The University of Southampton
University of Southampton Institutional Repository

Leadership for the systemization of health care: the unaddressed issue in health care reform

Degeling, Pieter and Carr, Adrian (2004) Leadership for the systemization of health care: the unaddressed issue in health care reform Journal of Allergy and Clinical Immunology, 18, (6), pp. 399-414. (doi:10.1108/14777260410569975).

Record type: Article


The case literature strongly suggests that both in England and in Australia health care reforms have had very little impact in terms of “improved performance”. It is in the context of a perceived failure in the implementation of the reforms that an interest has arisen in leadership at the level of individual clinical units (e.g. an orthopaedics unit or birth unit), as the possible “fix” for bridging the promise-performance gap. Drawing upon extensive case studies that highlight the problem and context for appropriate forms of leadership, this paper argues that the appropriate discourse, in terms of leadership in health reform, needs to focus upon the issue of authorization. In making this argument, addresses the current conceptions of leadership that have been advanced in the discourse before offering some case study material that is suggestive of why attention should be focused on the issue of authorization. Illustrates how and why the processes of leading, central to implementing reform, cannot be construed as socially disembodied processes. Rather, leading and following are partial and partisan processes whose potential is circumscribed by participants' position-takings and what is authorized in the institutional settings in which they are located. Argues that the “following” that clinical unit managers could command was shaped by the sub-cultures and “regulatory ideals” with which staff of each profession are involved. In the interests of reform, policy players in health should not be focusing attention solely upon the performative qualities and potential leadership abilities of middle level management, but also on their own performance. They should consider how their actions affect what is authorized institutionally and which sets the scope and limits of the leadership-followership dialectic in clinical settings.

Full text not available from this repository.

More information

Published date: December 2004
Keywords: health services, leadership, organisational performance


Local EPrints ID: 46212
ISSN: 1477-7266
PURE UUID: a2ed5944-38d3-4950-948b-2734530d1a40

Catalogue record

Date deposited: 06 Jun 2007
Last modified: 17 Jul 2017 15:08

Export record



Author: Pieter Degeling
Author: Adrian Carr

University divisions

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton:

ePrints Soton supports OAI 2.0 with a base URL of

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.