Suchergebnisse

This article aims to expand our understanding of what it is to be an agent within an organization. To do this, the views of both Archer and Giddens on the constitution of the agent are analysed. These expositions are used to differentially illuminate the specifics of an empirical case, where it is argued that a team of ten agents were crucial in taking forward a merger between two pharmaceutical companies ('A' and 'ω'). A discussion compares the insights into how agents are constituted that arise from the conceptual frames offered by Archer and Giddens. The article concludes that the constitution of the organizational agent encompasses both agential positioning (vis-à-vis organizational resources) and agential powers (where these powers can be appropriated from the organization and incorporated by the agent).

This paper uses the metaphor of the `two-way window' to understand the aspirations and activities of clinical directors (doctors with management responsibilities). Clinical directors work simultaneously with sets of ideas from both clinical practice and from management, therefore, their role (as `two-way windows') allows the possibility to create a new area of expertise — medical-management. To explore how `two-way windows' are being constituted, clinician managers in three medical organizations were interviewed. Three narratives were constructed from their accounts. The first narrative outlines the theories-in-use of clinical directors, the second and third consist of the strategizing of clinical directors as they seek to maintain their primary focus on clinical work whilst, at the same time, developing their management expertise and influence. The paper concludes that clinical directors can relatively easily occupy the `two-way' space opened up by the mediation of medicine and management. Only a lack of financial management expertise renders their new organizational positioning vulnerable. All public bureaucracies now involve complex mediation between professionals and managers; hence, `two-way windows' will become increasingly significant in organizational development. These `two-way' roles privilege professional over managerial expertise as it is assumed that the appropriate professional training is of paramount importance. Unique professional/managerial discourses are being created in public-sector organizations. This paper provides a basis for understanding the development of such discourses.

Recent developments in performance measurement and reporting systems in the UK National Health Service (NHS) have created new challenges in costing health care services. In particular, the introduction of the "National Reference Costing Exercise" (NRCE) has substantively changed the way in which health care cost information is reported and used. While the outputs of the NRCE are intended to support hospital management and control by facilitating cost benchmarking, the usefulness of NRCE data depends on the comparability of cost information across hospitals. This paper draws on questionnaire results to explore the challenges in standardising health care cost information, as perceived by those closest to the costing exercise. The results reveal several problems in costing practice, all of which contribute to high variability in the costs reported by hospitals. Until these problems are recognised and addressed, they present a barrier to the effective use of comparative cost data for the management of English hospitals.

"Trust and confidence are topical issues. Pundits claim that citizens trust governments and public services increasingly less - identifying a powerful new erosion of confidence that, in the US, goes back at least to Watergate in the 1970s. Recently, media exposure in the UK about MP expenses has been extensive, and a court case ruled in favor of publishing expense claims and against exempting MPs from the scrutiny which all citizens are subject to under 'freedom of information.' As a result, revelations about everything from property speculation to bespoke duck pond houses have fueled public outcry, and survey evidence shows that citizens increasingly distrust the government with public resources. This book gathers together arguments and evidence to answers questions such as: What is trust? Can trust be boosted through regulation? What role does leadership play in rebuilding trust? How does trust and confidence affect public services? The chapters in this collection explore these questions across several countries and different sectors of public service provision: health, education, social services, the police, and the third sector. The contributions offer empirical evidence about how the issues of trust and confidence differ across countries and sectors, and develop ideas about how trust and confidence in government and public services may adjust in the information age."--Publisher's website

Traditionally in health care and in the public sector more generally, little thought has been given to the impact of provider‐oriented incentives on the delivery of services. There has been an assumption that the language of incentives belonged to the private sector and was inappropriate in the public sector. Instead, the governance of health care has relied on the professional ethos of clinicians to direct decision making. Implicitly there has been an expectation that the ethical stance of clinicians would ensure that their actions were always in the best interest of patients. However, in the context of a heightened awareness of cost constraints there has been a greater emphasis on the active management of resources in medical organizations. This article argues that the structure of incentives in health care is highly significant in resource allocation, as medical ethics does not provide an unambiguous guide to clinical decision making. The paper defines the nature of the financial and professional incentives in medical organizations and discusses their impact on the delivery of services through an analysis of positive and negative effects. By undertaking a comparison between the UK and Canada, the paper identifies the differential nature of the incentives present in the health care systems of these two countries and discusses some of their consequences.