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Hybrid clinical-managers in Kenyan Hospitals : navigating between professional, official and practical norms
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Nzinga, Jacinta, McGivern, Gerry and English, Mike (2019) Hybrid clinical-managers in Kenyan Hospitals : navigating between professional, official and practical norms. Journal of Health Organization and Management, 33 (2). pp. 173-187. doi:10.1108/JHOM-08-2017-0203 ISSN 1477-7266.
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Official URL: https://doi.org/10.1108/JHOM-08-2017-0203
Abstract
Purpose
The purpose of this paper is to explore the way “hybrid” clinical managers in Kenyan public hospitals interpret and enact hybrid clinical managerial roles in complex healthcare settings affected by professional, managerial and practical norms.
Design/methodology/approach
The authors conducted a case study of two Kenyan district hospitals, involving repeated interviews with eight mid-level clinical managers complemented by interviews with 51 frontline workers and 6 senior managers, and 480 h of ethnographic field observations. The authors analysed and theorised data by combining inductive and deductive approaches in an iterative cycle.
Findings
Kenyan hybrid clinical managers were unprepared for managerial roles and mostly reluctant to do them. Therefore, hybrids’ understandings and enactment of their roles was determined by strong professional norms, official hospital management norms (perceived to be dysfunctional and unsupportive) and local practical norms developed in response to this context. To navigate the tensions between managerial and clinical roles in the absence of management skills and effective structures, hybrids drew meaning from clinical roles, navigating tensions using prevailing routines and unofficial practical norms.
Practical implications
Understanding hybrids’ interpretation and enactment of their roles is shaped by context and social norms and this is vital in determining the future development of health system’s leadership and governance. Thus, healthcare reforms or efforts aimed towards increasing compliance of public servants have little influence on behaviour of key actors because they fail to address or acknowledge the norms affecting behaviours in practice. The authors suggest that a key skill for clinical managers in managers in low- and middle-income country (LMIC) is learning how to read, navigate and when opportune use local practical norms to improve service delivery when possible and to help them operate in these new roles.
Originality/value
The authors believe that this paper is the first to empirically examine and discuss hybrid clinical healthcare in the LMICs context. The authors make a novel theoretical contribution by describing the important role of practical norms in LMIC healthcare contexts, alongside managerial and professional norms, and ways in which these provide hybrids with considerable agency which has not been previously discussed in the relevant literature.
| Item Type: | Journal Article | |||||||||
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| Subjects: | R Medicine > R Medicine (General) | |||||||||
| Divisions: | Faculty of Social Sciences > Warwick Business School | |||||||||
| Library of Congress Subject Headings (LCSH): | Clinic managers -- Kenya, Health services administrators -- Kenya | |||||||||
| Journal or Publication Title: | Journal of Health Organization and Management | |||||||||
| Publisher: | Emerald Group Publishing Ltd. | |||||||||
| ISSN: | 1477-7266 | |||||||||
| Official Date: | 28 March 2019 | |||||||||
| Dates: |
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| Volume: | 33 | |||||||||
| Number: | 2 | |||||||||
| Page Range: | pp. 173-187 | |||||||||
| DOI: | 10.1108/JHOM-08-2017-0203 | |||||||||
| Status: | Peer Reviewed | |||||||||
| Publication Status: | Published | |||||||||
| Access rights to Published version: | Open Access (Creative Commons) | |||||||||
| Date of first compliant deposit: | 7 November 2018 | |||||||||
| Date of first compliant Open Access: | 24 April 2019 | |||||||||
| RIOXX Funder/Project Grant: |
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