Soc. Sci. Med. Vol. 43, No. 5, pp. 799-808, 1996
Copyright © 1996 ElsevierScience Ltd Printed in Great Britain. All rights reserved 0277-9536/96 $15.00 + 0.00
SECTION P THE C H A N G I N G ROLES OF HEALTH CARE PERSONNEL IN HEALTH A N D HEALTH CARE M A N A G E M E N T
D A V I D J. H U N T E R Nuffield Institute for Health, University of Leeds, 71-75 Clarendon Road, Leeds LS2 9PL, England Abstract--Health care reform has become a global phenomenon. Countries are experiencing similar problems with their health care systems and are reaching for similar solutions. Management is seen as crucial in many countries as the principal means of securing supply-side reforms. Many of these centre on establishing a new relationship between professionals, notably the medical profession, and the state. The aim has been to exercise greater influence over how professionals practice and use resources. The application of new public management principles based on industrial sector practices and concepts of management has created tensions within professional groups who feel themselves, and their craft, to be under attack. But the new managerialism has to be seen within a context of rapid social and economic change. It is not possible to predict what the impact of such change is likely to be on health services in the future or on those who provide them. The paper offers an overview of health care reforms and assesses how it is shaping, or re-shaping, the roles and tasks of health care personnel. One conclusion is the mismatch between the management style favoured by policy-makers and reformers and the necessary flexibility required in skill mix and organization of work. High-trust relations lie at the heart of professional forms of organisation whereas the new managerialism appears to be based on the expectation of low-trust relations. The paper concludes with a brief look at the implications of all these developments for training and... [continues]
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