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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.

Aims to discover the work hospital clinician managers think they do and observe them in practice. A total of 14 managerial interests and concerns were identified in focus group discussions. Clinician managers’ jobs are pressurised, and are more about negotiation and persuasion than command and control. Their work is of considerable complexity, pace and responsibility and it is predicated more on managing inputs (e.g. money and people) than care processes, systems, outputs and outcomes. Thus the capacity of clinicians in these roles to respond to reforms such as those envisaged in the Bristol Inquiry may be problematic. Qualitative studies are re‐affirmed as important in providing grounded insights into not only clinical activities, but also organisational behaviour and processes.

Public accounts committees (PACs) in Australia as elsewhere are usually discussed and assessed in terms of their contributions to realizing the accountability of ministers and their departments to Parliament. Analysis of the history of the Joint Committee of Public Accounts (JCPA) of the Australian Commonwealth Parliament for the period 1914‐1932 shows, however, that the committee’s claimed centrality to financial accountability in government guaranteed neither the content of the issues which commanded its attention nor its survival. Suggests that the activities and standing of the JCPA were emergent contextually rather than design predetermined. Discusses the implications of these findings for further research.

This paper aims to report on research into human resource management within an operations management environment; specifically, operational team‐work amongst health care workers in a hospital.

Eight operational teams within a UK National Health Service hospital took part and the research used a combination of survey and group discussions.

The results show the construct of the team had little operational definition. Key factors identified as contributing to effective team‐working include: leadership; frequency of team meetings; a climate of trust and openness. There was limited evidence of truly multi‐disciplinary teams and of organisational support for team‐working.

The methodology applied was appropriate, generating data to facilitate discussion and draw specific conclusions therefrom. A perceived limitation is the single case approach; however, Remenyi et al. argue this can be enough to add to the body of knowledge. In terms of implications this paper demonstrates that team‐working is no panacea; as part of a bundle of good operations management practices it is associated with efficiency, effectiveness, and in this case improved patient care.

The paper suggests a new input, process, output model of effective team‐working and identifies issues to be faced in adopting a strategy of developing an operational team‐based organisation.

The value of this paper is the conclusion that the importance of operational team‐working is as a paradigm for assessing how effectively individuals and groups work together, rather than as a specific organisational form with an optimal size.

This paper aims to analyse the role of communication in shaping the mechanisms of accountability routines.

Conceptual elements of the theory of communicative action and the literature on routines were used to conduct a field study in two hospital districts in Finland, from 2009 to 2015. Data were based on interviews, document analysis, observed meetings and repeated contact with key informants.

The findings explain how accountability routines take different forms – weak or strong – in different organisations and at different hierarchical levels. Differences depend on the generative structures and mechanisms of the communicative process – relational and normative – used to give and ask information to and from organisation members involved in accountability relationships. An explorative finding is that discourse-based communication plays an important role in bridging the gap between weak and strong accountability routines. The main theoretical contribution is to conceptualise and show the role of communicative rationalities in shaping the mechanisms of accountability routines.

The implication for practitioners and policymakers is to show to what extent the organisation policies and communicative rationalities used in accountability have potential to improve or not to improve the practices of accountability routines. Mutual understanding, motivation and capacity of organisation members to do as expected and agreed upon without pressure improve accountability routines.

The value of this study is to explain how accountability routines take different forms in practice (weak or strong) in different organisations and at different hierarchical levels, depending on the generative structures of the communicative process used in practicing accountability routines.

Most developed countries have enacted privacy laws to govern the collection and use of personal information (PI) as a response to the increased misuse of PI. Yet, these laws rely heavily on the concept of informational self-determination through the “notice” and “consent” models, which is deeply flawed. This study aims at tackling these flaws achieve the full potential of these privacy laws.

The author critically reviews the concept of informational self-determination through the “notice” and “consent” model identifying its main flaws and how they can be tackled.

Existing approaches present interesting ideas and useful techniques that focus on tackling some specific problems of informational self-determination but fail short in proposing a comprehensive solution that tackles the essence of the overall problem.

This study introduces a model for informed consent, a proposed architecture that aims at empowering individuals (data subjects) to take an active role in the protection of their PI by simplifying the informed consent transaction without reducing its effectiveness, and an ontology that can partially realize the proposed architecture.