Article

Rethinking clinical organisational structures: an attitude survey of doctors, nurses and allied health staff in clinical directorates.

Centre for Clinical Governance Research in Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
Journal of Health Services Research & Policy (impact factor: 1.73). 02/2005; 10(1):10-7.
Source: PubMed

ABSTRACT To examine assumptions made by proponents and critics of clinical directorate (CD) structures in hospitals. Proponents argue that CDs are supported by the health professionals who constitute them and confer organisational and clinical benefits compared with traditional structural configurations. Critics deny these benefits and suggest CDs can compromise clinicians by incorporating them into management, to their cost. We investigated the attitudes of health professionals working in CDs to gather and consider evidence for these claims.
A questionnaire survey of 227 health professionals (78 doctors, 89 nurses and 60 allied health) in two large hospitals in Australia that had implemented CDs three years previously.
Respondents were more negative than positive about CDs. Significant attitudinal differences were found between professions. Doctors were the most negative and held their attitudes with the greatest certainty and intensity. Allied health staff were the most positive but their attitudes tended to lack strength or certainty. Nurses' attitudes were polarised and intense but more positive than were doctors'. Increased organisational politics was cited by 58% of respondents as CDs' most frequent effect, followed by improved accountability (48%) and dumping hard decisions on staff (39%). Only 26% thought patient care had improved.
Clinical directorates were designed to promote team approaches and to improve patient care delivery, but the results call for a rethink of what can be expected from structural reforms in organisations.

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Keywords

227 health professionals
 
78 doctors
 
89 nurses
 
Allied health staff
 
attitudes
 
clinical benefits
 
clinical directorate
 
Clinical directorates
 
frequent effect
 
Increased organisational politics
 
lack strength
 
large hospitals
 
Nurses' attitudes
 
organisations
 
patient care
 
patient care delivery
 
Significant attitudinal differences
 
structural reforms
 
team approaches
 
traditional structural configurations