books

Management of health care

Edited by Rosemary StewartAshgate 338 pages£80

This substantial book is just one of more than 30 titles already published in the International Library of Management series. The aim is to bring 'the most important articles in management theory and practice together in one core, definitive series'. The series preface is clear: 'The Library is the definitive series in management studies.' But then come two curious provisos: 'The editors have drawn especially from the Anglo-American tradition' and 'have tended to exclude articles which have been widely reprinted and are generally available'. Lastly, the series promises 'a thought-provoking introduction, which provides a stimulating setting for the chosen articles'.

Regrettably this is not so. I had hoped to gain some insights from one of 'England's most respected manager academics', but the six-page introduction is mechanical and strongly defensive: 'Readers may well reflect how differently they would have approached the task of selecting essays for this volume. The criteria underlying the selection were explained at the start and the reasons for some of the less obvious inclusions have also been explained.'

It's as if Dr Stewart had put together a cookbook of Mrs Beeton's recipes, and based the whole thing around a series of formal dinner parties.

The book consists of 31 papers drawn from 18 different journals and dating from 1978 to 1996, but most are very recent, with 21 selections from the 1990s. They are arranged into five sections: contracts for management, healthcare reforms, service management, performance indicators, and management of professionals.

Some are expected and welcome friends - Maxwell on quality from the BMJ, for example, or David Hawker on doctor-managers as poachers turned gamekeepers from Social Science and Medicine. Others are perhaps less obvious - Caplan on medical advances from Scientific American or Crompton on professions from Work, Employment and Society.

In the tradition of 'academic readers' in these days of cost cutting, the papers are reproduced from their source journals as facsimiles - which means a variety of typefaces, some, such as the reduced BMJ, quite small. There is no proper index, only an index of names - and the only details of the authors are those included in the original article.

The most successful sections, using the publisher's criteria, are the first and second. The material on context brings out the very particular managerial environment of ageing populations, technological advance and the complex inter-relationship of income, housing and health.

The section on health reforms looks at the variety of approaches adopted by governments in the 1980s in the US, UK and other European countries. Many English readers will be familiar with Alain Enthoven's 1991 piece on the NHS which reflected on how his 1985 report for the Nuffield Provincial Hospitals Trust had been seized on by the Conservative government as the core of the reforms of 1989.

The final three sections are drawn only from US or UK services, with all six papers on performance indicators written by UK-based authors. Despite its title the book is far from international. It also draws from the health policy end of the healthcare management spectrum rather than the management end.

One senses that the editor struggled with the selection criteria - and in particular with the need to draw on healthcare-based pieces with long- term relevance. Why is there nothing on gender issues, learning organisations or leadership theory? These would seem to be more generally relevant to the manager in healthcare.

In summary, the book is little more than 31 papers of varying relevance - anyone with access to a good academic library could put together the same set for about half the price.

Tim Scott

Senior fellow, British Association of Medical Managers