Just Managing: Power and Culture in the National Health by Stephen Harrison, etc., David Hunter, Gordon Marnoch,

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By Stephen Harrison, etc., David Hunter, Gordon Marnoch, Christopher Politt

Successive reorganisations of the British NHS were designed to optimise powerful source use and to carry pros to account for what they do. many of the alterations have proceeded in isolation from any proof that they are going to be successful. This ebook studies all released learn proof at the supplier and administration of the NHS and studies findings of a big examine conducted by means of the authors at the advent of common administration into the NHS utilizing key concepts:Power and tradition. The ebook considers the results of the study findings for the key industry ideas and pageant into the NHS.

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Moreover, the picture of the pre-Griffiths NHS manager which emerges from the research is a fairly coherent one in which the prime tasks are problem-solving, organisation maintenance, and the facilitation of processes. 51). Although the research provides evidence of occasional exceptions to this role (which we shall discuss in a moment), the respective cultures of NHS management and medicine had a good deal of common content (Schulz and Harrison, 1983 p. 44; Brown, 1979, p. 79, 191), resting inter alia on acceptance of the notion of 'clinical freedom', that is, that third party (including government and managers') restrictions on the doctor-patient relationship should be minimal, or at most confined to control over aggregate resources (Harrison, 1988a, p.

No one officer was in overall charge, and, as the 1960s and 1970s progressed, more and more occupations developed their own, exclusive, management structures (Harrison, 1988a, 14-17). The apogee of this was the creation, as part of the 1974 reorganisation, of multidisciplinary management teams of chief officers, taking decisions only by consensus, that is, where no member disagreed (DHSS, 1972a, 29-30). Such teams confirmed the profeSSions of nursing and financial management in their de facto equality of status with administration.

1975, pp. 25-6; Klein, 1984, p. 1708). Second, there was the issue of doctors' motivation: there is evidence that the view of clinical freedom held by the medical profession might have been somewhat more elastic than is sometimes suggested. From their study of doctors' conceptions of the notion, Harrison et al. conclude [C]linical freedom seems to be primarily of symbolic or polemical importance; it is not conceived of as absolute and existing 'breaches' are for the most part quickly accepted and rationalised.

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