Lawrence Benson

Assessing governance theory and practice in health-care organizations: a survey of UK hospices

This paper sets out a theoretical framework for analyzing board governance, and describes an empirical study of corporate governance practices in a subset of non-profit organizations (hospices in the UK). It examines how practices in hospice governance compare with what is known about effective board working. We found that key strengths of hospice boards included a strong focus on the mission and the finances of the organizations, and common weaknesses included a lack of involvement in strategic matters and a lack of confidence, and some nervousness about challenging the organization on the quality of clinical care. Finally, the paper offers suggestions for theoretical development particularly in relation to board governance in non-profit organizations. It develops an engagement theory for boards which comprises a triadic proposition of high challenge, high support and strong grip.

Use of action learning in a higher education setting to improve the quality of health care

Abstract Health care faces challenges that are only partially addressed by incremental innovations. This paper outlines the potential for action learning to be used to challenge existing paradigms and mindsets. It provides the background and introduction to the concept, and describes the main principles and approach. Limitations in the theoretical conceptualization and research evidence about action learning are explored. Meanwhile, action learning has been used as a learning tool for graduate entry-level health service managers, senior health-care leaders, and students on postgraduate courses. Evaluations of these programmes have unearthed the key characteristics and benefits of effective action learning. The conclusions are that effective action learning is enabled by skilled facilitation, has benefits in embedding double-loop learning and developing personal resilience, and may result in enhanced organizational ambidexterity. Further work is now required to build a stronger conceptual framework and to explore the theory–practice gap around the impact of action learning at the organization level.

Health network culture and reform

For policy-makers who favour health system marketization, that is the re-structuring of health systems to mimic the organizational structures and inter-organizational relationships found in markets, networks offer a surrogate governance structure in those parts of a ‘hollowed-out state’ where direct hierarchical control of individuals or organizations has been removed (Etzioni, 2001; Rhodes, 1997), supplementing hierarchies and markets as a ‘third way’ governance structure. Health care networks have correspondingly proliferated and now include professional (’expertise’) networks: clinical referral (’care’) networks; project networks; programme (linkage’) networks such as WHO-style programmes; ‘experience’ networks of users and carers; policy networks (including policy ‘communities’ as a special case); learning networks; and interest networks which promote particular policy or interest-group (Southon, Perkins and Galler, 2005). Meantime, ‘reforms’ of health-care bureaucracies have proceeded apace in many countries as have attempts to re-introduce or extend health-care markets.

A comparison of experiences, competencies and development needs of doctor managers in Kenya and the United Kingdom (UK).

PURPOSE The purpose of the research was to explore and compare the experiences, leadership and management competencies and development needs of doctor managers in Kenya and the UK. DESIGN/METHODOLOGY A comparative study d258esign involving fieldwork in Kenya and the UK was adopted. Data were collected using a multi-method approach: qualitative interviews and a survey with doctor managers. The template method was used for qualitative data analysis while appropriate statistical tests in SPSS were used for quantitative data analysis. FINDINGS The findings of the study add to the knowledge on experiences of doctor managers, competencies and development needs. Ways of addressing some of the difficulties are proposed. RESEARCH LIMITATIONS/IMPLICATIONS The study highlights issues of a comparative study across different cultures and the issue of bias that is associated with self reports. PRACTICAL AND SOCIAL IMPLICATIONS It is assumed that management decisions have much in common and the training and socialisation of doctors as professionals is somewhat similar. This paper explores if there are any experiences that are transferable and if competency frameworks in healthcare used in developed countries are transferable to a developing country. ORIGINALITY/VALUE The study gives baseline knowledge and insight into the experiences, competencies and development needs of doctor managers in a developing country and adds to existing knowledge on doctor managers in the UK. This study has also provided currently the only international study comparing the experiences, competencies and development needs of doctors in management.