The information revolution,health reform and doctor-manager relations

In the 1980s and 1990s in both Britain and America computerisation of patient data led to a raft of comparative performance indicators. The 'information revolution' began with measures of efficiency (or outputs, such as bed usage and length of hospital stay); more recently attention has begun to focus on effectiveness (or clinical outcomes, as in the case of evidence-based medicine). Simultaneously health reforms centred, in Britain, on improved management systems and the introduction of a quasi-market, and, in the United States, on managed care, cost controls and hospital mergers. This case-study of an American general hospital uses the classic Alford framework of three groups of structural interests (doctors, managers and patients) to assess the impact of these informational and organisational developments on doctor-manager relations in Britain and America. Cross-cutting local alliances based on common interests indicate that Alford's groups of structural interests should not be perceived as monolithic.