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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