Essential management issues for clinicians | |
From clinician to manager. An introduction to hospital and health services management. 2nd ed. James S Lawson, Arie Rotem. Sydney: McGraw-Hill, 2004 (xii + 236 pp). ISBN 0 074 71484 8 |
When the
When the Royal Australasian College of Medical Administrators held its first “Management for Clinicians" program in the early 1980s, many queried whether there was an audience for such an event. Some 20 years later, the demand for management training for clinicians is high and increasing. There are now many books, and even journals, devoted to improving the management skills of clinicians. The main intention of this book, a second and updated edition, is to cover the broad field of health service management, and “to provide sound practical advice and relevant anecdotal experience that encapsulate many of the essential management issues that the clinician is likely to meet as a manager”. The book succeeds with its first objective and provides a general overview of the context of health services management but falls short on the second. Despite its title, the book casts its net wider than clinicians, and tries to meet the needs of medical clinicians, and nursing, allied health and full-time career managers. The book is easy to read. The two main authors are well qualified in health service management, but only the chapter on “Quality of care”, a particularly good and up-to-date overview, is written by someone whom clinicians would call a “clinician manager”. While those unfamiliar with the overall structure of the Australian health system will find this book of use, part-time medical clinician managers may need to look elsewhere for assistance with the management problems that they face. Further, the emphasis is more on hospital and area/district health service management than, say, clinician management within the general practice context. Some management books use a case study approach, taking a problem and working through the various ways that it could be handled. The case studies in this book are really illustrative examples, some of which are quite dated. Some of the thinking about medical clinicians and management seems to be more typical of the early 1990s, rather than 2004. Indeed, there is the impression that the original text and examples have not been updated for this second edition. Rather, a few extra chapters have been added. For example, the authors comment (p 25) that “decentralisation of financial responsibility appears — as in the case of Sydney's Royal Prince Alfred Hospital — to have contributed to serious cost overruns." While this was true when the decentralised structure was first introduced, it is no longer true. RPAH has continued to involve clinicians in management through an area-wide clinical stream matrix organisational framework, which was introduced in 1994. This arrangement has worked well for the past decade, and has demonstrated a successful partnership between clinicians and management, in managing budget, and innovating to stretch the budget further. Jennifer Alexander
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