The UK NHS which is the largest organisation in Europe provides high quality healthcare free at the point of delivery to all its citizens. NHS managers play an instrumental role within it as they are expected to implement the various government led reforms designed to make the NHS an increasingly efficient, effective and accountable organisation. This study is concerned with examining the NHS managerial culture in the context of the various challenges and tensions facing the 21st century NHS managers. The study explores the NHS managers' core values with a view to investigating the relative strength of the managers' commitment towards altruistic based values befitting the NHS ethos. Furthermore given that it is widely recognised that the NHS managers believe the public hold a generally negative view of them, this study also develops an understanding of the implications of the NHS managers' negative perceived public image for their self and work identity. The importance of how managers perceive their self and work identity and how they believe they are perceived by others has implications for their work performance, organisational commitment and satisfaction. Through a qualitative based research design the study draws upon semi-structured interviews with twenty healthcare managers working in the public and private sectors within London and explores their views, perceptions and experiences in relation to the above issues. The interviewees consisted of healthcare managers working in an Acute Care NHS Trust and for comparative reasons also included managers who worked in a large private sector hospital. The comparative interviews were useful in determining the extent to which the key issues central to this study were unique to the NHS managerial culture or whether they were equally pertinent to the wider healthcare managerial sector. The main theoretical framework underpinning this study is derived from and is relevant to Organisation Culture, New Institutional Theory, Self and Work Identity Theory and Corporate Social Responsibility. These relatively disparate fields of study are drawn upon in an integrated manner to explore and discuss the findings as they prove useful in developing a more holistic and deeper understanding of the key issues central to this study. The study findings demonstrate that the majority of NHS managers had actively sought the opportunity to work in a caring based profession such as the NHS because it was underpinned by altruistic based values thereby demonstrating a high level of commitment to these values. Unlike the private healthcare managers, all the NHS managers interviewed reported that they believed the public viewed them negatively and for many of the NHS managers this caused tensions in relation to their self and work identity. Half of the NHS managers, regardless of whether they came from clinical or non-clinical backgrounds, reported emotions of demoralisation, frustration, irritation and anger as a result of this negative perceived public image. These findings provide unique and hitherto unexplored insights into the challenges and tensions facing NHS managers. Possible mitigating strategies and potential policy implications are explored in this thesis.

« Awareness » des gestionnaires est un facteur prédictif essentiel d'une coordination réussie. Il a été prouvé que la conscience joue un rôle crucial dans le processus de prise de décision et la performance, en particulier dans les systèmes complexes et dynamiques tels que les soins de santé. La personne avec une plus grande conscience de la situation sera susceptible de prendre des décisions raisonnables. En outre, la connaissance incomplète ou insuffisante peut entraîner une performance médiocre car les acteurs ne parviennent pas à approcher des solutions raisonnables. Le but principal de cette thèse est de développer une définition opérationnelle du concept de conscience dans la gestion des soins de santé. Nous souhaitons déterminer quels comportements, attitudes ou compétences doivent être considérées comme importants pour un responsable de la santé averti. Les résultats de l'étude contribueront à la gestion des soins de santé en identifiant les profils potentiels de ce qu'un responsable pourrait être. Dans notre recherche, nous supposons que le concept de prise de conscience est utile pour décrire les types de comportements de gestion pertinents dans le contexte de la gestion des soins de santé. Le premier chapitre de l'introduction résume les principaux points concernant le contexte et l'objectif de la recherche. Le chapitre deux de la revue de la littérature donne un aperçu du concept de conscience dans les soins de santé et dans certains autres domaines. Le chapitre trois est celui de la méthodologie qui justifie nos méthodes choisies. Nous avons adopté une combinaison de phénoménologie herméneutique et de recherche par sondage dans une approche séquentielle. Le chapitre quatre des résultats est consacré à la présentation de tous les résultats obtenus par des traitements qualitatifs et quantitatifs. Le chapitre cinq de discussion résume les principales conclusions et compare les éléments de notre définition avec ceux d’autres définitions proposées par des spécialistes dans d’autres domaines. / Managers’ awareness is a crucial predictor of successful coordination. Awareness is proven to play a crucial role in the decision‐making process and performance. The major purpose of this thesis Healthcare managers' awareness: an operational definition built on a combination of hermeneutic phenomenology and survey research is to develop an operational definition of the concept of awareness in healthcare management. The thesis consists of five chapters. Chapter one of introduction summarizes the main points about the background, the research objective and design. Chapter two of literature reviews provides an overview about the concept of awareness in healthcare and in some other domains. Chapter three of research approach and methods justifies our chosen methods. We adopt a combination of hermeneutic phenomenology and survey research in a sequential approach. There is no dominant phase and the role of each phase is clarified. For each phase, there are discussions of corresponding research traditions as well as the rationale for our specific choices. Chapter four of the results is devoted to presenting all the findings obtained by qualitative and quantitative treatments. Each of the two phases provides a specific type of knowledge with regard to the concept of awareness. Qualitative data analysis uncovers key proxies of the concept, including collecting the information, ensuring information verification, analyzing practices and integrative thinking and acting. The quantitative phase aims to facilitate the concept refinement applying exploratory factor analysis. We generate items, which clarify indicators of each proxy to design the survey questionnaire. The survey respondents are managers at some healthcare organizations in Vietnam. The results of exploratory factor analysis report a clear structure of four factors corresponding to the four identified proxies. The impacts of some sociodemographic characteristics on each proxy are also addressed. The results reveal that gender, healthcare management experience and organization type have no impact on the level of awareness. Meanwhile, the level of management might influence health care managers’ level of integrating. Senior managers are more likely to report a greater score in the component of integrating. The chapter five of discussion summarizes key findings and compare the elements of our definition with those of other definitions proposed by scholars in other fields. A discussion using qualitative data as a complement to quantitative findings is also provided. Other content of the chapter fiveis concerned with the strengths and limitations of the study. Finally, recommendations for future studies are also discussed.

Depuis ces trois dernières décennies, la modernisation du secteur hospitalier implique un nouveau mode d'organisation de l'activité et une nouvelle répartition des pouvoirs à l'hôpital. De nouveaux modes de management ont été transposés du secteur privé pour perfectionner et moderniser l'action du secteur public. Cependant, les objectifs de ces deux secteurs ne sont pas les mêmes : satisfaction de l'intérêt général pour l'un et rentabilité pour l'autre. Cette différence peut être enrichissante (exemples : émulation liée à la compétition, réalisation d'économies substantielles), mais aussi source de résistances et de stress. Cette nouvelle gestion publique déstabilise les différents acteurs des établissements qui doivent, à la fois, répondre aux grands principes du service public et à des logiques économiques de performance. Dans un tel contexte, des tensions de rôle peuvent-elles se développer chez le personnel soignant ? Ce travail de recherche s'intéresse tout particulièrement aux différentes stratégies d'ajustement utilisées par les cadres de santé, pour faire face aux tensions de rôle qui pourraient se développer. Les changements vécus suite à la mise en place du Nouveau Management Public dans les hôpitaux ont modifié le rôle et les fonctions des cadres de santé qui sont désormais à l'interface entre une culture du soin et une culture gestionnaire. Cette recherche est basée sur une étude exploratoire menée auprès de 15 cadres de santé dans un CHRU et sur une enquête confirmatoire réalisée auprès de 445 cadres de santé répartis dans 39 établissements hospitaliers publics français. Les résultats révèlent que les cadres de santé se trouvent dans une position délicate qui suscite différents types de tensions de rôle quotidiennes. Des stratégies d'ajustement utilisées par les cadres de santé pour faire face à ces tensions de rôle ont également été identifiées. / Over the past three decades, the modernization of the hospital sector has given rise to a new way of organizing the activity and a new distribution of power in hospitals. New management methods have been transposed from the private sector with the aim to improve and modernize the public sector action. However, the objectives of these two sectors are not the same: satisfaction of the public interest for one of them and profitability for the other one. This difference can be beneficial (emulation in link with competition, substantial savings), but also a source of resistance and stress. This new public management destabilizes the different hospital actors who must respond, in the same time, to the principles of public service and to the economic logics of performance. In this context, role stresses can they develop for caregivers? This research is particularly concerned with the different strategies used by the healthcare managers to cope with this kind of potential role stresses. Different changes implemented with the new public management in hospitals, have modified the role and functions of healthcare managers who are henceforth at the interface between a culture of care and a management culture. This research comprises an exploratory study conducted among 15 French healthcare managers in a public hospital and a confirmatory survey conducted among 445 French healthcare managers in 39 public hospitals. The results show that the healthcare managers are in a delicate position that raises different type of daily role stresses. Strategies used by healthcare managers to cope with these role stresses have been also identified.

The focus of this study is the problem of declining trend in obstructive sleep apnea (OSA) patient compliance. Studies reported improved compliance in patients with chronic diseases due to technology-based interventions. However, researchers have not investigated the advantages of technology to improve the compliance of OSA patients in detail. The specific problem was the lack of engagement between patients and healthcare managers, resulting in low compliance within OSA patients. The purpose of this qualitative study was to evaluate how technology-based interventions can improve OSA patient engagement with the healthcare managers resulting in improved compliance with treatment procedures. In this study, the technology acceptance model was used as the instrument in evaluating the information collected through interviews with 20 healthcare managers about their attitudes toward usage, perceived usefulness, and perceived ease of use. The transcribed interviews were open-coded using the RQDA library in R Studio. In general, results from this study indicated that the healthcare managers showed a positive attitude towards the use of technology for patient engagement and expressed that the technology is useful for patient engagement and is easier to use. However, they identified technology-related and patient-related challenges in implementing technology for patient engagement. Further, the respondents identified process-related and patient-related opportunities in using technology for patient engagement. Results from this study have practice and policy implications by enabling healthcare managers to devise better compliance plans for OSA patient management. The findings could have a social benefit by helping healthcare managers to implement technology-based interventions to better achieve a higher compliance resulting in better patient health at lower costs.