Ellen Kuhlmann

Bringing a European perspective to the health human resources debate: A scoping study

Healthcare systems across the world are increasingly challenged by workforce shortages and misdistribution of skills. Yet, no comprehensive European approach to health human resources (HHR) policy exists and action remains fragmented. This scoping study seeks to contribute to the debates by providing an overview of existing HHR research, and by exploring the challenges of a European approach with a focus on workforce planning. In terms of methods, we build on a scoping review comprising literature analysis and qualitative data gathered from policy experts. In our analysis we observe an overall lack of integrated HHR approaches as major obstacle of efficient HHR planning, and find that five dimensions of integration in HHR policy are needed: system, occupational, sector, gender, and socio-cultural integration. Increasing the analytical complexity of HHR planning models does not automatically bring about more reliable and efficient planning, as the added value of these models is highly context-dependent. Yet Europe is highly diverse and we therefore argue the need for a strategic HHR perspective that is capable of bridging many different HHR policies and planning systems, and combining national and European solutions efficiently.

A manager in the minds of doctors: a comparison of new modes of control in European hospitals.

BackgroundHospital governance increasingly combines management and professional self-governance. This article maps the new emergent modes of control in a comparative perspective and aims to better understand the relationship between medicine and management as hybrid and context-dependent. Theoretically, we critically review approaches into the managerialism-professionalism relationship; methodologically, we expand cross-country comparison towards the meso-level of organisations; and empirically, the focus is on processes and actors in a range of European hospitals.MethodsThe research is explorative and was carried out as part of the FP7 COST action IS0903 Medicine and Management, Working Group 2. Comprising seven European countries, the focus is on doctors and public hospitals. We use a comparative case study design that primarily draws on expert information and document analysis as well as other secondary sources.ResultsThe findings reveal that managerial control is not simply an external force but increasingly integrated in medical professionalism. These processes of change are relevant in all countries but shaped by organisational settings, and therefore create different patterns of control: (1) ‘integrated’ control with high levels of coordination and coherent patterns for cost and quality controls; (2) ‘partly integrated’ control with diversity of coordination on hospital and department level and between cost and quality controls; and (3) ‘fragmented’ control with limited coordination and gaps between quality control more strongly dominated by medicine, and cost control by management.ConclusionsOur comparison highlights how organisations matter and brings the crucial relevance of ‘coordination’ of medicine and management across the levels (hospital/department) and the substance (cost/quality-safety) of control into perspective. Consequently, coordination may serve as a taxonomy of emergent modes of control, thus bringing new directions for cost-efficient and quality-effective hospital governance into perspective.

THE ‘HEALTHCARE STATE’ IN TRANSITION: National and international contexts of changing professional governance

ABSTRACT The building of a European nation challenges entrenched ties between the state and the professions. Yet, in relation to healthcare, European law is especially weak and professional power is particularly strong. Against this background, the present paper aims to map out the specific configurations of the changing governance of healthcare and the dynamics arising from intersecting contexts of change. We argue that the ‘healthcare state’ is strongly shaped by national regulatory frameworks, while the platform for the power of a self-regulatory medical profession is increasingly international in nature. Across countries managerialism and performance measures together with evidence-based medicine and clinical guidelines are meant to improve the accountability of professionals and the safety of the public. However, the new regulatory tools may also have the opposite effect and indeed serve as a means to reassert professional power; here, the heightened internationalization of healthcare even provides new opportunities. We use material from different countries gathered in a number of research projects to assess the changing governance of healthcare and its contexts. The paper concludes by highlighting the significance of both national regulatory frameworks and (international) professionalism.

A global call for action to include gender in research impact assessment

Global investment in biomedical research has grown significantly over the last decades, reaching approximately a quarter of a trillion US dollars in 2010. However, not all of this investment is distributed evenly by gender. It follows, arguably, that scarce research resources may not be optimally invested (by either not supporting the best science or by failing to investigate topics that benefit women and men equitably). Women across the world tend to be significantly underrepresented in research both as researchers and research participants, receive less research funding, and appear less frequently than men as authors on research publications. There is also some evidence that women are relatively disadvantaged as the beneficiaries of research, in terms of its health, societal and economic impacts. Historical gender biases may have created a path dependency that means that the research system and the impacts of research are biased towards male researchers and male beneficiaries, making it inherently difficult (though not impossible) to eliminate gender bias. In this commentary, we – a group of scholars and practitioners from Africa, America, Asia and Europe – argue that gender-sensitive research impact assessment could become a force for good in moving science policy and practice towards gender equity. Research impact assessment is the multidisciplinary field of scientific inquiry that examines the research process to maximise scientific, societal and economic returns on investment in research. It encompasses many theoretical and methodological approaches that can be used to investigate gender bias and recommend actions for change to maximise research impact. We offer a set of recommendations to research funders, research institutions and research evaluators who conduct impact assessment on how to include and strengthen analysis of gender equity in research impact assessment and issue a global call for action.

Gender, professions and public policy: new directions

Purpose – This article aims to provide an overview on key trends in public sector policy and professional development and how they intersect with gender and diversity. It seeks to explore new configurations in the relationship between gender and the professions and to develop a matrix for the collection of articles presented in this volume.Design/methodology/approach – The authors link social policy and governance approaches to the study of professions, using the health professions and academics as case studies. Material from a number of studies carried out by the authors together with published secondary sources provide the basis of our analysis; this is followed by an introduction of the scope and structure of this thematic issue.Findings – The findings underline the significance of public policy as key to better understand gender and diversity in professional groups. The outline of major trends in public sector professions brings into focus both the persistence of gender inequality and the emergence of...

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

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.

Professional self-regulation in a changing architecture of governance: comparing health policy in the UK and Germany

This chapter compares transformations in professional self-regulation in the UK and Germany through the lens of governance. We introduce an expanded concept of governance that includes national configurations of state–profession relationships and places selfregulation in the context of other forms of governance. The analysis shows that a general trend towards network governance plays out differently. In the UK, a plural structure of network governance and stakeholder arrangements is emerging in the context of stateled change. In Germany, partnership governance between sickness funds and medical associations shape the transformations and act as a barrier towards the entry of new players.

From Women's Health to Gender Mainstreaming and Back Again Linking Feminist Agendas and New Governance in Healthcare

This article links experience from the womens health movement to gender mainstreaming approaches and feminist agendas. The aim is to assess the options and limitations of gender mainstreaming and the links with changing governance in healthcare in western countries. From the late 1960s, the womens health movement was a forerunner of todays commonplaces of successful models of health reform. Women significantly advanced new policy approaches on user participation, a collaborative health workforce and better and safer information. This article traces these trajectories and the dynamics in healthcare systems. It argues the need for feminist agendas in order to mainstream gender approaches into health reform processes and thereby, counteract neoliberal concepts that shape health policy debates across countries. Linking the experience of the womens health movement to gender mainstreaming approaches highlights that feminist agendas contribute to a better quality of care for women and men.

Researching transformations in healthcare services and policy in international perspective: An introduction

Across countries healthcare systems face new pressures for change towards more cost-effective and sustainable health services for all citizens. In recent years health policy-makers have responded to these challenges mainly by introducing or reinforcing market mechanisms and by expanding managerial controls. This is leading to major transformations in health policy and, subsequently, to the organization and delivery of healthcare services. This collection brings an international perspective to the research on contemporary transformations in health policy and services, by focusing on countries as wide-ranging as the US and Western and Eastern European countries, to Japan, China and Australia and by addressing different healthcare sectors from hospital to home care. Together these international experiences help us to better understand both the risks of social inequality embedded in new health policies and the opportunities of mobilizing new resources towards better healthcare for all citizens.

The Palgrave international handbook of healthcare policy and governance

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