Historical background

In 1983, the Griffiths Report into the management of the NHS called for changes, chiefly in the form of hierarchical line management and command and control structures which reflected wider movement in both the United Kingdom and elsewhere in the world (e.g. the United States, New Zealand, and Australia). This shift from administration to management is quite an important step. Historically, the organization and delivery of government services (including health and education) in the United Kingdom had been characterized by the development of a career-based system of public service and the organization and delivery of services by established professionals. In the case of control administration, the ideal is a neutral career-based civil service that does the bidding of the government of the day. (1) In such an administrative system the politicians tend to be separated from the delivery of service by the administrative system that neutrally implements their policies and yet acts as a conduit between the politicians and the professional groups who are responsible for delivery of services. In the 1980s, public administration was gradually replaced by public management with the evolution of a top-down system of control. Whereas the administrators followed the route set by others, managers were expected to set their own targets and were expected to achieve them. The focus gradually began to shift to economy, efficiency, and effectiveness, new personal management systems, and enhancement of delegated financial management.

Providing an efficient and effective health-care system is and should be a priority of any government, as well as clinicians who are providing this care professionally. In any process of developing health-care services, clinicians are best placed to identify the needs of the population they choose to serve and also to provide a system which is effective. In addition, the professionalism has meant that clinicians themselves are responsible for self-regulation and their performance is influenced by the sanctity of the doctor-patient relationship.

Health-care management generally works as a customer service depending upon the local resources, health-care models, and socio-economic models. In private care systems there is also an intermediary between the health professional and the patient. Sometimes this is obvious but at other times it is not clear who, if anyone, is negotiating with the doctor on behalf of the patient. Clinicians have to understand their role with respect to developing services and delivering them to those most in need in a way which is effective and accessible.

In this chapter, we examine the roles and responsibilities of clinicians as managers and consider how these roles can merge in one individual. The process and content of management are described, as is the role of clinicians.

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