Are external management consultancies effective in healthcare improvement, do they reflect value for money and what are the alternative models?

Despite the increasing use and costs associated with external management consultancy for healthcare improvement, there is a paucity of formal evaluations examining impact. This paper aims to: (i) discuss the potential benefits and disadvantages of external consultancies in addressing complex healthcare challenges and delivering healthcare improvement in Australia; and (ii) explore potential alternative models, including internal consultancy and hybrid models delivered through platforms of collaborative expertise. We propose that the substantive reliance on high cost external management consultancies without demonstrating value or benefit, is unsustainable.

[The status of the medical profession: reinforced or challenged by the new public management?].

This article aims to assess if the status of the medical profession has been reinforced or weakened with the new public management. With this purpose, it collects the opinion of two international experts regarding situation in the United Kingdom, in order to apply some lessons to the Spanish case. Both agree that, far from losing status and power with the healthcare reform, the medical profession has protected its status and autonomy against other social agents such as managers, politicians and patients.

Medicine and management in European hospitals: a comparative overview.

Background: Since the early 1980s all European countries have given priority to reforming the management of health services. A distinctive feature of these reforms has also been the drive to co-opt professionals themselves into the management of services, taking on full time or part time (hybrid) management or leadership roles. However, although these trends are well documented in the literature, our understanding of the nature and impact of reforms and how they are re-shaping the relationship between medicine and management remains limited.

Clinicians on the board: what difference does it make?

Around the world clinical professionals have increased their involvement in the management of health services. However the evidence to suggest that these changes will lead to improved performance remains fragmented. In this paper we address this matter focussing on the impact of clinicians appointed to the boards of directors of English NHS hospital trusts.

Supplier behaviour and public contracting in the English agency nursing market.

The worldwide expansion in the use of private firms to deliver public services and infrastructure has promoted a substantial literature on public sector contract and relationship management. This literature is currently dominated by the notion that supplier relationships should be based upon trust. Less prominent are more sceptical approaches that emphasize the need to assiduously manage potential supplier exploitation and opportunism.

Cardiovascular magnetic resonance in mild to moderate clozapine-induced myocarditis: is there a role in the absence of electrocardiographic and echocardiographic abnormalities?

Clozapine is an atypical, neuroleptic medication that can cause myocarditis. While the "gold standard" for diagnosis of myocarditis is perceived to be via myocardial biopsy, cardiovascular magnetic resonance (CMR) has also proven its utility in this respect, primarily through its ability to detect myocardial scar by late-gadolinium enhancement (LGE). Until recently, however, clozapine-induced myocarditis specifically has not been known to be associated with LGE on CMR.

Medicine and management in a comparative perspective: the case of Denmark and England.

In health systems around the world the current trend has been for doctors to increase their participation in management. This has been taken to imply a common process of re-stratification with new divisions emerging between medical elites and the rank and file. However, our understanding of this change remains limited and it is open to question just how far one can generalize.