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Tensions within management roles in healthcare organisations

Scott, Anne; Timmons, Stephen


Anne Scott

Professor of Health Services Management


Aim: This article reports the results of a study that gives an insight into ward leaders’ perspectives of their leadership role and explores how they deliver leadership at ward level within organisational constraints and processes. Previous studies have been evaluations of clinical leadership in general, or literature reviews of the ward leader role. The aim of this study was to examine the leadership role of ward sisters and to understand how they lead improvements in quality of care on their wards.

Methods: A qualitative methodology was used, incorporating 19 in-depth interviews with ward leaders and modern matrons.

Results: Three main themes were identified: empty conformity, authority and autonomy, and visibility and leading by example. Participants aimed to be role models in leading and maintaining standards of care for patients, but this was sometimes constrained by organisational processes, lack of authority and autonomy, and lack of support and preparation.

Conclusion Perceived differences between nursing and health service management mean that ward leaders’ efforts to lead improvements in quality care are often undermined. Ward leaders must strike a balance between leading high-quality nursing care, in the context of organisational and political performance requirements, and the demands of administrative work, while often lacking autonomy and authority.


Scott, A., & Timmons, S. (2017). Tensions within management roles in healthcare organisations. Nursing Management, 24(1), 31-37.

Journal Article Type Article
Acceptance Date Nov 28, 2016
Publication Date Mar 30, 2017
Deposit Date May 9, 2017
Publicly Available Date May 9, 2017
Journal Nursing Management
Print ISSN 1354-5760
Electronic ISSN 2047-8976
Publisher RCN Publishing
Peer Reviewed Peer Reviewed
Volume 24
Issue 1
Pages 31-37
Keywords hospital management, leadership, nursing, nursing management, organisational behaviour, role conflict, ward sister
Public URL
Publisher URL
Additional Information This is not the version of record.


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