Steget till chefskap - om läkare som verksamhetschefer

Sammanfattning: This thesis reports a study of clinical managers in the Swedish healthcare sector. This is a recently created position, which requires no special competencies such as medical, as the case was prior to 1997. The introduction of this position came together with recommendations from ‘the National Board of Health and Welfare’, which pointed to the importance of general managerial skills for the clinical managerial job. The focus of the study was on clinical managers' understanding and experience of their jobs, completed with an investigation of how the managerial work is actually performed in the Swedish healthcare organizations. In the first part of the thesis, the narratives of the managers’ careers are presented and categorised. Several different career patterns have been found, but in general the recruitment process is heavily influenced by the medical profession, and the recruitment is tailored to fit the profession's declared need for leadership. In consequence, the recruitment process conflicts with the demand of general managerial skills. Second, the learning of the managerial job is discussed from the perspective of the managers’ everyday practice. It turns out that neither role models nor the practical experience help the managers to comprehend their job, as they clash. The lack of visible examples of managerial work within the organisations induces unrealistic expectations of a medical leadership, which creates frustration and confusion among the managers when they enter the everyday practice of the managerial job, which requires administrative management. One way of relieving the managers of these feelings was to attend courses in managerial education. The education offered them the sense of legitimacy, a feeling of fellowship, and most important, a theory to process their experiences intellectually. In such courses, theory and practice can be combined and thus serve as a bridge between the prior expectations and the everyday practice. Finally, the thesis moves to a discussion of the future shaping of managerial roles in the hospitals, and more specifically, a possibility of creating meeting points between managerialism and professionalism in such contexts. One such possibility is the creation of a hybrid managerial role that combines both. The study gave scarce confirmation of the practicability of such solution. Another possibility, suggested at the end of the thesis, is that clinical management is performed by a hybrid team, which can combine the requirements of both management and medicine in a way that could be more satisfactory to all the parties involved.