This gap in mutual understanding was highlighted in a survey of 850 hospital staff which revealed a range of profession-based attitudes and beliefs. The study revealed significant differences in the beliefs of medical, management and nursing staff as to the degree to which clinical decision-making should consider resources issues and, thus, the extent to which clinicians should be held responsible for the resource implications of their practices. Similarly, there were significant differences in the degree to which different groups believed that work process control structures and methods, for example, protocols and clinical pathways, should be applied to clinical work. In addition, service leaders in quality, human resources and finance are involved in the decision-making teams. This team approach has been successfully applied in strategic planning and business planning in Mental Health Services.
Decisions balance the requirements of both clinicians and managers.
A multidisciplinary approach to decision-making and service delivery. Wide promulgation of financial and output information such that staff are aware of issues for the business. This represents a significant shift in thinking as, historically, systems and behaviour in medicine were not necessarily client-oriented, ie, designed to assist client access, client needs, etc. A Concept of Clinical Management Partnerships As outlined above, revised management structures in some clinical units in Community and Mental Health Services have resulted in a situation where the Service Manager and Clinical Coordinator are jointly accountable for the management of that service, for example, in Health Services for Older People, Mental Health Services. Effective clinical management partnerships are based on clear delineation of responsibility.