Journal of management in medicine
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The role of consultant obstetricians is under considerable debate. This has particularly focused on the role of consultants in intrapartum care. ⋯ These viewpoints determine a range of common themes which mean the duties of consultants over their career lifecycle need to be addressed; the need to expand consultant posts; and the tensions which inevitably occur. The authors believe these need to be addressed because of the need to ensure consultant roles in delivery suite are developed as a key part of seeing quality improvement.
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Reports the findings of a study which was undertaken to examine the effects of radical organizational changes, the move towards NHS trust status, on the health and wellbeing of health care workers within a large district hospital and community service. A prospective longitudinal design was adopted incorporating pre- and post-trust measures. ⋯ The findings suggest that the transition towards trust status has not resulted in negative outcomes for the organization as a whole, as measured by levels of sickness absence. However, certain employees may be particularly vulnerable during the early stages of organizational change.
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Partners and practice managers are beginning to understand implications of management issues raised by recent reforms. Practices involved in this study agree the need for improvement, but partners and managers were often unable to define improvements needed. Demonstrates that effective management structure is vital to future success for general practice. ⋯ Regardless of the chosen option the question of training remains. There is a need to involve consultants, managers, and doctors already advancing the boundaries of practice development, in a dialogue with institutions providing management training, to design suitable programmes. Academic institutions too often produce management programmes geared towards the old environment, whereas managerial skills which changes in the NHS demand from future practice managers are now required.
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The impact of the NHS reforms, and the resulting purchaser-provider split, has refocused attention on the relationship between management and medicine in acute hospitals. It is timely to assess the explanatory power of various theoretical models regarding the management-medicine interface. Argues that this interface is currently rather fluid and that a dynamic and adaptive model is best suited to understanding the way in which doctors and managers develop their relationship within the changing policy context. Two examples illustrate these shifting boundaries.
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The concept of the primary health-care team involving an increasingly diverse range of health care professionals is widely recognized as central to the pursuit of a primary care-led health service in the UK. Although GPs are formally recognized as the team leaders, there is little by way of policy prescription as to how team roles and relationships should be developed, or evidence as to how their roles have in fact evolved. Thus the notion of the primary health-care team while commonly employed, is in reality lacking definition with the current contribution of practice managers to the operation of this team being poorly understood. ⋯ Drawing on questionnaire data, reinforced by qualitative data from the current interview phase, describes the role played by practice managers in differing practice contexts. This facilitates a discussion of a set of ideal type general practice organizational and managerial structures. Discusses the relationships and skills required by practice managers in each of these organizational types with reference to data gathered to date in the research.