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“It is not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change.”
Charles Darwin

This well-known Darwinian quote might not immediately bring to mind thoughts of hospital management and doctors’ roles within it! Doctors (or physicians as they are better known in some countries) are attributed with having significant influence on our survival, and as a species are themselves under pressure to adapt, to socio-economic changes and the political responses to these.

The particular changes in ways of working I am referring to here revolve around doctors having increased involvement with the management of health care systems. Since the 1990’s, alongside caring for patients, keeping up to date with medical advancements and teaching their junior colleagues doctors (to varying degrees) have been expected to engage with such things as budgets, writing business plans and marketing their services.

The shift in developed countries

These changes in ways of working are aligned with the shift across developed countries to new forms of public governance and new institutional forms, which have at their core management practices seen more traditionally in private, for-profit corporations. Policymakers and a number of academics argue that doctors’ engagement with the management of health systems is increasingly necessary; to enhance decision making and thereby improve care outcomes and performance on a variety of measures.

Policymakers and a number of academics argue that doctors’ engagement with the management of health systems is increasingly necessary

Evidence as to the ways that doctors in different countries have responded, in terms of how they engage with and shape management roles and practices, and how they interact with non-clinical managers (where they exist), continues to grow.

Less, however, is known about the impact that the changing medical-management relationship is having for patients and organizations. Research to date has also been dominated by country specific case studies, with little comparative (particularly pan European) work or interdisciplinary work conducted.

A four-year collaborative project

Keen to begin to address this, a group of academics and practitioners from a variety of disciplines embarked on a four year (2009-2013) collaborative project, led by Professor Ian Kirkpatrick, to compare what is happening across European health systems. This was enabled by a European Union ‘Cooperation in Science and Technology (COST)’ grant.

This supplement provides an overview of this four-year collaboration. It sets out the landscape within which hospitals across Europe operate, including the drivers of change and the various institutional forms (in terms of funding and governance) that now exist, and will structure the way in which further reform occurs.

The topics discussed include the changing relationship between doctors and managers, including the way new organizational structures do or don’t support this interaction

The topics discussed include the changing relationship between doctors and managers, including the way new organizational structures do or don’t support this interaction, ways in which doctors have reacted to taking on management roles within different organizational settings and some of the challenges of engaging them and providing effective management training and development.

Future work

As to whether medical and broader clinical involvement in management is associated with better hospital performance, two papers (one a systematic review of existing evidence and one reporting on a large study of doctors involvement with hospital governance in 19 OECD countries) show that where there is greater medical involvement with management this is largely beneficial on measures of quality and other outcomes.

While our research has enhanced the understanding of doctors’ relationships with management groups and processes, as we highlight, a need remains for further comparative research that looks at processes of change, and at how doctors and other clinical professionals shape organizational outcomes.