management structures evolved with undermining of autonomous discretion of member professionals, with silencing of their input into management decisions, with dismissal of long-time loyal staff, and with rigorous performance monitoring of remaining employees, focusing on narrow measures of attaining financial targets. 6 Over the same period, managerialism increasingly spread from the corporate business world to hospitals, universities, charities and other public organizations across the Commonwealth and beyond. In hospitals and health care, power shifted from physicians to managers, and institutional values changed from compassionate patient care to budgetary efficiencies. 7, 8 Some categories of patients- once viewed as integral to the institutional mission for providing compassionate care- were relabeled as financial burdens to the organization. In universities, managerialism produced suppression of dissent and barriers to speaking out without management permission, an enormous erosion of traditional academic freedom. 9-11
Komesaroff et al. then used their organization, the Royal Australasian College of Physicians( RACP), as a case study in managerialism and its consequences. The authors describe RACP management changes into a managerial format from 2007 on, which were called“ corporatization” internally. Paid managers of the college replaced elected physician committees, and some committees, such as ethics and therapeutics, were abolished. The representative nature of the RACP board was eliminated, and a“ nominating committee” from management decided who could stand for election. Salaries of managers were no longer disclosed to members. The authors cite the consequences to be substantial, with an undermining of staff morale and sharp escalation of turnover. Physician members came to express open hostility toward the College hierarchy, with some actively discussing steps to secede, and some filing lawsuits.
Komesaroff and co-authors conclude by asking if the“ scourge of managerialism” can be reversed, and they offer these suggestions for remedies:( 1) return the college to its original mission of communication among physicians for better patient care;( 2) eliminate management secrecy and nonaccountability to physician members;( 3) restore respect for contrary views; and( 4) reinstate and re-empower physician-led committees. Their conclusion expresses uncertainty as to whether these changes can happen. They also question if the damage of managerialism to larger institutions, such as the public hospitals and universities of the Commonwealth, can be reversed, given the widespread penetration of managerialism and the incentives involved. 12 Even if so, they predict that the destructive effects will linger for years.
References
1. Komesaroff PA, Kerridge IH, Isaacs D, Brooks PM. The scourge of managerialism and the Royal Australasian College of Physicians. Med J Aust. 2015; 202:519-21.
2. Griffin L. Medical titanic. Louisville Med. 2016; 64( 2): 29-30.
3. Roberts JL. Unhappy doctors make for unhappy patients. Louisville Med. 2016; 64( 3): 5.
4. Enteman WF. Managerialism: the emergence of a new ideology. Madison: University of Wisconsin Press, 1993.
5. Cunliffe AL. A very short, fairly interesting and reasonably cheap book about management. London: Sage Publications, 2009.
6. Simmons J. Managing in the post-managerialist era: towards socially responsible corporate governance. Management Decision 2004; 42:601-611.
7. Alvesson M, Willmott H, editors. Critical management studies. London: Sage Publications, 1992.
8. Pollitt C. Managerialism and the public services: the Anglo-American experience. Oxford: Blackwell, 1993.
9. Preston DS. Managerialism and the post-enlightenment crisis of the British university. Educational Philosophy and Theory 2001; 33:343-363.
10. Saunders M. The madness and malady of managerialism. Quadrant 2006: Mar: 9-17.
11. Deem R. Brehony KJ. Management as ideology: the case of“ new managerialism” in higher education. Oxford Review of Education 2005; 31:217-235.
12. Klikauer T. Managerialism: critique of an ideology. Basingstoke: Palgrave Macmillan, 2013.
Dr. Tobin is a professor at the University of Louisville School of Medicine, Department of Surgery, Division of Plastic and Reconstructive Surgery. He practices with UofL Physicians-Plastic and Reconstructive Surgery.
Public, educational and medical institutions everywhere would be well advised to review the experience and opinions of Komesaroff et al. and reflect on the phenomena and concerns they address.
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