar
Mintzberg, H. (1997). Towards healthier hospitals. Health Care Management Review, 22(4), 9–18.Google Scholar
Murray, C. J. L., & Frenk, J. (2010). Ranking 37th – Measuring the performance of the U.S. health care system. The New England Journal of Health Management, 14, 362(2), 98–99. Retrieved from http://www.nejm.org/toc/nejm/362/2Google Scholar
National Health and Hospital Reform Commission. (2009). A healthier future for all Australians – Final report – June 2009 Canberra. Retrieved from http://www.health.gov.au/internet/nhhrc/publishing.nsf/Content/nhhrc-reportGoogle Scholar
New South Wales Health Department. (2011). National health reform. Retrieved from http://www.health.nsw.gov.au/initiatives/healthreform/index.aspGoogle Scholar
Nwabueze, U., & Kanji, G. K. (1997). The implementation of total quality in the NHS: How to avoid failure. Total Quality Management, 8(5), 265–280.Google Scholar
O'Brien, L. (2003). Phenomenology. In Schneider, Z., Elliott, D., Beanland, C., LoBoiondo-Wood, G., & Haber, J. (Eds.), Nursing research – Methods, critical appraisal and utilisation (pp. 191–204). Sydney, NSW: Mosby Elsevier.Google Scholar
Palmer, L., & Hardy, C. (2000). Thinking about Management – Implications of organisational debates for practice. London, England: Sage.Google Scholar
Parry, J. (2003). Making sense of executive sensemaking. A phenomenological case study with methodological criticism. Journal of Health Organisation and Management, 17(4), 240–263.Google Scholar
Patton, M. Q. (2002). Qualitative Evaluation and Research Methods. Thousand Oaks, CA: Sage.Google Scholar
Podger, A. S. (2006). A model health system for Australia. Part 1: Directions for reform of the Australian health system. Asia Pacific Journal of Health Management, 1(1), 10–16.Google Scholar
Pope, C., Ziebland, S., & Mays, N. (2000). Qualitative research in health care: Analysing qualitative data. British Medical Journal 320(7227), 114–116.Google Scholar
Powell, W., & DiMaggio, P. (Eds.) (1991). The new institutionalism in organizational analysis. Chicago, IL: The University of Chicago Press.Google Scholar
Preston, D., & Loan-Clarke, J. (2000). The NHS manager: A view from the bridge. Journal of Management in Medicine, 14(2), 100–108.Google Scholar
Ransom, S., Hinings, B., & Greenwood, R. (1980). The structuring of organisational structures. Administrative Science Quarterly, 25(1), 1–17.Google Scholar
Rathwell, T., & Persaud, D. D. (2002). Running to stay still: Change and management in Canadian healthcare. Healthcare Management Forum, 15(3), 10–11.Google Scholar
Reedy, P., & Learmonth, M. (2000). Nursing managers, transformed or deformed? A case study in the ideology of competence. Journal of Management in Medicine, 14(3/4), 153–165.Google Scholar
Rix, M., Owen, A., & Eager, K. (2005). (Re)form with substance? Restructuring and governance in the Australian health system 2004/05. Australian and New Zealand Health Policy, 2(19), 1–8.Google Scholar
Rosenhead, J. (1998). Complexity theory and management practice. The Human Nature Daily Review. Retrieved from http://human-nature.com/science-as-culture/rosenhead.htmlGoogle Scholar
Schulz, F. C. (2004). Who should lead a healthcare organisation: MDs or MBAs? Journal of Healthcare, 49(2), 103–117.Google Scholar
Shortell, S. M., & Kaluzny, A. D. (2006). Organization theory and health service management. In Shortell, S. M. & Kaluzny, A. D. (Eds.), Health care management – Organization design and behavior. New York, NY: Thomson Delmar Learning.Google Scholar
Silverman, D. (2001). Interpreting Qualitative Data. London, England: Sage.Google Scholar
Sutherland, K., & Dawson, S. (1998). Power and quality improvement in the new NHS: The role of doctors and managers. Quality in Health Care, 7(Suppl), S16–S23.Google Scholar
Thorne, M. L. (2002). Colonising the new world of NHS management: The shifting power of professionals. Health Service Management Research, 15(1), 14–26.Google Scholar
Van Der Weyden, M. B. (2003). Australian healthcare reform: In need of political courage and champions. Medical Journal of Australia, 179, 280–281.Google Scholar
Weick, K. (1979). The Social Psychology of Organising. New York, NY: Random House.Google Scholar
Weick, K. (1993). Sensemaking in organisations: Small structures with large consequences. In Murnigham, J. K. (Ed.) Social psychology in organisations: Advances in theory and research. Englewood Cliffs, NJ: Prentice Hall.Google Scholar
Weick, K. (1995). Sensemaking in organisations. London, England: Sage.Google Scholar
Wilson, L. (2004). What's wrong with our hospitals? Australian Health Review, 28(1), 20–25.Google Scholar