books

Published: 09/05/2002, Volume II2, No. 5804 Page 30 31

Managing in Health and Social Care Edited by Vivian Martin and Euan Henderson

Publisher: Routledge.

ISBN: 0415251907. 360 pages.£16.99.

Management in Healthcare By Neil Wheeler and Diana Grice

Publisher: Nelson Thornes.

ISBN: 0748740384. 224 pages.£20.

Evidence-based Management By Rosemary Stewart

Publisher: Radcliffe Medical Press.

ISBN: 1857754581.

176 pages.£19.95.

Ethics, Management and Mythology Rational decision making for health service professionals By Michael Loughlin Publisher: Radcliffe Medical Press.

ISBN: 185775574X.

304 pages.£24.95.

Over the past 20 years, policy initiatives have shifted services out of public sector bureaucracies and into the marketplace.

Bureaucracies designed to deliver equitable services with public probity have been derided as inefficient and captured by professional interests.New modes of governance have gained popularity.

Public sector management theory increasingly draws on private sector concepts.And contemporary healthcare management textbooks reflect the trend towards a flexible workforce with transferable skills, business models of quality improvement and evidence-based practice.

Martin and Henderson and Wheeler and Grice offer 'how to' texts that resonate well with the demands of management in services designed to new public management precepts.The NHS's fast-track, postgraduate management training scheme, delivered by Birmingham University's health services management centre in partnership with De Montford University, uses Martin and Henderson as a set text. It is not hard to see why, as the content conforms closely to the required skills base.

Sections include improving your effectiveness as a manager, developing performance, managing change, planning and managing projects and improving service quality.The structure also lends itself to action-learning approaches as each section provides activities, case studies and key references for further study. If you want to know what future high flyers are reading, and get an insight into your current management behaviour into the bargain, this is a good place to start.

Wheeler and Grice cover similar ground, offering an introduction to managing oneself and the health and social care organisation, aimed at those new to management.

The main difference is in the format.

Each chapter is divided into a theoretical framework to give an overview of relevant literature, then application of the theory via case studies.The management of services across health and social care is increasingly important, and provides a challenge for managers forming networks with provider organisations with different underlying values and methods of working.

While both of the texts discuss the difficulties of working across team boundaries, there is surprisingly little coverage of managing across health and social care.This is an intriguing omission, which will no doubt be rectified in second editions.

Those keen to explore the applicability of 'evidence-based' approaches beyond clinical practice may be interested in Evidencebased Management: a practical guide for health professionals, written in the 'how to'style of popular management textbooks.

It avoids the empiricist excesses of certain factions of the EBP movement in healthcare.You will not find any shrill insistence on a rigid 'hierarchy'of evidence with randomised trials at the apex, regardless of the research question, and the experiential knowledge of others is valued as a source of learning.

While the broader definition of what counts as evidence is welcome, there is a problem in the conceptual framework of the book.Stewart adopts a 'problem-solving'approach.This involves identifying management problems, searching for a solution through existing or new research, and implementing 'the answer' in practice.

Notable difficulties with this include the intractable nature of many management problems and the ambiguity of research evidence, making direct application difficult.

Though less popular in EBP circles, the 'dialogical model', developed by sociologist Anthony Giddens, is a potentially more helpful approach to research use.

This model takes interaction between interest groups as the starting point and views social knowledge as jointly constructed from interaction between researchers, practitioners and managers.

The problem-solving model poses the question 'what is the best way of securing quality improvements?', then seeks to implement the results.A dialogical perspective takes the contexts within which findings are to be implemented directly into account, developing strategies to persuade others of the relevance of research.

There is also confusion over the function of Stewart's text.At times, it seeks to provide guidance on commissioning and implementing research; at others, it distils lessons from research relating to specific areas, such as decision making. It seems to be acting as both a general management text and as a resource guide for evidence-based management approaches.

All the authors share a priestly concern with disseminating received wisdom within the current dominant paradigm, yet there are plenty of prophets to challenge it.Step forward Michael Loughlin and Ethics, Management and Mythology.

Loughlin is a philosopher who takes up the challenge of the new orthodoxy, arguing against uncritical repetition of jargon in favour of critical thinking.He employs a scattergun approach towards currently fashionable targets in healthcare management, including total quality management and private-sector production metaphors.

The book offers a polemical challenge to quality improvement initiatives in the new NHS and the role of managers within it, positioning itself as an antidote to the crop of 'how to' management guides.

He is self-consciously iconoclastic, and occasionally reads like an Old Testament prophet crying in the wilderness. I have a soft spot for iconoclasts.While their refusal to go with the tide of opinion often renders them unfashionable, they are always first to spot the naked emperor.The only problem is that to the iconoclast, all emperors are naked.

To all but the least reflective reader, this book offers a challenging critique of the basis of much contemporary management practice, and I would urge you to engage critically with its implications.

The persistence of 'wicked problems' faced by public and private organisations has seen the further blurring of boundaries between the state and the market, with the emergence of networks of public and private sector agencies pursuing joint goals across boundaries.Examples include collaborations between primary and social care, action zones and the private finance initiative.

Such strategic alliances require complex management in ambiguous environments, requiring a host of new skills.Expect the next generation of management texts to directly address these challenges.