Coleman Anna, Segar Julia, Checkland Kath, McDermott Imelda, Harrison Stephen, Peckham Stephen
Manchester University.
J Health Organ Manag. 2015;29(1):75-91. doi: 10.1108/JHOM-04-2013-0075.
The purpose of this paper is to explore the early experiences of those involved with the development of Clinical Commissioning Groups (CCGs), examining how the aspiration towards a "clinically-led" system is being realised. The authors investigate emerging leadership approaches within CCGs in light of the criterion for authorisation that calls for "great leaders".
DESIGN/METHODOLOGY/APPROACH: Qualitative research was carried out in eight case studies (CCGs) across England over a nine-month period (September 2011 to May 2012) when CCGs were in their early development. The authors conducted a mix of interviews (with GPs and managers), observations (at CCG meetings) and examined associated documentation. Data were thematically analysed.
The authors found evidence of two identified approaches to leadership - positive deviancy and responsible guardianship - being undertaken by GPs and managers in the developing CCGs. Historical experiences and past ways of working appeared to be influencing current developments and a commonly emerging theme was a desire for the CCG to "do things differently" to the previous commissioning bodies. The authors discuss how the current reorganisation threatens the guardianship approach to leadership and question if the new systems being implemented to monitor CCGs' performance may make it difficult for CCGs to retain creativity and innovation, and thus the ability to foster the positive deviant approach to leadership.
ORIGINALITY/VALUE: This is a large scale piece of qualitative research carried out as CCGs were beginning to develop. It provides insight into how leadership is developing in CCGs highlighting the complexity involved in these roles.
本文旨在探究参与临床委托小组（CCGs）发展的人员的早期经历，考察“临床主导”系统的愿景是如何实现的。作者根据要求有“伟大领导者”的授权标准，调查了CCGs内部新出现的领导方法。
设计/方法/途径：在CCGs处于早期发展阶段的九个月期间（2011年9月至2012年5月），对英格兰的八个案例研究（CCGs）进行了定性研究。作者进行了多种形式的访谈（与全科医生和管理人员）、观察（在CCG会议上）并查阅了相关文件。对数据进行了主题分析。
作者发现，在发展中的CCGs中，全科医生和管理人员采用了两种已确定的领导方法——积极偏离和责任守护。历史经验和过去的工作方式似乎在影响当前的发展，一个普遍出现的主题是CCG希望与以前的委托机构“采取不同的做法”。作者讨论了当前的重组如何威胁到领导的守护方法，并质疑为监测CCGs绩效而实施的新系统是否会使CCGs难以保持创造力和创新能力，从而难以培养积极偏离的领导方法。
原创性/价值：这是在CCGs开始发展时进行的一项大规模定性研究。它深入了解了CCGs中领导方式的发展，突出了这些角色所涉及的复杂性。
