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Professor Gianluca Veronesi wins award for research on medical management in English public hospitals

5 May 2020

A paper co-authored by Management’s Professor Gianluca Veronesi, has won an award from the Society for Studies in Organizing Healthcare

With the outbreak of Covid 19, healthcare management has been at the forefront for many as hospitals, related businesses and individuals all work to adapt.

Professor Veronesi, along with co-authors Professors Ian Kirkpatrick and Alessandro Zardini, investigates healthcare management in the paper: Professional Re-Stratification and the (Defensive) Adaptation of Status Hierarchy: Medical Management in English Public Hospitals.

The paper explores the effects of status hierarchy within healthcare and its impact on career progression to senior management and board-level roles for medical professionals.


The medical profession is traditionally an occupation strongly dominated by a status hierarchy, where seniority and exercise of authority are linked to professional prestige and reputation. On an individual level, success criteria and career progression are usually associated with established professional indicators of prestige and competence rather than organisational demands and priorities. Such status hierarchies are not limited to medicine; they can be seen throughout society. They are self-sustaining and inherently conservative. However, it is also possible to see adjustments driven by internal and external factors.

This study focuses on the effect of management reforms within the English NHS over the past 30 years, which have increasingly required doctors to carry out managerial responsibilities in their organisations. They have been expected to develop skills associated with management and take on roles outside their traditional disciplinary boundaries. The key question is whether these management reforms have led to changes in the traditional professional status hierarchy. Precisely, the research looks at the case of medical professionals who have become members of the board of directors of English National Health Sector acute care hospital trusts. Based on a number of datasets, including a private database of management in the NHS, a cross-sectional analysis was conducted employing a configurational approach.

The findings confirm that professional status hierarchies are resilient, but there is also evidence that some dynamics of change occur. Professional prestige and reputation still remain a key factor for membership in hospital trust governing boards. Only doctors who belong to the professional elite sit on boards of high performing organisations. However, the evidence also shows that management experience is important for doctors accessing senior governance positions. This happens in particular in NHS organisations that have been granted Foundation Trust status, which gives more autonomy and freedom of decision making. Here, we observe a combination of two criteria for seniority in professional management roles: professional credibility and management competency. We conclude suggesting that the medical profession has adapted to the changes introduced by the policy reforms rather than opposing them.

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