Exploring health work: a critical-action perspective.

Purpose The purpose of this paper is to describe a hybrid approach to the research developed during a multi-researcher, ethnographic study of NHS management in the UK. Design/methodology/approach This methodological paper elaborates a hybrid approach to the sociological analysis - the critical-action theory - and indicates how it can contribute to the critical health management studies. Findings After exploring the various theoretical, methodological and philosophical options available, the paper discusses the main research issues that influenced the development of this perspective and the process by which the critical-action perspective was applied to the studies of managerial work in four health service sectors - acute hospitals, ambulance services, community services and mental healthcare. Research limitations/implications This methodological perspective enabled a critical analysis of health service organisation that considered macro, meso and micro effects, in particular and in this case, how new public management drained power from clinicians through managerialist discourses and practices. Practical implications Healthcare organisations are often responding to the decisions that lie outside of their control and may have to enact changes that make little sense locally. In order to make sense of these effects, micro-, meso- and macro-level analyses are necessary. Originality/value The critical-action perspective is presented as an adjunct to traditional approaches that have been taken to the study of health service organisation and delivery.

What have NHS managers ever done for us?

The image of the UK National Health Service manager has not always been positive. Like others in the public sector, NHS managers are sometimes associated in the media with waste and inefficiency, in contrast to those in 'front line roles'. Thus healthcare professionals and members of the public might ask, in the tradition of Monty Python's Life of Brian, what NHS managers have ever done for us. In this short article, we outline some of the evidence from the literature on attitudes to, and role of, healthcare managers, before drawing on our own interview and observation based fieldwork with managers themselves. We argue that the role of the healthcare manager is not always well understood, and that in a sector facing ever more intense and large scale organisational challenges, managers should be seen as important partners in a health service focused on clinical outcomes.