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Hybrid management, organizational configuration, and medical professionalism: evidence from the establishment of a clinical directorate in Portugal

Overview of attention for article published in BMC Health Services Research, May 2016
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1 tweeter

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16 Dimensions

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49 Mendeley
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Title
Hybrid management, organizational configuration, and medical professionalism: evidence from the establishment of a clinical directorate in Portugal
Published in
BMC Health Services Research, May 2016
DOI 10.1186/s12913-016-1398-2
Pubmed ID
Authors

T. Correia, J. L. Denis

Abstract

The need of improving the governance of healthcare services has brought health professionals into management positions. However, both the processes and outcomes of this policy change highlight differences among the European countries. This article provides in-depth evidence that neither quantitative data nor cross-country comparisons have been able to provide regarding the influence of hybrids in the functioning of hospital organizations and impact on clinicians' autonomy and exposure to hybridization. The study was designed to witness the process of institutional change from the inside and while that process was underway. It reports a case study carried out in a public hospital in Portugal when the establishment of a clinical directorate was being negotiated. Data collection comprises semi-structured interviews with general managers and surgeons complemented with observations. The clinical directorate under study illustrates a divisionalized professional bureaucracy model that combines features of professional bureaucracies and divisionalized forms. The hybrid manager is key to understand the extent to which practising clinicians are more accountable and to whom given that managerial tools of control have not been strengthened, and trust-based relations allow them to keep professional autonomy untouched. In sum, clinicians are allowed to profit from their activity and to perform autonomously from the hospital's board of directors. The advantageous conditions enjoyed by the clinical directorate intensify internal re-stratification in medicine, thus suggesting forms of divisionalized medical professionalism grounded in organizational dynamics. It is discussed the extent to which policy change to the governance of health organizations regarding the relationship between medicine and management is subject to specific constraints at the workplace level, thus conditioning the expected outcomes of policy setting. The study also highlights the role of hybrid managers in determining the extent to which practising professionals are more accountable to managerial criteria. The overall conclusion is that although medical and managerial values link to each other, clinicians reconfigure managerial criteria according to specific interests. Ultimately, medical autonomy and authority may be reinforced in organizational settings subject to NPM-driven reforms.

Twitter Demographics

The data shown below were collected from the profile of 1 tweeter who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 49 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 49 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 12 24%
Student > Ph. D. Student 10 20%
Student > Bachelor 4 8%
Researcher 4 8%
Student > Doctoral Student 3 6%
Other 9 18%
Unknown 7 14%
Readers by discipline Count As %
Business, Management and Accounting 12 24%
Social Sciences 8 16%
Medicine and Dentistry 6 12%
Nursing and Health Professions 3 6%
Engineering 2 4%
Other 8 16%
Unknown 10 20%

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 24 May 2016.
All research outputs
#4,022,730
of 7,747,098 outputs
Outputs from BMC Health Services Research
#1,964
of 2,911 outputs
Outputs of similar age
#145,819
of 268,947 outputs
Outputs of similar age from BMC Health Services Research
#53
of 78 outputs
Altmetric has tracked 7,747,098 research outputs across all sources so far. This one is in the 28th percentile – i.e., 28% of other outputs scored the same or lower than it.
So far Altmetric has tracked 2,911 research outputs from this source. They typically receive a little more attention than average, with a mean Attention Score of 5.1. This one is in the 20th percentile – i.e., 20% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 268,947 tracked outputs that were published within six weeks on either side of this one in any source. This one is in the 35th percentile – i.e., 35% of its contemporaries scored the same or lower than it.
We're also able to compare this research output to 78 others from the same source and published within six weeks on either side of this one. This one is in the 19th percentile – i.e., 19% of its contemporaries scored the same or lower than it.