Medical Managers: puppetmasters or puppets? Sources of power and influence in clinical directorates

Abstract

The theme of the relationship between the medical profession and management has been at the centre of both academic and policy debates since the creation of the National Health Service and affects the design of most health care organisations worldwide. It surfaces and gains prominence when any new structural arrangements are in prospect, both shaping and constraining the way problems are defined and tackled (Buchanan et al., 1997). Usually there is some kind of accommodation between political interests, managerial or bureaucratic necessity and professional capabilities and demands. The overwhelming challenge is how to establish appropriate governance and how to integrate and organise ‘those responsible for medicine with those responsible for money’ (Dawson et al., 1995, p.172); ‘those spending and those managing money’ (Strong and Robinson, 1988). There are also the related questions of who should manage ‘experts’, how to reconcile corporate and professional interests and whether health care organisations pose a different managerial task from other organisations.