Sense-making by clinical and non-clinical executive directors within new governance arrangements.

PURPOSE The purpose of this paper is to explore the various ways in which clinical executive directors and non-clinical executive directors are interpreting and responding to the extensive reforms and restructuring in the UK health service. DESIGN/METHODOLOGY/APPROACH The paper draws upon detailed research in two very large teaching hospital organizations in order to understand how actors crucial to the delivery of this vision are responding. Schedule-structured interviews with executive directors were conducted, recorded, transcribed and coded. FINDINGS The clinical and non-clinical directors of these organizations engaged in a process of active sense-making are found, which is leading to significant changes to the service and also changes to identity. The clinical directors are revealing a willingness to assume accountability for devolved profit centres in their service lines. The non-clinical directors are supportive of this idea in broad terms but are cautious about releasing "too much" central control. RESEARCH LIMITATIONS/IMPLICATIONS The paper is based on just two case studies and the analyses are made through the perspectives of the executive teams in each case. PRACTICAL IMPLICATIONS Changes to healthcare environments of this kind are occurring in many countries, but such is the extent and intensity of these changes in the UK that the government's aspiration is high--it sees this set of reforms leading to a peerless world class health service. The way in which the actors make sense of and navigate their way through the cross cutting principles and the layered reforms is a critical issue. ORIGINALITY/VALUE There have been few systematic studies of the practical reality involved in the enactment of profit centre and service line management initiatives in acute hospital settings and the ways these are understood and negotiated at executive team level.