Health service structures,management and professional practice: Beyond clinical management

Abstract

At the heart of the operation of the health system is the relationship betweenmanagers and the various professionals who provide clinical services. While thereis an inherent conflict between these two groups, this conflict has been avoided inthe past by the managers playing a supporting rather than a controlling role.However, the current demands of cost-control are placing managers and professionalsinto direct conflict; a situation that many organisations are addressing by puttingclinicians into management roles. This measure has had initial success in somesituations, but it is argued that this success will be limited because clinicaldepartments are not able to address many of the broader issues that affect theperformance of health services. This paper proposes an alternative approach that willenable these broader issues to be effectively addressed, and also reduce the structuralconflict.