The lived experience of health service managers, their perceptions of the health system and the health management role

Abstract

Health managers are central to, and responsible for, the implementation of health system reform in Australia. There has been little research in the Australian and New Zealand context that describes, from the health managers' perspectives, their perceptions of the impact of the changing health system on their role. This qualitative study utilises a hermeneutical phenomenological approach to explore how health managers perceive and undertake their role. Semi-structured interviews were conducted with 19 health managers across Australia and New Zealand. The interviews explored why and how the participants became health managers, how they learned the role, the challenges they faced and are facing and how they think health systems might be better organised and managed. This study uses an eclectic Theoretical Framework. The framework was adopted to help understand the influence of change through: complexity theories, as synthesised by Dann (2006) and applied in healthcare by Kernick (2003) and Anderson and McDaniel (2000); neo-institutional theory and the typology of archetypes of Greenwood et al. (1993) and Brock (2006); the sensemaking theory of Weick (1993; 1995); and the structural interests theory of Alford (1975). This study found that health managers perceived and described the health system in terms of constant complex change. The change was viewed by the participants in mostly negative terms because of the highly centralised control of bureaucratic and political structural interests that have limited the adaptation and integration within the system. Consequently, their description of the role suggests a major sensemaking focus. Despite the shared negative perception of the health system, the health managers were positive about their role, but held contested and dual views about who should manage based on professional backgrounds. Their motivation in the role is values based, influenced by other managers, good and bad, and by the use of role models and mentors. The study respondents agreed that for health managers to be successful they need highly developed contextual health system knowledge. Health managers favoured work-based informal learning ahead of formal knowledge, even though the latter was credited with providing credibility, confidence and context.