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Medics as Managers

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  • Full or part time
    Dr D Harradine
  • Application Deadline
    Applications accepted all year round

Project Description

The history of the involvement of doctors in the management of hospitals and their financial control has been at the heart of many of the reforms in healthcare since the 1970s in the UK, which have mirrored approaches in other developed countries. The main initiatives are as follows:

• Specialty Costing (Prowle & Jones, 1982);
• General Management (Griffiths, 1983; Prowle & Jones, 1982);
• Clinical and Management Budgeting (Perrin, 1988);
• Market based systems (Ellwood, 1996; Flynn & Williams, 1997; Lovell, Rowe, Harradine, et al., 2001);
• Clinical Directors (Ashburner, 1996), and
• Service Line Reporting (SLR) (Harradine & Prowle, 2012; Monitor, 2006).

Each of these initiatives encouraged doctors to be involved in the management of hospitals and especially the financial aspects of management. These initiatives, however, when reviewed, have not provided the benefits originally intended in terms of performance and cost savings. The above approaches in the UK were attempts to harness the abilities and understanding of the doctors in a healthcare environment; to bring them into the management process. The most recent of initiative in England, SLR, when reviewed, which is still in its relatively early stages of development, indicates some initial evidence that there are limitations to what has been achieved (Harradine & Prowle, 2012). The reason for the lack of achievement for these systems, in most instances, is the doctor/managerial interface, which appears to be problematic.

There can be little debate concerning the importance of the medical profession to healthcare organisations. Doctors are the most highly trained professionals within these organisations and indeed their profession is at the core of the activities of those organisations. They have an intimate knowledge of the workings of these organisations and therefore are in a unique position to understand the issues of the organisation and more importantly how they might be overcome. Their longevity within their organisations is considerable compared to that of their managerial counterparts, where the average tenure of a chief executive in the English NHS is approximately twenty months. A consultant may be in post for over twenty years in one particular organisation. Commentators in the management of the NHS (Atun, 2003) tend to agree, therefore, that there is a considerable argument given the training and their potential understanding of the organisation and how it works make senior doctors ideal to be involved in the management of their organisations. These points indicate a need for the inclusion of senior doctors, however, the above review of systems in the UK designed to draw this group into the management process, appear from previous studies, to have and continue to experience difficulties in maintaining involvement (Brown, Alaszewski et al., 2011). Studies indicate that professional validation is unlikely to be achieved through the involvement in the management process: indeed this may lead to conflict between the clinician and his/her clinical colleagues.

The proposed study therefore is to examine the issues concerning the managerial roles of senior medical staff in particular their role within financial control.


Ashburner, L. (1996) The role of the clinician in the management of the NHS, J. Leopold, I. Glover & M. Hughes
(Eds.), Beyond Reason? The National Health Service and the Limits of Management, pp. 207-226,
Aldershot: Avebury, Aldershot.
Atun, R. A. (2003) Doctors and managers need to speak a common language, BMJ, No.326.
Brown, P., Alaszewski, A., Pilgrim, D., & Calnan, M. (2011) The quality of interaction between managers and
clinicians: a question of trust, Public Money and management, January 2011, pp.43-49.
Ellwood, S. (1996), Cost-based Pricing in the NHS Internal Market, London: CIMA Publishing.
Flynn, R., & Williams, G. (1997) Contracting for Health: Quasi-markets and the National Health Service, Oxford:
Oxford University Press.
Griffiths, R. (1983) NHS Management Enquiry Report, London: DHSS.
Harradine, D., & Prowle, M. J. (2012) Service line reporting in a NHS foundation trust: an initial assessment of
its relevance and applicability, Public Money and Management, Vol. 32, pp. 217-224. Le Grand, J. (1991)
Quasi markets and social policy, The Economic Journal, Vol 101, No 408.
Lovell, A., Rowe, M., Harradine, D., Jones, M., & Ball, G. (2001) Internal Charging in the Public Sector:
Accounting for Illusions, Research Report, London: The Association of Chartered Certified Accountants.
Monitor (2006) Guide to developing reliable financial data for service-line reporting, London: HMSO.
Perrin, J. (1988) Resource Management in the NHS, London: Chapman & Hall.
Prowle, M. J., & Jones, T. W. (1982) Health Service Finance: An Introduction, London: Certified Accountants
Education Trust.

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