'Managing the cracks': management development for health care interfaces.
The realm of public policy (including health policy) is, in many ways, more complex than that of decision-making within the corporate organisations found in the private sector. The range of stakeholders is generally wider; many of the ways of influencing action are more subtle and indirect; and, arrangements for representation, accountability and consultation are correspondingly more elaborate. A future of this complexity in healthcare systems is the presence of numerous organisational and managerial interfaces. The paper considers three key sectors and the interfaces between them: primary health care, hospital care, and community care. Proposals for reforming the British National Health Service and community care services are destined to multiply the interfaces to be managed since they are predicated upon a split between purchasing services and providing them. The intention is to encourage a plurality of providers who will compete for contracts. The paper argues that the challenge posed by interface management is probably greater than any other in healthcare management. The requisite skills for successful interface management are reviewed. The paper concludes that these network skills are in short supply and that those responsible for management development in the NHS must tackle this lacuna as a matter of some urgency.
Hunter
D J
DJ
Nuffield Institute for Health Services Studies, University of Leeds, LS2 9PL, England.
D000288:Administrative Personnel / Q000193:education*; D003153:Community Health Services / Q000458:organization & administration; D006779:Hospitals, Public / Q000458:organization & administration; D007373:Interinstitutional Relations; D010559:Personnel Management; D011320:Primary Health Care / Q000458:organization & administration; D013192:Staff Development; D013222:State Medicine / Q000458:organization & administration*; D006113:United Kingdom