The effect of new public management on intensive care unit staff
The NHS is largely dependent on two groups of professionals – medics and nurses. Recent government changes support the development of a central role for management. The impact of these changes on the roles and relationships of those working in the NHS must be understood in light of the structures already in place within it. Medical dominance in healthcare decision‐making, nursing power emanating from the strength of the medical‐nursing relationship and the hierarchies within and between the two professions all affect and are affected by recent management changes. In intensive care a key feature of the context, insularity, had already significantly modified these structures prior to recent reforms. This paper starts by discussing and contrasting the response of medics and nurses to these changes before highlighting the differences in the way these changes have impacted on staff in intensive care. Analysis is based on data from an observational study of the formation of a new directorate and interviews with senior nurses, medics and managers in intensive care.
Medical Managers: puppetmasters or puppets? Sources of power and influence in clinical directorates
The theme of the relationship between the medical profession and management has been at the centre of both academic and policy debates since the creation of the National Health Service and affects the design of most health care organisations worldwide. It surfaces and gains prominence when any new structural arrangements are in prospect, both shaping and constraining the way problems are defined and tackled (Buchanan et al., 1997). Usually there is some kind of accommodation between political interests, managerial or bureaucratic necessity and professional capabilities and demands. The overwhelming challenge is how to establish appropriate governance and how to integrate and organise ‘those responsible for medicine with those responsible for money’ (Dawson et al., 1995, p.172); ‘those spending and those managing money’ (Strong and Robinson, 1988). There are also the related questions of who should manage ‘experts’, how to reconcile corporate and professional interests and whether health care organisations pose a different managerial task from other organisations.
Experimental Study on Acoustic Agglomeration of Fine Particles from Coal Combustion
The removal of fine particles in coal-fired fumes was experimentally studied based on acoustic agglomeration. An experiment facility was designed and set up. In this facility, a fluidized bed coal combustor was used as fume generator, and an Electrical Low Pressure Impact or (ELPI) was used to measure the fine particle concentration and size distribution in the fumes. The results show that under the effect of high intensity sound waves, there is good performance to remove fine particles in coal-fired fumes, which with a number mean diameter of 0.07μm. Especially, under the conditions of the frequency of 1 000Hz and the sound intensity of 161.5dB, the number concentration of 0.0233~9.314μm particles decreased by 85.2%, and their mass concentration decreased by 92.5%.