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The changing roles of health care personnel in health and health care management


  • Hunter, David J.


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 education and finds that there is still a long way to go before there is any real prospect of providing and equipping health care personnel with the requisite skills to enable them to meet the complex challenges that are a common characteristic of health care systems.

Suggested Citation

  • Hunter, David J., 1996. "The changing roles of health care personnel in health and health care management," Social Science & Medicine, Elsevier, vol. 43(5), pages 799-808, September.
  • Handle: RePEc:eee:socmed:v:43:y:1996:i:5:p:799-808

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    Cited by:

    1. Radnor, Zoe J. & Holweg, Matthias & Waring, Justin, 2012. "Lean in healthcare: The unfilled promise?," Social Science & Medicine, Elsevier, vol. 74(3), pages 364-371.
    2. Andreassen, Hege K. & Kjekshus, Lars Erik & Tjora, Aksel, 2015. "Survival of the project: A case study of ICT innovation in health care," Social Science & Medicine, Elsevier, vol. 132(C), pages 62-69.
    3. Gross, Revital & Tabenkin, Hava & Brammli-Greenberg, Shuli, 2007. "Factors affecting primary care physicians' perceptions of health system reform in Israel: Professional autonomy versus organizational affiliation," Social Science & Medicine, Elsevier, vol. 64(7), pages 1450-1462, April.
    4. Martin, Graham P. & Learmonth, Mark, 2012. "A critical account of the rise and spread of ‘leadership’: The case of UK healthcare," Social Science & Medicine, Elsevier, vol. 74(3), pages 281-288.
    5. Riewpaiboon, Wachara & Chuengsatiansup, Komatra & Gilson, Lucy & Tangcharoensathien, Viroj, 2005. "Private obstetric practice in a public hospital: mythical trust in obstetric care," Social Science & Medicine, Elsevier, vol. 61(7), pages 1408-1417, October.
    6. Williams, Allison M. & Caron, Michelle V. & McMillan, Maria & Litkowich, Anne & Rutter, Noreen & Hartman, Arlete & Yardley, John, 2001. "An evaluation of contracted palliative care home care services in Ontario, Canada," Evaluation and Program Planning, Elsevier, vol. 24(1), pages 23-31, February.
    7. Frankish, C. James & Kwan, Brenda & Ratner, Pamela A. & Higgins, Joan Wharf & Larsen, Craig, 2002. "Social and political factors influencing the functioning of regional health boards in British Columbia (Canada)," Health Policy, Elsevier, vol. 61(2), pages 125-151, August.
    8. Racko, Girts, 2017. "Bureaucratization and medical professionals’ values: A cross-national analysis," Social Science & Medicine, Elsevier, vol. 180(C), pages 76-84.
    9. Lewis, Jenny M., 2006. "Being around and knowing the players: Networks of influence in health policy," Social Science & Medicine, Elsevier, vol. 62(9), pages 2125-2136, May.
    10. van der Geer, Eric & van Tuijl, Harrie F.J.M. & Rutte, Christel G., 2009. "Performance management in healthcare: Performance indicator development, task uncertainty, and types of performance indicators," Social Science & Medicine, Elsevier, vol. 69(10), pages 1523-1530, November.


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