Michael D Fischer

Global investment in biomedical research has grown significantly over the last decades, reaching approximately a quarter of a trillion US dollars in 2010. However, not all of this investment is distributed evenly by gender. It follows, arguably, that scarce research resources may not be optimally invested (by either not supporting the best science or by failing to investigate topics that benefit women and men equitably). Women across the world tend to be significantly underrepresented in research both as researchers and research participants, receive less research funding, and appear less frequently than men as authors on research publications. There is also some evidence that women are relatively disadvantaged as the beneficiaries of research, in terms of its health, societal and economic impacts. Historical gender biases may have created a path dependency that means that the research system and the impacts of research are biased towards male researchers and male beneficiaries, mak...

As medical students transition to become trainee doctors, they must confront the potential for making medical errors. In the high stakes environment of medicine, errors can be catastrophic for the patients and for doctors themselves. Doctors have been found to experience guilt, shame, fear, humiliation, loss of confidence, deep concerns about their professional skills and social isolation, effectively becoming the second victim of an error.1 ,2

A number of programmes and practices have been suggested to provide psychological first aid to second victims after an error has occurred.3 Little attention, however, has focused on how medical training can prepare doctors for the inevitability of error, and thus help protect them from potentially severe emotional consequences in the future. The WHO has developed the Patient Safety Curriculum Guide for Medical Schools, which includes training on understanding and learning from mistakes.4 In addition, the case has been made for error management training in which students are encouraged to experience error in safe settings, such as simulation exercises.5 ,6 While these approaches are promising, a more broad-spectrum psychological intervention aimed at changing how students perceive mistakes and cope with setbacks could be advantageous. Research from social psychology suggests a promising intervention that could help assist students in being resilient when encountering difficulties and setbacks.

In this article, we discuss temporal work and temporal politics situated between groups with different temporal orientations, arguing that attention needs to be paid to covert and unarticulated silent politics of temporal work. Drawing on a case study of a management consultancy project to redesign public health care, we explain how unarticulated temporal interests and orientations shape the construction of problems, which, in turn, legitimate tasks and time frames. We also show how task and time frames are temporarily fixed and imposed through boundary objects, and the way these may then be reinterpreted and co-opted to deflect pressure to change. Thus, we argue, unarticulated, covert and political temporal inter-dynamics produce expedient provisional temporal settlements, which resolve conflict in the short-term, while perpetuating it in the longer run.

Emotional-affective aspects of risk work are integral to risk management in many fields, particularly in human service organizations; yet rational notions of risk management often obscure these emotional-affective aspects.  In this chapter, we discuss the case of high risk mental healthcare (for people with personality disorders), characterised by both formal and informal risk management systems.  Drawing on sociomaterial perspectives, we explore empirically how affective dimensions of routine clinical risk work flow between these formal and informal risk management systems, affecting intersubjective relations and experiences.  We show how affect can ‘inflame’ incidents, producing heated interactions that escalate and ‘overflow’ through the risk management technologies, devices and systems intended to contain and manage them.  The chapter draws conclusions on dynamics of affective flows and overflows that are present – if less visible – in other areas of risk work.

We discuss the mobilisation of management knowledge in health care, drawing on six qualitative case studies in a diverse range of health care settings. Drawing on theory about management knowledge and practices' 'fit', and emergent theory about 'epistemic stances', we explain how cultural/institutional, political and epistemic fit and clashes between the norms, interests and epistemic stances of different communities affected knowledge mobilisation in these settings. We also highlight the key role of knowledge brokers in 'fitting' knowledge within contexts as part of their own identity work. Yet we note that knowledge brokers' ability to mobilise and fit knowledge depended on having a senior role or senior level support, and credibility/legitimacy with dominant communities. We suggest that our novel concepts of 'epistemic fit' and 'fitting' are useful in explaining the process of knowledge mobilisation, particularly in complex pluralistic health care contexts containing multiple epistemic communities which produce, use and value knowledge in different ways.

Global investment in biomedical research has grown significantly over the last decades, reaching approximately a quarter of a trillion US dollars in 2010. However, not all of this investment is distributed evenly by gender. It follows, arguably, that scarce research resources may not be optimally invested (by either not supporting the best science or by failing to investigate topics that benefit women and men equitably). Women across the world tend to be significantly underrepresented in research both as researchers and research participants, receive less research funding, and appear less frequently than men as authors on research publications. There is also some evidence that women are relatively disadvantaged as the beneficiaries of research, in terms of its health, societal and economic impacts. Historical gender biases may have created a path dependency that means that the research system and the impacts of research are biased towards male researchers and male beneficiaries, making it inherently difficult (though not impossible) to eliminate gender bias. In this commentary, we – a group of scholars and practitioners from Africa, America, Asia and Europe – argue that gender-sensitive research impact assessment could become a force for good in moving science policy and practice towards gender equity. Research impact assessment is the multidisciplinary field of scientific inquiry that examines the research process to maximise scientific, societal and economic returns on investment in research. It encompasses many theoretical and methodological approaches that can be used to investigate gender bias and recommend actions for change to maximise research impact. We offer a set of recommendations to research funders, research institutions and research evaluators who conduct impact assessment on how to include and strengthen analysis of gender equity in research impact assessment and issue a global call for action.

Leadership development and its effectiveness has not been explored in depth empirically, especially across university settings. It is therefore timely that the Leadership Foundation has sought to invest in exploring what is known in the area of the impact of leadership development in higher education settings.

Our review is structured thematically and led by the five stated objectives of the commissioned work namely:

1. To identify promising leadership interventions applied in UK higher education that have a reliable evidence base and/or are theoretically informed.

2. To provide clarification on the conceptual and theoretical lenses applied to leadership and leadership development in the higher education sector and how these have developed over time, with reference to developments in related knowledge intensive sectors and settings.

3. To outline a conceptual framework for thinking about leadership development in higher education at different organisational levels and across institutional contexts.

4. To identify any metrics and/or tools currently used to evaluate the effectiveness and impact of leadership interventions, which could assist the Leadership Foundation in generating its own leadership development metrics in future.

5. To identify gaps in the literature on leadership and leadership development in higher education and make suggestions for future research.

The team leading this review have many years’ experience researching different aspects of leadership in public sector organisations, mainly but not exclusively in complex healthcare settings. Some of the team are also involved in designing and delivering leadership development activities more broadly.

We adopted a rigorous review methodology that drew on a diverse range of information sources - such as leadership texts – as well as previous literature reviews that had adopted looser approaches. Our approach was pragmatic and question driven, with due attention paid to the quality of the literature and appropriate inclusion and exclusion criteria.

In summary, the current literature on leadership development approaches in UK higher education appears small scale, fragmented and often theoretically weak, with many different models, approaches and methods co-existing with little clear pattern of consensus formation. The report highlights a paradox. The higher education sector is a “knowledge industry” but has a relatively poor record of investing in studying its own effectiveness.

One problem we identified was that leadership development was often seen as synonymous with leader development. We suggest the need to develop a broader conceptualisation of what leadership and leadership development is in higher education settings that moves beyond individual leaders and which considers leadership processes in higher education settings in more distributed, relational and contextual terms.

It is difficult to measure a leadership development programme impact if you are not clear about the definition of the nature of leadership development processes in higher education settings in the first place. In the studies we reviewed on leadership evaluation and metrics there appears to be no boundary that can be easily drawn around possible fields of measurement of higher education development programmes. Studies varied according to whether they are measuring the degree of changes in individuals, changes in the effectiveness of groups to which the leaders belong or wider forms of organisational change.

Published by the Leadership Foundation for Higher Education, London

http://www.lfhe.ac.uk/en/research-resources/publications/index.cfm/S5-03

This article explores contrasting forms of ‘knowledge leadership’ in mobilising management research into organizational practice. Drawing on a Foucauldian perspective on power-knowledge, we introduce three axes of power-knowledge relations, through which we analyse knowledge leadership practices. We present empirical case study data focused on ‘polar cases’ of managers engaged in mobilising management research in six research-intensive organizations in the UK healthcare sector. We find that knowledge leadership involves agentic practices through which managers strive to actively become the knowledge object – personally transposing, appropriating or contending management research. This article contributes to the literature by advancing the concept of knowledge leadership in the work of mobilising management research into organizational practice.

ABSTRACT: We explore which management texts and associated knowledges are found in a major public services field: English health care. We initially wondered whether Evidence Based Management based texts might be present but we found few such examples. Instead, we found management texts written by authors from American business school and management consultancies. We argue their ready diffusion relates to two macro level forces: (i) the influence of the underlying political economy of public services reform and (ii) a strongly developed Business School/management consulting knowledge nexus. This macro perspective theoretically complements existing explanations operating at the meso or middle level of analysis which examine diffusion processes within the public services field, and also the more micro literature which focusses on agency from individual knowledge leaders.

This report is based on a research project funded by the GMC/ESRC Public Services Programme entitled „The Visible and Invisible Performance Effects of Transparency in Professional regulation‟. The research compared the effects of regulation for doctors with developing regulation for psychotherapists and counsellors (as outlined in the 2007 White Paper „Trust, Assurance and Safety: The regulation of health professionals‟).

"Purpose – The purpose of this paper is to explore general practitioners' (GPs') and psychiatrists' views and experiences of transparent forms of medical regulation in practice, as well as those of medical regulators and those representing patients and professionals.

Design/methodology/approach – The research included interviews with GPs, psychiatrists and others involved in medical regulation, representing patients and professionals. A qualitative narrative analysis of the interviews was then conducted.

Findings – Narratives suggest rising levels of complaints, legalisation and blame within the National Health Service (NHS). Three key themes emerge. First, doctors feel “guilty until proven innocent” within increasingly legalised regulatory systems and are consequently practising more defensively. Second, regulation is described as providing “spectacular transparency”, driven by political responses to high profile scandals rather than its effects in practice, which can be seen as a social defence. Finally, it is suggested that a “blame business” is driving this form of transparency, in which self-interested regulators, the media, lawyers, and even some patient organisations are fuelling transparency in a wider culture of blame.

Research limitations/implications – A relatively small number of people were interviewed, so further research testing the findings would be useful.

Practical implications – Transparency has some perverse effects on doctors' practice.

Social implications – Rising levels of blame has perverse consequences for patient care, as doctors are practicing more defensively as a result, as well as significant financial implications for NHS funding.

Originality/value – Transparent forms of regulation are assumed to be beneficial and yet little research has examined its effects in practice. In this paper we highlight a number of perverse effects of transparency in practice."

We explore how doctors, psychotherapists and counsellors in the UK react to regulatory transparency, drawing on qualitative research involving 51 semi-structured interviews conducted during 2008–10. We use the concept of ‘reactivity mechanisms’ (Espeland & Sauder, 2007) to explain how regulatory transparency disrupts practices through simplifying and decontextualizing them, altering practitioners’ reflexivity, leading to defensive forms of practice. We make an empirical contribution by exploring the impact of transparency on doctors compared with psychotherapists and counsellors, who represent an extreme case due to their uniquely complex practice, which is particularly affected by this form of regulation. We make a contribution to knowledge by developing a model of reactivity mechanisms, which explains how clinical professionals make sense of media and professional narratives about regulation in ways that produce emotional reactions and, in turn, defensive reactivity to transparency.

Have generic management texts and associated knowledges now extensively diffused into public services organizations? If so, why? Our empirical study of English healthcare organizations detects an extensive presence of such texts. We argue that their ready diffusion relates to two macro-level forces: (i) the influence of the underlying political economy of public services reform and (ii) a strongly developed business school/management consulting knowledge nexus. This macro perspective theoretically complements existing explanations from the meso or middle level of analysis which examine diffusion processes within the public services field, and also more micro literature which focuses on agency from individual knowledge leaders.

This article explores and explains escalating contradictions between two modes of clinical risk management which resisted hybridisation.  Drawing on a Foucauldian perspective, these two modes – ethics-orientated and rules-based – are firstly characterised in an original heuristic we develop to analyse clinical risk management systems.  Some recent sociologically orientated accounting literature is introduced, exploring interactions between accountability and risk management regimes in corporate and organizational settings; much of this literature suggests these systems are complementary or may readily form hybrids.  This theoretical literature is then moved into the related domain of clinical risk management systems, which has been under-explored from this analytic perspective.  We note the rise of rules-based clinical risk management in UK mental health services as a distinct logic from ethics-orientated clinical self-regulation.  Longitudinal case study data is presented, showing contradiction and escalating contest between ethics-orientated and rules-based systems in a high-commitment mental health setting, triggering a crisis and organizational closure.  We explore theoretically why perverse contradictions emerged, rather than complementarity and hybridisation suggested by existing literature.  Interactions between local conditions of strong ideological loading, high emotional and personal involvement, and rising rules-based risk management are seen as producing this contest and its dynamics of escalating and intractable conflict.  The article contributes to the general literature on interactions between different risk management regimes, and reveals specific aspects arising in clinically based forms of risk management.  It concludes by considering some strengths and weaknesses of this Foucauldian framing.

Background: Relatively little is known about how people and groups who function in boundary-spanning positions between different sectors, organisations and professions contribute to improved quality of health care and clinical outcomes.

Objectives: To explore whether or not boundary-spanning processes stimulate the creation and exchange of knowledge between sectors, organisations and professions and whether or not this leads, through better integration of services, to improvements in the quality of care.

Design: A 2-year longitudinal nested case study design using mixed methods.

Setting: An inner-city area in England (‘Coxford’) comprising 26 general practices in ‘Westpark’ and a comparative sample of 57 practices.

Participants: Health-care and non-health-care practitioners representing the range of staff participating in the Westpark Initiative (WI) and patients.

Interventions: The WI sought to improve services through facilitating knowledge exchange and collaboration between general practitioners, community services, voluntary groups and acute specialists during the period late 2009 to early 2012. We investigated the impact of the four WI boundary-spanning teams on services and the processes through which they produced their effects.

Main outcome measures: (1) Quality-of-care indicators during the period 2008–11; (2) diabetes admissions data from April 2006 to December 2011, adjusted for deprivation scores; and (3) referrals to psychological therapies from January 2010 to March 2012.

Data sources: Data sources included 42 semistructured staff interviews, 361 hours of non-participant observation, 36 online diaries, 103 respondents to a staff survey, two patient focus groups and a secondary analyses of local and national data sets.

Results: The four teams varied in their ability to, first, exchange knowledge across boundaries and, second, implement changes to improve the integration of services. The study setting experienced conditions of flux and uncertainty in which known horizontal and vertical structures underwent considerable change and the WI did not run its course as originally planned. Although knowledge exchanges did occur across sectoral, organisational and professional boundaries, in the case of child and family health services, early efforts to improve the integration of services were not sustained. In the case of dementia, team leadership and membership were undermined by external reorganisations. The anxiety and depression in black and minority ethnic populations team succeeded in reaching its self-defined goal of increasing referrals from Westpark practices to the local well-being service. From October to December 2010 onwards, referrals have been generally higher in the six practices with a link worker than in those without, but the performance of Westpark and Coxford practices did not differ significantly on three national quality indicators. General practices in a WI diabetes ‘cluster’ performed better on three of 17 Quality and Outcomes Framework (QOF) indicators than practices in the remainder of Westpark and in the wider Coxford primary care trust. Surprisingly, practices in Westpark, but not in the diabetes cluster, performed better on one indicator. No statistically significant differences were found on the remaining 13 QOF indicators. The time profiles differed significantly between the three groups for elective and emergency admissions and bed-days.

Conclusions: Boundary spanning is a potential solution to the challenge of integrating health-care services and we explored how such processes perform in an ‘extreme case’ context of uncertainty. Although the WI may have been a necessary intervention to enable knowledge exchange across a range of boundaries, it was not alone sufficient. Even in the face of substantial challenges, one of the four teams was able to adapt and build resilience. Implications for future boundary-spanning interventions are identified. Future research should evaluate the direct, measurable and sustained impact of boundary-spanning processes on patient care outcomes (and experiences), as well as further empirically based critiques and reconceptualisations of the socialisation→externalisation→combination→internalisation (SECI) model, so that the implications can be translated into practical ideas developed in partnership with NHS managers.

Funding: The National Institute for Health Research Health Services and Delivery Research programme.

"Despite much work on how clinicians use and enact clinical research, which is now well-known, there is less on healthcare managers' use of management research and how this might be evolving. Earlier work by members of the research team concluded that healthcare management was largely invisible in the Evidence Based Medicine (EBM) arena. So the baseline is one of very limited engagement of healthcare managers with research. The poor uptake of management research by practitioners has been attributed to numerous factors: the fact that academics and managers possess different perceptions and assumptions about knowledge utilization and research; a lack of proven knowledge transfer and dissemination models within academia; divergent institutional incentives and rewards in educational institutions and organisational contexts.  Recently it has been argued that healthcare managers' motivation and ability to access and use management research may (under some circumstances) be increasing from historically low levels, due to the professionalisation of management and a developing high quality knowledge-base. Some studies have shed light on the effects of theories and research deriving from the disciplines of economics and finance on managers'decision-making. However there is a need for empirical research on how healthcare managers, whether general managers or those doctors, nurses and other professionals with clinical as well as managerial responsibilities (called here clinical managers or sometimes 'clinical hybrids'), use the research base of management and organisational knowledge in the decision process. The available literature does not indicate empirical studies of healthcare managers' or clinical hybrids' use of management research, nor how they derive principles from research evidence and translate them into concrete actions to resolve organizational challenges. This project seeks to address this major lacuna.

The study had three main aims.
1. To explore healthcare managers' own responses to the research question: "under what circumstances and how do managers access and use management research-based knowledge in their decision making?". In order to situate the enquiry in terms of managers' day to day practice, this question was operationalised by seeking to understand how managers, engage with management-related knowledge – including, although not exclusively, research-based knowledge.
2. To explore the utilisation of management knowledge in context. This question was addressed by purposively studying the use of management knowledge found being cited and used in some way in the organisations studied. These case settings provide another lens for studying how the two knowledge domains of formal/ codified and experiential/ relational knowledges interact in these settings. What do these sites reveal about how and why research- based management knowledge of different forms may be transposed and used or rejected?
3. What is the value of the action learning set (ALS) as a method of sharing research-based learning and of encouraging and facilitating the uptake and utilization of research-based evidence?

The research design used mixed methods, having a three-phase design, which deliberately explored the boundary between management research and practice. Core to the design was exploring the acquisition and utilisation of knowledge from the field of management /organisation studies in a wide diversity of health-related settings. These were purposively selected for their significance to facets of processes of knowledge production and utilisation in a 21st century health knowledge economy which  has become more diverse and multi-layered and to explore the links between individual motivation, learning and action. The case sites, which were given pseudonyms, were: Beechwell, a Policy Unit; Elmhouse, a Health Care Consultancy; Firgrove, an Academic Health Sciences Centre (AHSC); Mapleshire, a Collaboration for Leadership in Applied Health Research and Care (CLAHRC); Oakmore, an Independent Charitable Trust offering specialist services; Willowton, a Primary Care Trust (PCT).

The research design consisted of three phases: In Phase 1, the unit of analysis was the individual manager. Phase 1 involved 45 interviews with general managers and clinical managers in the sites, who were identified as interested in using management research and knowledge. This phase focused on exploring the individuals' perspectives on what motivated them to seek management knowledge, what search  processes and sources were used, how management knowledge was utilised within their work and finally, what were the main influences of their 'knowledge career' on their management practices. The primary focus of Phase 2 was the utilisation of management knowledge in context. It comprised six in-depth comparative case studies of management knowledge utilisation; 92 interviews were carried out in this phase, making a total of 137 interviews overall. Phase 3 was always classed as 'experimental'. The research protocol states that the ALSs were 'to test and evaluate this form of intervention as a method of sharing research-based learning and of encouraging and facilitating the uptake and utilisation of research based evidence'.

Results: In all the cases, managers were most highly oriented towards knowledge drawn from their own experiences and from others within their own communities of practice. Managers' careers play an important (and previously neglected) role in shaping their orientation to knowledge – including their motivation and willingness to engage with and adapt management texts. Research-based knowledge and particularly management journals appear as the lowest source of interest and influence for most managers. This suggests an interesting and marked tension between two contrasting forms and sources of knowledge domains: a) relationship- and experientially-based knowledge; b) evidence-based management texts and codified knowledge. Some knowledge leaders appear to be accomplished at transposing abstract knowledge into a form useable in a specific organisational context. This was demonstrated in Phase 2, where the importance of the activities and presence of certain knowledge leaders in  transposing the management knowledge was observed. Converting theories and formal evidence into the local management practices involved them in inventiveness and improvisation, not captured by conceptual models of knowledge translation. A wide range of diverse management knowledges in use was found in the sites. Formal management knowledges tended to cluster in two main areas: performance management and productivity/quality improvement represented one group, and approaches to desired organisational change another. Formal management knowledges were often accompanied by more experiential forms; for example, case studies, training and development activities, workshops, mentors, and coaches. The theme of management knowledge transposition appeared important, implying a more far-reaching, non-linear process of transforming knowledge from the field of expertise to the field of practice. Managers often tested out 'evidence based knowledge' in context, re-evaluating the issue and indeed the management knowledge (formal and experiential) that they referenced. The analysis suggests that knowledge leaders are greatly assisted in transposing management knowledge if there are formative spaces where people can step away from their immediate context and engage with a variety of formal management knowledges and the experiences of others. The study of Action Learning Sets confirms and extends understanding of the motivation of individuals to seek new knowledge. It was found in the sets that individuals are driven to look for knowledge when they have a personal commitment and involvement with a work issue. The medium of ALS offers several unique characteristics seemingly not always available to individuals within their own organisations. These include: independent perspectives; credible other professionals whom individuals can consult; and the opportunity to debate topics which cannot be openly discussed inside the organisation.

Conclusions: At the heart of the conclusions is a desire to signal the complexity of the social processes involved in accessing, contextualising and using management knowledge. As noted by others commenting on the field, the results suggest management knowledge is not one unified thing; it rather involves multiple formal and informal aspects. These findings question the assumption that knowledge translation is a linear and rational process. The plurality of knowledge forms (tacit, explicit, embodied, codified) and the proliferation of products and organisations available in the 'knowledge economy' suggests more complex models of knowledge flow and exchange may be timely. The empirical cases demonstrated a plurality and blending/transposing of knowledge sources that gave rise to a non-linear and dynamic picture of management knowledge utilisation; one less congruent with rational accounts of evidence-based knowledge transfer. This concept of knowledge transposition seems to better capture the complexity of the processes observed informing management knowledge use. Finally, it was concluded that Action Learning Sets may be valuable for intermixing codified, experiential and interpersonal knowledges and enabling the crossing of disciplinary and institutional boundaries."

This study identifies the regulatory activities that best support patient safety and enhancement of quality of care, finding that formative spaces for reflective discussion are vital for effective regulation.  Academic researchers at Warwick Business School, University of Oxford Saïd Business School, University of Melbourne, University of Nottingham, and the British School of Osteopathy conducted the research among osteopaths, patients and osteopathic organisations in order to explore the factors that support, encourage or inhibit osteopaths from practising in accordance with the Osteopathic Practice Standards.  Commissioned by the UK General Osteopathic Council,  this study answers the research questions: What regulatory activities best support osteopaths to be able to deliver care and to practice in accordance with the Osteopathic Practice Standards (OPS)? What factors inhibit osteopaths from practising in accordance with OPS? What factors encourage osteopaths to practice in accordance with OPS?  The research included literature reviews, an online survey (completed by 809 osteopaths, 17% of registered osteopaths in the UK), semi-structured interviews with 55 people (including 37 osteopaths) involved in and affected by osteopathic regulation, as well as health professional regulation more broadly.  This research establishes an important evidence base on which to build effective osteopathic regulation and identifies key recommendations where improvements are needed. 

The research reports were published in February 2015 and are available for download.

Main Report: Exploring and explaining the dynamics of osteopathic regulation, professionalism and compliance with standards in practice
Appendix 1: Osteopathy Practice, Profession and Regulation Literature Review
Appendix 2: Regulation Literature Review
Appendix 3: Survey Questionnaire
Appendix 4: Survey Results

This paper describes and analyses the creation and development of an Academic Health Science Centre (AHSC) as a major organizational innovation diffusing in the health knowledge economy, internationally.  Drawing on an institutionalist model utilized in an earlier study of a failed merger in the USA (Kitchener, 2002), we explore empirically why the creation of this new AHSC in the UK produced very different organizational outcomes.  Whereas institutionalist framing predicts ‘sedimented’ instability and repeated contest between managerialist and embedded (and ultimately, dominant) professional logics, the higher levels of clinical-academic engagement in our case exerted ‘upwards’ institutional pressure, creating a more stable, collaborative form.  Our paper challenges and develops the institutionalist model, and explores the possibility of ’counter-colonization’ through a new organizational form invented in the academic-clinical domain.

"This report is based on a research project funded by the GMC/ESRC Public Services Programme entitled ‘The Visible and Invisible Performance Effects of Transparency in Professional regulation’. The research compared the effects of regulation for doctors with developing regulation for psychotherapists and counsellors (as outlined in the 2007 White Paper ‘Trust, Assurance and Safety: The regulation of health professionals’). We summarise here some of the key findings in our study focusing on issues that are relevant to the HPC consultation on the regulation of counsellors and psychotherapists.

First we examine the way that doctors (GPs and psychiatrists) said that current forms of regulation affected their practice. Although their practice and context differ from those of psychotherapists and counsellors, their experience highlights a number of issues and questions about professional regulation, which we believe should be considered in the future regulation of psychotherapists and counsellors. Second, we examine the experiences of psychotherapists and counsellors working in the NHS, voluntary and independent sectors. Although these experiences do not reflect the wider contexts of psychotherapists and counsellors per se, they do shed light on the effects of a more regulated mental health context. Third, we briefly highlight what we regard to be an emerging assemblage of regulatory processes in the field of psychotherapy and counselling. Whilst the question of regulation is ostensibly restricted to the present focus of the HPC PLG, we draw attention to what we believe are important wider forces shaping this process. Finally, we draw conclusions and make some recommendations designed to inform the development of future regulation. We do not claim that the findings outlined in this report are representative of the whole field of psychotherapy and counselling. However our research does reflect how regulation is perceived in different contexts, it may indicate how future regulation would be interpreted and implemented in practice, and suggest some of its potential visible and invisible effects."

While the implementation of evidence-based medicine guidelines is well studied, there has been little investigation into the extent to which a parallel evidence-based management movement has been influential within health care organizations. This book explores the various management knowledges and associated texts apparent in English health care organizations, and considers how the local reception of these texts was influenced by the macro level political economy of public services reform evident during the period of the politics of austerity.

The research outlined in this volume shows that very few evidence-based management texts are apparent within health care organizations, despite the influence of certain knowledge producers, such as national agencies, think tanks, management consultancies, and business schools in the industry. Bringing together the often disconnected academic literature on management knowledge and public policy, the volume addresses the ways in which preferred management knowledges and texts in these publicly funded settings are sensitive to the macro level political economy of public services reform, offering an empirically grounded critique of the evidence-based management movement.