Bringing Anglo-governmentality into public management scholarship : the case of evidence-based medicine in UK health care

The field of public administration and management exhibits a limited number of favored themes and theories, including influential New Public Management and Network Governance accounts of contemporary government. Can additional social science–based perspectives enrich its theoretical base, in particular, analyzing a long-term shift to indirect governance evident in the field? We suggest that a variant of Foucauldian analysis is helpful, namely “Anglo-governmentality.” Having reviewed the literatures, we apply this Anglo-governmentality perspective to two case studies of “post hierarchical” UK health care settings: first, the National Institute for Health and Clinical Excellence (NICE), responsible for producing evidence-based guidelines nationally, and the second, a local network tasked with enacting such guidelines into practice. Compared with the Network Governance narrative, the Anglo-governmentality perspective distinctively highlights (a) a power–knowledge nexus giving strong technical advice; (b) pervasive grey sciences, which produce such evidence-based guidelines; (c) the “subjectification” of local governing agents, herein analyzed using Foucauldian concepts of the “technology of the self” and “pastoral power”; and (d) the continuing indirect steering role of the advanced neoliberal health care State. We add to Anglo-governmentality literature by highlighting hybrid “grey sciences,” which include clinical elements and energetic self-directed clinical–managerial hybrids as local governing agents. These findings suggest that the State and segments of the medical profession form a loose ensemble and that professionals retain scope for colonizing these new arenas. We finally suggest that Anglo-governmentality theory warrants further exploration within knowledge-based public organizations

Affective overflows in clinical riskwork

The terms ‘clinical’ and ‘risk management’ are commonly associated with rational detachment and cold, objective calculation, emotionally removed from the subjective experience of dealing with sickness, injury and death. In contrast, we suggest that emotion and affect are integral to the work of managing clinical risk, often involving the intimate handling of human subjects and their embodied subjectivities. Dominant ideals of clinical risk management obscure these emotional-affective dimensions and what we describe below as ‘affective overflows’ in the ‘heat’ of day-to-day risk management (Dolan & Doyle, 2000; Godin, 2004; Hirschhorn, 1999). In day-to-day clinical practices emotions are materially entangled with the micro-technologies and devices of risk management, in its routine practices, habits and scripts (Fischer & Ferlie, 2013; Power, 2011). Indeed, these practices reveal an informal and more ‘indigenous’ practice of clinical ‘risk work’, in which risk technologies and devices are tactically deployed, refashioned or undermined (Fischer, 2012; McGivern & Ferlie, 2007; McGivern & Fischer, 2010; 2012; Nicolini et al., 2011; Waring, 2005)

Routes to the top : the developmental journeys of medical, clinical and managerial NHS Chief Executives

Introduction Leadership, and the role of a Chief Executive in healthcare organisations, has never been more important. This review provides one of the first retrospective cross-sectional analyses of the developmental journeys of chief executives within the National Health Service (NHS). Methods Twenty-eight semi-structured qualitative interviews were conducted with medical, clinical and non-clinical NHS chief executives from the Health Service Journal’s list of ‘Top Chief Executives’ 2014–2018. Through a thematic analysis of their narratives, lessons for the development of aspiring NHS chief executives emerge. Results Few proactively sought leadership opportunities and there was a lack of an active leadership development strategy. Yet the ‘seeds of leadership development’ took root early. Combined with a blended approach of formal leadership development and ‘on-the-job’ informal leadership development, emerging NHS chief executives were exposed to multiple ‘crucible moments’ that helped them develop into and excel at the top of their field. Discussion Top NHS chief executives possess inherent values and a strong sense of social responsibility that underpin their developmental journeys, guide their behaviour, and strengthen their resilience. Capable, high quality leaders are needed from all professional backgrounds to support high quality care and much more needs to be done, particularly for medical and clinical professionals but for non-clinicians too, to maximise leadership potential within the NHS and develop a pipeline of aspiring NHS chief executives

Hybrid clinical-managers in Kenyan Hospitals : navigating between professional, official and practical norms

Purpose The purpose of this paper is to explore the way “hybrid” clinical managers in Kenyan public hospitals interpret and enact hybrid clinical managerial roles in complex healthcare settings affected by professional, managerial and practical norms. Design/methodology/approach The authors conducted a case study of two Kenyan district hospitals, involving repeated interviews with eight mid-level clinical managers complemented by interviews with 51 frontline workers and 6 senior managers, and 480 h of ethnographic field observations. The authors analysed and theorised data by combining inductive and deductive approaches in an iterative cycle. Findings Kenyan hybrid clinical managers were unprepared for managerial roles and mostly reluctant to do them. Therefore, hybrids’ understandings and enactment of their roles was determined by strong professional norms, official hospital management norms (perceived to be dysfunctional and unsupportive) and local practical norms developed in response to this context. To navigate the tensions between managerial and clinical roles in the absence of management skills and effective structures, hybrids drew meaning from clinical roles, navigating tensions using prevailing routines and unofficial practical norms. Practical implications Understanding hybrids’ interpretation and enactment of their roles is shaped by context and social norms and this is vital in determining the future development of health system’s leadership and governance. Thus, healthcare reforms or efforts aimed towards increasing compliance of public servants have little influence on behaviour of key actors because they fail to address or acknowledge the norms affecting behaviours in practice. The authors suggest that a key skill for clinical managers in managers in low- and middle-income country (LMIC) is learning how to read, navigate and when opportune use local practical norms to improve service delivery when possible and to help them operate in these new roles. Originality/value The authors believe that this paper is the first to empirically examine and discuss hybrid clinical healthcare in the LMICs context. The authors make a novel theoretical contribution by describing the important role of practical norms in LMIC healthcare contexts, alongside managerial and professional norms, and ways in which these provide hybrids with considerable agency which has not been previously discussed in the relevant literature

Improvisation during a crisis : hidden innovation in healthcare systems

Background Crises, such as the COVID-19 pandemic, risk overwhelming health and social care systems. As part of their responses to a critical situation, healthcare professionals necessarily improvise. Some of these local improvisations have the potential to contribute to important innovations for health and social care systems with relevance beyond the particular service area and crisis in which they were developed. Findings This paper explores some key drivers of improvised innovation that may arise in response to a crisis. We highlight how services that are not considered immediate priorities may also emerge as especially fertile areas in this respect. Conclusion Health managers and policymakers should monitor crisis-induced improvisations to counteract the potential deterioration of non-prioritised services and to identify and share useful innovations. This will be crucial as health and social care systems around the world recover from the COVID-19 pandemic and head into another potential crisis: a global economic recession

The impact of leadership and leadership development in higher education: a review of the literature and evidence

Leadership development and its effectiveness has not been explored in depth empirically, especially across university settings. It is therefore timely that the Leadership Foundation has sought to invest in exploring what is known in the area of the impact of leadership development in higher education settings

Exploring and explaining the dynamics of osteopathic regulation, professionalism and compliance with standards in practice

This is a report on research conducted by an independent team of academics from the Universities of Warwick, Melbourne/ Oxford and Nottingham, and the British School of Osteopathy, funded by the General Osteopathic Council (GOsC) to answer the research questions: What regulatory activities best support osteopaths to be able to deliver care and to practice in accordance with the Osteopathic Practice Standards (OPS)? What factors inhibit osteopaths from practising in accordance with OPS? What factors encourage osteopaths to practice in accordance with OPS