Michael D Fischer | University of Oxford (original) (raw)

Papers by Michael D Fischer

Higher Education Quarterly

Leadership development (LD) activity and its effectiveness has not been explored rigorously acros... more Leadership development (LD) activity and its effectiveness has not been explored rigorously across changing university settings globally. As Higher Education (HE) settings change radically throughout the world, HE professionals are operating in more uncertain environments, and leaders are taking increasingly complex and diverse approaches to their leadership roles. LD activities therefore become important in supporting this highly complex context, yet little is known in the literature about LD and its impact in HE. We examine peer-reviewed work on LD in HE settings globally to understand what may be learned about its content, processes, outcomes and impact. Our results suggest the current literature is small-scale, fragmented and often theoretically weak, with many different and co-existing models, approaches and methods, and little consensus on what may be suitable and effective in the HE context. We reflect on this state of play and develop a novel theoretical approach for designing LD activity in HEIs.

Health research policy and systems / BioMed Central, Jan 19, 2016

Global investment in biomedical research has grown significantly over the last decades, reaching ... more 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, mak...

In this article, we discuss temporal work and temporal politics situated between groups with diff... more In this article, we discuss temporal work and temporal politics situated between groups with different temporal orientations, arguing that attention needs to be paid to covert and unarticulated silent politics of temporal work. Drawing on a case study of a management consultancy project to redesign public health care, we explain how unarticulated temporal interests and orientations shape the construction of problems, which, in turn, legitimate tasks and time frames. We also show how task and time frames are temporarily fixed and imposed through boundary objects, and the way these may then be reinterpreted and co-opted to deflect pressure to change. Thus, we argue, unarticulated, covert and political temporal interdynamics produce expedient provisional temporal settlements, which resolve conflict in the short-term, while perpetuating it in the longer run.

As medical students transition to become trainee doctors, they must confront the potential for ma... more As medical students transition to become trainee doctors, they must confront the potential for making medical errors. In the high stakes environment of medicine, errors can be catastrophic for the patients and for doctors themselves. Doctors have been found to experience guilt, shame, fear, humiliation, loss of confidence, deep concerns about their professional skills and social isolation, effectively becoming the second victim of an error.1 ,2

A number of programmes and practices have been suggested to provide psychological first aid to second victims after an error has occurred.3 Little attention, however, has focused on how medical training can prepare doctors for the inevitability of error, and thus help protect them from potentially severe emotional consequences in the future. The WHO has developed the Patient Safety Curriculum Guide for Medical Schools, which includes training on understanding and learning from mistakes.4 In addition, the case has been made for error management training in which students are encouraged to experience error in safe settings, such as simulation exercises.5 ,6 While these approaches are promising, a more broad-spectrum psychological intervention aimed at changing how students perceive mistakes and cope with setbacks could be advantageous. Research from social psychology suggests a promising intervention that could help assist students in being resilient when encountering difficulties and setbacks.

Organization Studies, 2017

In this article, we discuss temporal work and temporal politics situated between groups with diff... more In this article, we discuss temporal work and temporal politics situated between groups with different temporal orientations, arguing that attention needs to be paid to covert and unarticulated silent politics of temporal work. Drawing on a case study of a management consultancy project to redesign public health care, we explain how unarticulated temporal interests and orientations shape the construction of problems, which, in turn, legitimate tasks and time frames. We also show how task and time frames are temporarily fixed and imposed through boundary objects, and the way these may then be reinterpreted and co-opted to deflect pressure to change. Thus, we argue, unarticulated, covert and political temporal inter-dynamics produce expedient provisional temporal settlements, which resolve conflict in the short-term, while perpetuating it in the longer run.

Emotional-affective aspects of risk work are integral to risk management in many fields, particul... more Emotional-affective aspects of risk work are integral to risk management in many fields, particularly in human service organizations; yet rational notions of risk management often obscure these emotional-affective aspects. In this chapter, we discuss the case of high risk mental healthcare (for people with personality disorders), characterised by both formal and informal risk management systems. Drawing on sociomaterial perspectives, we explore empirically how affective dimensions of routine clinical risk work flow between these formal and informal risk management systems, affecting intersubjective relations and experiences. We show how affect can ‘inflame’ incidents, producing heated interactions that escalate and ‘overflow’ through the risk management technologies, devices and systems intended to contain and manage them. The chapter draws conclusions on dynamics of affective flows and overflows that are present – if less visible – in other areas of risk work.

We discuss the mobilisation of management knowledge in health care, drawing on six qualitative ca... more We discuss the mobilisation of management knowledge in health care, drawing on six qualitative case studies in a diverse range of health care settings. Drawing on theory about management knowledge and practices' 'fit', and emergent theory about 'epistemic stances', we explain how cultural/institutional, political and epistemic fit and clashes between the norms, interests and epistemic stances of different communities affected knowledge mobilisation in these settings. We also highlight the key role of knowledge brokers in 'fitting' knowledge within contexts as part of their own identity work. Yet we note that knowledge brokers' ability to mobilise and fit knowledge depended on having a senior role or senior level support, and credibility/legitimacy with dominant communities. We suggest that our novel concepts of 'epistemic fit' and 'fitting' are useful in explaining the process of knowledge mobilisation, particularly in complex pluralistic health care contexts containing multiple epistemic communities which produce, use and value knowledge in different ways.

Global investment in biomedical research has grown significantly over the last decades, reaching ... more 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.

Leadership development and its effectiveness has not been explored in depth empirically, especial... more Leadership development and its effectiveness has not been explored in depth empirically, especially across university settings. It is therefore timely that the Leadership Foundation has sought to invest in exploring what is known in the area of the impact of leadership development in higher education settings.

Our review is structured thematically and led by the five stated objectives of the commissioned work namely:

1. To identify promising leadership interventions applied in UK higher education that have a reliable evidence base and/or are theoretically informed.

2. To provide clarification on the conceptual and theoretical lenses applied to leadership and leadership development in the higher education sector and how these have developed over time, with reference to developments in related knowledge intensive sectors and settings.

3. To outline a conceptual framework for thinking about leadership development in higher education at different organisational levels and across institutional contexts.

4. To identify any metrics and/or tools currently used to evaluate the effectiveness and impact of leadership interventions, which could assist the Leadership Foundation in generating its own leadership development metrics in future.

5. To identify gaps in the literature on leadership and leadership development in higher education and make suggestions for future research.

The team leading this review have many years’ experience researching different aspects of leadership in public sector organisations, mainly but not exclusively in complex healthcare settings. Some of the team are also involved in designing and delivering leadership development activities more broadly.

We adopted a rigorous review methodology that drew on a diverse range of information sources - such as leadership texts – as well as previous literature reviews that had adopted looser approaches. Our approach was pragmatic and question driven, with due attention paid to the quality of the literature and appropriate inclusion and exclusion criteria.

In summary, the current literature on leadership development approaches in UK higher education appears small scale, fragmented and often theoretically weak, with many different models, approaches and methods co-existing with little clear pattern of consensus formation. The report highlights a paradox. The higher education sector is a “knowledge industry” but has a relatively poor record of investing in studying its own effectiveness.

One problem we identified was that leadership development was often seen as synonymous with leader development. We suggest the need to develop a broader conceptualisation of what leadership and leadership development is in higher education settings that moves beyond individual leaders and which considers leadership processes in higher education settings in more distributed, relational and contextual terms.

It is difficult to measure a leadership development programme impact if you are not clear about the definition of the nature of leadership development processes in higher education settings in the first place. In the studies we reviewed on leadership evaluation and metrics there appears to be no boundary that can be easily drawn around possible fields of measurement of higher education development programmes. Studies varied according to whether they are measuring the degree of changes in individuals, changes in the effectiveness of groups to which the leaders belong or wider forms of organisational change.

Published by the Leadership Foundation for Higher Education, London

http://www.lfhe.ac.uk/en/research-resources/publications/index.cfm/S5-03

This article explores contrasting forms of ‘knowledge leadership’ in mobilising management resear... more This article explores contrasting forms of ‘knowledge leadership’ in mobilising management research into organizational practice. Drawing on a Foucauldian perspective on power-knowledge, we introduce three axes of power-knowledge relations, through which we analyse knowledge leadership practices. We present empirical case study data focused on ‘polar cases’ of managers engaged in mobilising management research in six research-intensive organizations in the UK healthcare sector. We find that knowledge leadership involves agentic practices through which managers strive to actively become the knowledge object – personally transposing, appropriating or contending management research. This article contributes to the literature by advancing the concept of knowledge leadership in the work of mobilising management research into organizational practice.

Academy of Management Proceedings, 2014

Mobilizing research-based management knowledge into practice is an important, yet elusive dimensi... more Mobilizing research-based management knowledge into practice is an important, yet elusive dimension of a developing knowledge economy. This paper introduces and explores empirically knowledge leadership as an important but uncommon process for mobilizing knowledge into practice. Drawing on a large, comparative and processual research study of six prestigious and diverse knowledge-intensive organizations, operating in the UK health knowledge economy, we trace the knowledge leadership work of managers and clinical leaders as 'positive outliers'.

ABSTRACT: We explore which management texts and associated knowledges are found in a major public... more ABSTRACT: We explore which management texts and associated knowledges are found in a major public services field: English health care. We initially wondered whether Evidence Based Management based texts might be present but we found few such examples. Instead, we found management texts written by authors from American business school and management consultancies. We argue their ready diffusion relates to two macro level forces: (i) the influence of the underlying political economy of public services reform and (ii) a strongly developed Business School/management consulting knowledge nexus. This macro perspective theoretically complements existing explanations operating at the meso or middle level of analysis which examine diffusion processes within the public services field, and also the more micro literature which focusses on agency from individual knowledge leaders.

This report is based on a research project funded by the GMC/ESRC Public Services Programme entit... more This report is based on a research project funded by the GMC/ESRC Public Services Programme entitled „The Visible and Invisible Performance Effects of Transparency in Professional regulation‟. The research compared the effects of regulation for doctors with developing regulation for psychotherapists and counsellors (as outlined in the 2007 White Paper „Trust, Assurance and Safety: The regulation of health professionals‟).

"Purpose – The purpose of this paper is to explore general practitioners' (GPs') and psychiatrist... more "Purpose – The purpose of this paper is to explore general practitioners' (GPs') and psychiatrists' views and experiences of transparent forms of medical regulation in practice, as well as those of medical regulators and those representing patients and professionals.

Design/methodology/approach – The research included interviews with GPs, psychiatrists and others involved in medical regulation, representing patients and professionals. A qualitative narrative analysis of the interviews was then conducted.

Findings – Narratives suggest rising levels of complaints, legalisation and blame within the National Health Service (NHS). Three key themes emerge. First, doctors feel “guilty until proven innocent” within increasingly legalised regulatory systems and are consequently practising more defensively. Second, regulation is described as providing “spectacular transparency”, driven by political responses to high profile scandals rather than its effects in practice, which can be seen as a social defence. Finally, it is suggested that a “blame business” is driving this form of transparency, in which self-interested regulators, the media, lawyers, and even some patient organisations are fuelling transparency in a wider culture of blame.

Research limitations/implications – A relatively small number of people were interviewed, so further research testing the findings would be useful.

Practical implications – Transparency has some perverse effects on doctors' practice.

Social implications – Rising levels of blame has perverse consequences for patient care, as doctors are practicing more defensively as a result, as well as significant financial implications for NHS funding.

Originality/value – Transparent forms of regulation are assumed to be beneficial and yet little research has examined its effects in practice. In this paper we highlight a number of perverse effects of transparency in practice."

Higher Education Quarterly

Leadership development (LD) activity and its effectiveness has not been explored rigorously acros... more Leadership development (LD) activity and its effectiveness has not been explored rigorously across changing university settings globally. As Higher Education (HE) settings change radically throughout the world, HE professionals are operating in more uncertain environments, and leaders are taking increasingly complex and diverse approaches to their leadership roles. LD activities therefore become important in supporting this highly complex context, yet little is known in the literature about LD and its impact in HE. We examine peer-reviewed work on LD in HE settings globally to understand what may be learned about its content, processes, outcomes and impact. Our results suggest the current literature is small-scale, fragmented and often theoretically weak, with many different and co-existing models, approaches and methods, and little consensus on what may be suitable and effective in the HE context. We reflect on this state of play and develop a novel theoretical approach for designing LD activity in HEIs.

Health research policy and systems / BioMed Central, Jan 19, 2016

Global investment in biomedical research has grown significantly over the last decades, reaching ... more 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, mak...

In this article, we discuss temporal work and temporal politics situated between groups with diff... more In this article, we discuss temporal work and temporal politics situated between groups with different temporal orientations, arguing that attention needs to be paid to covert and unarticulated silent politics of temporal work. Drawing on a case study of a management consultancy project to redesign public health care, we explain how unarticulated temporal interests and orientations shape the construction of problems, which, in turn, legitimate tasks and time frames. We also show how task and time frames are temporarily fixed and imposed through boundary objects, and the way these may then be reinterpreted and co-opted to deflect pressure to change. Thus, we argue, unarticulated, covert and political temporal interdynamics produce expedient provisional temporal settlements, which resolve conflict in the short-term, while perpetuating it in the longer run.

As medical students transition to become trainee doctors, they must confront the potential for ma... more As medical students transition to become trainee doctors, they must confront the potential for making medical errors. In the high stakes environment of medicine, errors can be catastrophic for the patients and for doctors themselves. Doctors have been found to experience guilt, shame, fear, humiliation, loss of confidence, deep concerns about their professional skills and social isolation, effectively becoming the second victim of an error.1 ,2

A number of programmes and practices have been suggested to provide psychological first aid to second victims after an error has occurred.3 Little attention, however, has focused on how medical training can prepare doctors for the inevitability of error, and thus help protect them from potentially severe emotional consequences in the future. The WHO has developed the Patient Safety Curriculum Guide for Medical Schools, which includes training on understanding and learning from mistakes.4 In addition, the case has been made for error management training in which students are encouraged to experience error in safe settings, such as simulation exercises.5 ,6 While these approaches are promising, a more broad-spectrum psychological intervention aimed at changing how students perceive mistakes and cope with setbacks could be advantageous. Research from social psychology suggests a promising intervention that could help assist students in being resilient when encountering difficulties and setbacks.

Organization Studies, 2017

In this article, we discuss temporal work and temporal politics situated between groups with diff... more In this article, we discuss temporal work and temporal politics situated between groups with different temporal orientations, arguing that attention needs to be paid to covert and unarticulated silent politics of temporal work. Drawing on a case study of a management consultancy project to redesign public health care, we explain how unarticulated temporal interests and orientations shape the construction of problems, which, in turn, legitimate tasks and time frames. We also show how task and time frames are temporarily fixed and imposed through boundary objects, and the way these may then be reinterpreted and co-opted to deflect pressure to change. Thus, we argue, unarticulated, covert and political temporal inter-dynamics produce expedient provisional temporal settlements, which resolve conflict in the short-term, while perpetuating it in the longer run.

Emotional-affective aspects of risk work are integral to risk management in many fields, particul... more Emotional-affective aspects of risk work are integral to risk management in many fields, particularly in human service organizations; yet rational notions of risk management often obscure these emotional-affective aspects. In this chapter, we discuss the case of high risk mental healthcare (for people with personality disorders), characterised by both formal and informal risk management systems. Drawing on sociomaterial perspectives, we explore empirically how affective dimensions of routine clinical risk work flow between these formal and informal risk management systems, affecting intersubjective relations and experiences. We show how affect can ‘inflame’ incidents, producing heated interactions that escalate and ‘overflow’ through the risk management technologies, devices and systems intended to contain and manage them. The chapter draws conclusions on dynamics of affective flows and overflows that are present – if less visible – in other areas of risk work.

We discuss the mobilisation of management knowledge in health care, drawing on six qualitative ca... more We discuss the mobilisation of management knowledge in health care, drawing on six qualitative case studies in a diverse range of health care settings. Drawing on theory about management knowledge and practices' 'fit', and emergent theory about 'epistemic stances', we explain how cultural/institutional, political and epistemic fit and clashes between the norms, interests and epistemic stances of different communities affected knowledge mobilisation in these settings. We also highlight the key role of knowledge brokers in 'fitting' knowledge within contexts as part of their own identity work. Yet we note that knowledge brokers' ability to mobilise and fit knowledge depended on having a senior role or senior level support, and credibility/legitimacy with dominant communities. We suggest that our novel concepts of 'epistemic fit' and 'fitting' are useful in explaining the process of knowledge mobilisation, particularly in complex pluralistic health care contexts containing multiple epistemic communities which produce, use and value knowledge in different ways.

Global investment in biomedical research has grown significantly over the last decades, reaching ... more 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.

Leadership development and its effectiveness has not been explored in depth empirically, especial... more Leadership development and its effectiveness has not been explored in depth empirically, especially across university settings. It is therefore timely that the Leadership Foundation has sought to invest in exploring what is known in the area of the impact of leadership development in higher education settings.

Our review is structured thematically and led by the five stated objectives of the commissioned work namely:

1. To identify promising leadership interventions applied in UK higher education that have a reliable evidence base and/or are theoretically informed.

2. To provide clarification on the conceptual and theoretical lenses applied to leadership and leadership development in the higher education sector and how these have developed over time, with reference to developments in related knowledge intensive sectors and settings.

3. To outline a conceptual framework for thinking about leadership development in higher education at different organisational levels and across institutional contexts.

4. To identify any metrics and/or tools currently used to evaluate the effectiveness and impact of leadership interventions, which could assist the Leadership Foundation in generating its own leadership development metrics in future.

5. To identify gaps in the literature on leadership and leadership development in higher education and make suggestions for future research.

The team leading this review have many years’ experience researching different aspects of leadership in public sector organisations, mainly but not exclusively in complex healthcare settings. Some of the team are also involved in designing and delivering leadership development activities more broadly.

We adopted a rigorous review methodology that drew on a diverse range of information sources - such as leadership texts – as well as previous literature reviews that had adopted looser approaches. Our approach was pragmatic and question driven, with due attention paid to the quality of the literature and appropriate inclusion and exclusion criteria.

In summary, the current literature on leadership development approaches in UK higher education appears small scale, fragmented and often theoretically weak, with many different models, approaches and methods co-existing with little clear pattern of consensus formation. The report highlights a paradox. The higher education sector is a “knowledge industry” but has a relatively poor record of investing in studying its own effectiveness.

One problem we identified was that leadership development was often seen as synonymous with leader development. We suggest the need to develop a broader conceptualisation of what leadership and leadership development is in higher education settings that moves beyond individual leaders and which considers leadership processes in higher education settings in more distributed, relational and contextual terms.

It is difficult to measure a leadership development programme impact if you are not clear about the definition of the nature of leadership development processes in higher education settings in the first place. In the studies we reviewed on leadership evaluation and metrics there appears to be no boundary that can be easily drawn around possible fields of measurement of higher education development programmes. Studies varied according to whether they are measuring the degree of changes in individuals, changes in the effectiveness of groups to which the leaders belong or wider forms of organisational change.

Published by the Leadership Foundation for Higher Education, London

http://www.lfhe.ac.uk/en/research-resources/publications/index.cfm/S5-03

This article explores contrasting forms of ‘knowledge leadership’ in mobilising management resear... more This article explores contrasting forms of ‘knowledge leadership’ in mobilising management research into organizational practice. Drawing on a Foucauldian perspective on power-knowledge, we introduce three axes of power-knowledge relations, through which we analyse knowledge leadership practices. We present empirical case study data focused on ‘polar cases’ of managers engaged in mobilising management research in six research-intensive organizations in the UK healthcare sector. We find that knowledge leadership involves agentic practices through which managers strive to actively become the knowledge object – personally transposing, appropriating or contending management research. This article contributes to the literature by advancing the concept of knowledge leadership in the work of mobilising management research into organizational practice.

Academy of Management Proceedings, 2014

Mobilizing research-based management knowledge into practice is an important, yet elusive dimensi... more Mobilizing research-based management knowledge into practice is an important, yet elusive dimension of a developing knowledge economy. This paper introduces and explores empirically knowledge leadership as an important but uncommon process for mobilizing knowledge into practice. Drawing on a large, comparative and processual research study of six prestigious and diverse knowledge-intensive organizations, operating in the UK health knowledge economy, we trace the knowledge leadership work of managers and clinical leaders as 'positive outliers'.

ABSTRACT: We explore which management texts and associated knowledges are found in a major public... more ABSTRACT: We explore which management texts and associated knowledges are found in a major public services field: English health care. We initially wondered whether Evidence Based Management based texts might be present but we found few such examples. Instead, we found management texts written by authors from American business school and management consultancies. We argue their ready diffusion relates to two macro level forces: (i) the influence of the underlying political economy of public services reform and (ii) a strongly developed Business School/management consulting knowledge nexus. This macro perspective theoretically complements existing explanations operating at the meso or middle level of analysis which examine diffusion processes within the public services field, and also the more micro literature which focusses on agency from individual knowledge leaders.

This report is based on a research project funded by the GMC/ESRC Public Services Programme entit... more This report is based on a research project funded by the GMC/ESRC Public Services Programme entitled „The Visible and Invisible Performance Effects of Transparency in Professional regulation‟. The research compared the effects of regulation for doctors with developing regulation for psychotherapists and counsellors (as outlined in the 2007 White Paper „Trust, Assurance and Safety: The regulation of health professionals‟).

"Purpose – The purpose of this paper is to explore general practitioners' (GPs') and psychiatrist... more "Purpose – The purpose of this paper is to explore general practitioners' (GPs') and psychiatrists' views and experiences of transparent forms of medical regulation in practice, as well as those of medical regulators and those representing patients and professionals.

Design/methodology/approach – The research included interviews with GPs, psychiatrists and others involved in medical regulation, representing patients and professionals. A qualitative narrative analysis of the interviews was then conducted.

Findings – Narratives suggest rising levels of complaints, legalisation and blame within the National Health Service (NHS). Three key themes emerge. First, doctors feel “guilty until proven innocent” within increasingly legalised regulatory systems and are consequently practising more defensively. Second, regulation is described as providing “spectacular transparency”, driven by political responses to high profile scandals rather than its effects in practice, which can be seen as a social defence. Finally, it is suggested that a “blame business” is driving this form of transparency, in which self-interested regulators, the media, lawyers, and even some patient organisations are fuelling transparency in a wider culture of blame.

Research limitations/implications – A relatively small number of people were interviewed, so further research testing the findings would be useful.

Practical implications – Transparency has some perverse effects on doctors' practice.

Social implications – Rising levels of blame has perverse consequences for patient care, as doctors are practicing more defensively as a result, as well as significant financial implications for NHS funding.

Originality/value – Transparent forms of regulation are assumed to be beneficial and yet little research has examined its effects in practice. In this paper we highlight a number of perverse effects of transparency in practice."

Is or should management be Evidence Based? We here contribute to the Evidence Based Management (E... more Is or should management be Evidence Based? We here contribute to the Evidence Based Management (EBMgt) debate which has hitherto (paradoxically) been dominated by commentary and opinion rather than empirical evidence. Health care organizations have here been held up as strategic sites, given the legacy of and possible spillover from Evidence Based Medicine (EBM). But what kind of management knowledges do they use in practice? We adduce comparative case study data drawn from a range of six major UK health care organizations which explores various management knowledges which have been (at least partially) absorbed. We find a wide range of diverse and even competing knowledges in use: the image of the 'Tower of Babel' conveys the many different languages spoken. Such diversity makes key conventions of the EBM/EMgt movement (hierarchy of evidence; systematic review) deeply problematic. Can we get beyond this Tower of Babel and rethink EBMgt? We do not wish to abandon EBMgt, but call for a modest and pluralist EBMgt project which is multi lingual and able to handle theoretical diversity, for example using narrative rather than systematic reviews.

Oxford University Press, 2018

While the implementation of evidence-based medicine guidelines is well studied, there has been li... more While the implementation of evidence-based medicine guidelines is well studied, there has been little investigation into the extent to which a parallel evidence-based management movement has been influential within health care organizations. This book explores the various management knowledges and associated texts apparent in English health care organizations, and considers how the local reception of these texts was influenced by the macro level political economy of public services reform evident during the period of the politics of austerity.

The research outlined in this volume shows that very few evidence-based management texts are apparent within health care organizations, despite the influence of certain knowledge producers, such as national agencies, think tanks, management consultancies, and business schools in the industry. Bringing together the often disconnected academic literature on management knowledge and public policy, the volume addresses the ways in which preferred management knowledges and texts in these publicly funded settings are sensitive to the macro level political economy of public services reform, offering an empirically grounded critique of the evidence-based management movement.