Summary points

Calls to modernise health services require health professionals to accept that all clinical decisions have resource dimensions, recognise the need to balance clinical autonomy with transparent accountability, support the systemisation of clinical work, and subscribe to the power sharing implications of team based approaches to clinical work

There are consistent and marked differences in how medical, nursing, and managerial staff across countries evaluate individual aspects of such a reform programme

Policy authorities' efforts to overcome resistance to reforms by widening the scope and reach of “top-down” performance management and regulation are self defeating

What is required is more support for clinicians and others (including nurse managers) to pursue modernised clinical work practices

Re-establishing “responsible autonomy” as the primary organising principle of clinical work will empower health professionals to strike a balance between the clinical and resource dimensions of care and between clinical autonomy and transparent accountability