Doctors and the management of health services: A sociological study of the medical advisory structure in two Scottish hospitals

Green, Stephen (1978) Doctors and the management of health services: A sociological study of the medical advisory structure in two Scottish hospitals. PhD thesis, University of Glasgow.

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This research is a sociological examination of the introduction and operation of Medical Advisory Structures in the National Health Service in Scotland. Sociologists, in analysing the differences between bureaucratic and professional forms of work organisation, have pointed to the problems of involvement of independent professionals in large organisations. Medical Advisory Structures have been designed to provide structured involvement of the medical profession in the management of the National Health Service. These structures are intended to encourage the profession to manage itself and to allow the whole profession to advise the administration on management and policy issues. This study is primarily about two levels of that structure - the divisional or specialty level and the Committee of Divisional Chairmen, or hospital level. In a theoretical examination of the structure two major inputs into the way in which the structure will function are identified. First of all, there is the structure and what it asks consultants to do. Secondly, there' is the nature of the profession which has to work within that structure. It is argued that members of divisions and the Committee of Divisional Chairmen face a role conflict between the representation of self or group interests and opinions and making decisions on the basis of broader criteria which are required for the rational management and administration of the service. At the same time a number of professional values and characteristics are identified. At the individual level clinical and professional autonomy is identified as the key value. At the specialty level, lack of inter-specialty knowledge, specialty autonomy and differences in specialty status are identified as the key professional values and characteristics. It is argued that these professional features will interact with the role conflict to encourage solutions to it which do not damage professional values and relationships. It is suggested that if this is the case such decisions will deviate from the aims of the structure. (5) The way in which Medical Advisory Structures work was studied for two years by observation in two hospitals. This covered the year before and the year after reorganisation. At the end of the period of observation interviews were conducted with consultants in the two hospitals. The establishment of the two Medical Advisory Structures in the two hospitals and their respective Districts and Areas is described and analysed with particular attention to the dominant concerns of the profession. Following this the operation of the structure is described and analysed using descriptive material on three categories of decision. First of all, decisions internal to the profession at the level of the specialty are analysed. These include decisions about increased staffing, requests for additional equipment and the evaluation of patient care. In the second category of decision similar issues are examined at the hospital level. Medical Advisory Structures were also designed to play a part in the management of the hospital and decisions which required this are dealt with in the third category. The findings of the research indicate that the operation of Medical Advisory Structures is deeply influenced by the nature and values of the profession. At the divisional or specialty level it appears that individual autonomy influences the solution of the role conflict in favour of the ratification of individual requests or in ways that do not conflict with individual autonomy. At the hospital level a concern with specialty autonomy and lack of inter-specialty knowledge have a similar effect in that specialty requests and interests tend to be agreed to on a piecemeal basis. However, in decisions which require choices to be made between specialties differential specialty status appears to have some influence with the higher status specialties tending to be more successful. Suggestions are made about ways in which the operation of the structure might be improved and conclusions are drawn about the medical profession and its involvement in the management of the National Health Service.

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Additional Information: Adviser: Fred Martin
Keywords: Health care management
Date of Award: 1978
Depositing User: Enlighten Team
Unique ID: glathesis:1978-72809
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 11 Jun 2019 11:06
Last Modified: 11 Jun 2019 11:06

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