Are healthcare middle management jobs extreme jobs?

PURPOSE: The purpose of this paper is to explore the incidence of "extreme jobs" among middle managers in acute hospitals, and to identify individual and organizational implications. DESIGN/METHODOLOGY/APPROACH: The paper is based on interviews and focus groups with managers at six hospitals, a "proof of concept" pilot with an operations management team, and a survey administered at five hospitals. FINDINGS: Six of the original dimensions of extreme jobs, identified in commercial settings, apply to hospital management: long hours, unpredictable work patterns, tight deadlines with fast pace, broad responsibility, "24/7 availability", mentoring and coaching. Six healthcare-specific dimensions were identified: making life or death decisions, conflicting priorities, being required to do more with fewer resources, responding to regulatory bodies, the need to involve many people before introducing improvements, fighting a negative climate. Around 75 per cent of hospital middle managers have extreme jobs. RESEARCH LIMITATIONS/IMPLICATIONS: This extreme healthcare management job model was derived inductively from a qualitative study involving a small number of respondents. While the evidence suggests that extreme jobs are common, further research is required to assess the antecedents, incidence, and implications of these working practices. PRACTICAL IMPLICATIONS: A varied, intense, fast-paced role with responsibility and long hours can be rewarding, for some. However, multi-tasking across complex roles can lead to fatigue, burnout, and mistakes, patient care may be compromised, and family life may be adversely affected. ORIGINALITY/VALUE: As far as the authors can ascertain, there are no other studies exploring acute sector management roles through an extreme jobs lens.

Sweat the small stuff: a case study of small-scale change processes and consequences in acute care.

Solving small, annoying problems may appear to be unimportant in a political, demographic, and economic climate that focuses attention on radical long-term changes to the organization, delivery, funding, and regulation of the healthcare system. Most contemporary commentary emphasizes the need for large-scale, major, strategic, transformational change. Deliberately designed to focus on minor issues, however, the intervention reported here, in a hospital gastroenterology department, demonstrates how small changes generate major benefits for patients, staff, and hospital performance. This approach can also strengthen clinical-managerial relationships, which are key to larger scale changes and which suffer when 'the small stuff' is not fixed. The success of this intervention is explained with reference to a model of change combining context, content, process, and individual dispositions. The intervention, however, is easily modified to suit different contexts and was subsequently used successfully in other service areas in the same hospital. These outcomes present a challenge to the contemporary preoccupation with transformational change. Healthcare managers are thus advised, on the basis of this experience, to be alert to what appear to be minor unresolved issues, and to address these rapidly, in addition to larger scale, longer term projects.