`Two-Way Windows': Clinicians as Medical Managers

Abstract

This paper uses the metaphor of the `two-way window' to understand the aspirations and activities of clinical directors (doctors with management responsibilities). Clinical directors work simultaneously with sets of ideas from both clinical practice and from management, therefore, their role (as `two-way windows') allows the possibility to create a new area of expertise — medical-management. To explore how `two-way windows' are being constituted, clinician managers in three medical organizations were interviewed. Three narratives were constructed from their accounts. The first narrative outlines the theories-in-use of clinical directors, the second and third consist of the strategizing of clinical directors as they seek to maintain their primary focus on clinical work whilst, at the same time, developing their management expertise and influence. The paper concludes that clinical directors can relatively easily occupy the `two-way' space opened up by the mediation of medicine and management. Only a lack of financial management expertise renders their new organizational positioning vulnerable. All public bureaucracies now involve complex mediation between professionals and managers; hence, `two-way windows' will become increasingly significant in organizational development. These `two-way' roles privilege professional over managerial expertise as it is assumed that the appropriate professional training is of paramount importance. Unique professional/managerial discourses are being created in public-sector organizations. This paper provides a basis for understanding the development of such discourses.