Medicine and management in European healthcare systems: how do they matter in the control of clinical practice?

Ellen Kuhlmann (1) , Viola Burau (2) , Christa Larsen (3) , Roman Andrzej Lewandowski (4) , Christos Lionis (5) , José Repullo (6)

1 Social and Policy Sciences
2 Department of Political Science
3 Goethe-University Frankfurt am Main
4 Kotarbinski Academy of Informatics and Management in Olsztyn
5 School of Medicine
6 UC3M - Universidad Carlos III de Madrid [Madrid]

During recent years, management has brought tighter controls into all areas of clinical practice, responding mainly to financial shortages coupled with increasing public demand for quality and safety of care. Management is not simply expanding and creating new roles for non-clinical managers, but doctors, too, are charged with managerial responsibilities. Consequently, the boundaries between medicine and management are no longer sustainable and this, in turn, may have complex implications for control and leadership in clinical practice. This Perspective article seeks to explore how the transformations in medicine and management matter in the control of clinical practice. The way forward is informed by rich case-study material from Denmark, England, Germany, Greece, Poland, and Spain. Research was carried out by the authors and includes analyses of policy documents and primary and secondary sources. The case study material reveals that no uniform model of control emerges across European healthcare systems. Instead, what matters in the control of clinical practice in European healthcare systems is the specific composition of a set of controls and how they are connected and re-connected and may create new more 'hybrid' patterns of controls. We suggest exploring the 'variations on the theme' of control more systematically by focusing on the organisational settings in different European healthcare states and the actors involved in the transformations. Using cross-country comparison adds further value by filtering out how organisational settings matter in relation to the wider architecture of healthcare states. Finally, this will help to outline future avenues for 'medicine and management' that are likely to create more sustainable and integrated controls in clinical practice.

Mots clés: Medicine

Ellen Kuhlmann, Viola Burau, Christa Larsen, Roman Andrzej Lewandowski, Christos Lionis, et al.. Medicine and management in European healthcare systems: how do they matter in the control of clinical practice?. International Journal of Clinical Practice, 2011, 65 (7), pp.722. ⟨10.1111/j.1742-1241.2011.02665.x⟩. ⟨hal-00635799⟩