Making a "Happy Hospital": Emotional Investment and Professional Identity Amongst Anglo-American Hospital Administrators.

This article examines the place of emotion in modern hospital administration and the relationship between professional identities and emotional landscapes in the healthcare field. The focus is a broad emotional and philosophical investment that many administrators made in their work. In the United States and then in Britain, amidst rapid change in the practice and provision of health services, a new sense of professional identity emerged. This was often underpinned by a kind of emotional investment, one which had to be constructed and cultivated. Here formal training and education, collective identities, and a shared understanding of the kind of personal qualities required were important. The extent to which developments in Britain were influenced by best practice in the US is also striking. This process might best be understood as the further drawing out of established beliefs and ways of working rather than an abstract transfer of ideas and practices across the Atlantic, but there was a distinct Anglo-American dimension to the development of hospital administration.

From "Honeymoon Period" to "Stable Marriage": The Rise of Management Consultants in British Health Policymaking.

Since the creation of the National Health Service in 1948, different groups of experts have competed to inform the development of British health policy. This article analyzes the long-term rise of one of these groups-management consultants. The scale and regularity of their engagement has increased considerably over time, strikingly in recent years, and the functions fulfilled by consultants have become ever more diverse. At important moments they were often seen by policymakers-particularly when there was understood to be a lack of internal expertise-as possessors and imparters of important knowledge. Firms and individuals worked consciously to integrate themselves into emerging health policy networks. But there has often been relatively little consideration of their real suitability for work in the health field. Many debates around the use of external consultants today-accountability, value for money, dependency-were foreshadowed during earlier periods, with implications for current policymakers.

'The type of person needed is one possessing a wide humanity': the development of the NHS national administrative training scheme.

The first national training scheme for NHS administrators was established in 1956. A successor scheme continues today. This article draws on archival research and oral history interviews to examine its development. It argues that while the well-established shift from 'administration' to 'management' in the NHS and other important changes can be seen in many of the ways in which the national administrative training scheme has developed, there are also many remarkable elements of continuity which suggest that such changes may have taken place over a longer period of time than has often been recognised.

McKinsey and the 'Tripartite Monster': The Role of Management Consultants in the 1974 NHS Reorganisation.

The first major reorganisation of the National Health Service took place in 1974, twenty-six years after the service had been established. It has long been perceived as a failure. This article draws on archival records and a witness seminar held in November 2016 to provide a more nuanced assessment of the 1974 reorganisation and understand more fully why it took the form that it did. In particular it identifies the reorganisation as an important moment in the ongoing story of management consultants engaging with health policymakers, and explores the role of McKinsey and Co. in detail for the first time. Key explanatory factors for their involvement are identified, including the perceived lack of expertise and manpower inside the civil service and the NHS, and perceptions of their impact and effectiveness are discussed. Many debates about the use of management consultants today were directly foreshadowed during the early 1970s. Alongside this, the role of other groups of policy actors, including civil servants, politicians and medical professionals, are established and the extent to which British health policymakers have had to work within existing cultural, political, legislative and practical constraints when trying to initiate change is demonstrated. The fact that many of the 'mistakes' that were made have been repeated in the course of subsequent reforms, speaks to the poor institutional memory of Whitehall, and the Department of Health and Social Care in particular. In the run up to 1974 management consultants could make only a limited contribution to an imperfect compromise.