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The purpose of this paper is to explore how the patient comes to be seen as a solution to governance problems.

The paper studies health policy discourse in Denmark from 1970 to 2000. Based on an analysis of national policy documents, the paper traces how the patient is redefined as part of governance problems.

The paper suggests that “the new patient” coincides with changes in healthcare governance and is not just a clinical concern. The persona of the patient has been mobilized in dissimilar ways in addressing specific policy problems, resulting in both a duty-based idea of a socio-economically responsible patient and a rights-based idea of a demanding health-service consumer.

The study is limited to policy documents that address healthcare governance in one country. It does not describe the broader evolution of patient ideas or the practical impact of political discourses.

Practitioners should expect to encounter conflicting views of patient responsibilities, interests and involvement. Such conflicts are not only related to a lack of conceptual clarity but are indicative of how the new, active and responsible patient has become a key clinical concern and a central element of health policy governance.

The paper contributes to the understanding of “the new patient” in discussions on patient-centred healthcare and empowerment by emphasizing the definition of the patient in a political context. The latter has often been ignored in existing research.

An inquiry into the constitution of the experience of patienthood. It understands “becoming a patient” as a production of a subjectivity, in other words as a process of individuation and milieu that occurs through an ontology of production. This ontology of production can, of course, also be understood as a political ontology. Therefore, this is, first of all, an inquiry into a mode of production, and, secondly, an inquiry into its relation to the issue of social justice – because of effects of digital divisions. In these terms, it also reflects on how expert discourses, such as in medical sociology and science studies (STS), can (and do) articulate their problems.

An integrative mode of discourse analysis, strongly related to discursive institutionalism, called semantic agency theory: it considers those arrangements (institutions, informal organizations, networks, collectivities, etc.) and assemblages (intellectual equipment, vernacular epistemologies, etc.) that are constitutive of how the issue of “patient experience” can be articulated form its position within an ontology of production.

The aim not being the production of a finite result, what is needed is a shift in how “the construction of patient experience” is produced by expert discourses. While the inquiry is not primarily an empirical study and is also limited to “Western societies,” it emphasizes that there is a relation between political ontologies (including the issues of social justice) and the subjectivities that shape the experiences of people in contemporary health care systems, and, finally, that this relation is troubled by the effects of the digital divide(s).

A proposal “to interrogate and trouble” some innovative extensions and revisions – even though it will not be able to speculate about matters of degree – to contemporary theories of biomedicalization, patienthood, and managed care.

This study is a considered interpretation of the National Registration and Accreditation Scheme for the health professions, which commenced operations in Australia in 2010. The development of the Scheme and its operational elements (namely the Australian Health Practitioner Regulation Agency and 14 profession-specific national Boards) are positioned within the context of regulatory capitalism. Regulatory capitalism merges the experience of neoliberalism with an attentiveness to risk, particularly by the State. Nationally consistent legislation put in place a new set of arrangements that enabled the continuity of governments’ role in health workforce governance. The new arrangements resulted in an entity which is neither exclusively subservient to nor independent of the State, but rather “quasi-independent.” In exploring this arrangement, specific consideration is given to how the regulatory response matched the existing reality of a global (and national) health workforce market. This study considers this activity by the State as one of consolidation, as opposed to fracturing, against a backdrop of purposeful regulatory reform.

Examining the self-identification of physician managers with their manager and clinician roles, and its impact on the state and professional powers in healthcare governance.

With purposive sampling, a total of 15 frontline clinical department managers (mainly principal consultants) and directorial managers (mainly Hospital Chief Executives) were recruited to elite interviews. The themes for data collection and analysis were based on a systematic scoping review of previous empirical studies.

Physician managers maintained respective jurisdictions in policymaking and clinical governance, as well as their primary self-identification as rationalizers or protectors of medicine, according to their managerial roles at a directorial or departmental level. However, a two-way hybridization of physician managers allowed the exchange of clinical and managerial authority, resulting in cooperation alongside struggles among medical elites; while some frontline managers were exposed to managerial values with the awareness of budget and organizational administration, some directorial managers remained aligned to a traditional mode of professional communication, such as persuasion through informal personal networks and by using clinician language and maintaining symbolic contact with the clinical field.

This study identifies the inconsistency in physician managers’ identity work, as well as its patterns. It goes beyond a dichotomized framework of professionalism versus managerialism or an arbitrarily blurred identity.

Using the example of medication safety, this paper aims to explore the impact of three managerial interventions (adverse incident reporting, ward‐level support by pharmacists, and a medication safety subcommittee) on different professional communities situated in the English National Health Service (NHS).

Semi‐structured interviews were conducted with clinical and managerial staff from two English NHS acute trusts, supplemented with meeting observations and documentary analysis.

Attitudes toward managerial intervention differ by professional community (between doctors, nurses and pharmacists) according to their existing norms of safety and perceptions of formal governance processes.

The heterogeneity of social norms across different professional communities and medical specialties has implications for the design of organisational learning mechanisms in the field of patient safety.

The paper shows that theorisation of professional “resistance” to managerialism privileges the study of doctors' reactions to management with the consequent neglect of the perceptions of other professional communities.

The purpose of this paper is to explore general practitioners' (GPs') and psychiatrists' views and experiences of transparent forms of medical regulation in practice, as well as those of medical regulators and those representing patients and professionals.

The research included interviews with GPs, psychiatrists and others involved in medical regulation, representing patients and professionals. A qualitative narrative analysis of the interviews was then conducted.

Narratives suggest rising levels of complaints, legalisation and blame within the National Health Service (NHS). Three key themes emerge. First, doctors feel “guilty until proven innocent” within increasingly legalised regulatory systems and are consequently practising more defensively. Second, regulation is described as providing “spectacular transparency”, driven by political responses to high profile scandals rather than its effects in practice, which can be seen as a social defence. Finally, it is suggested that a “blame business” is driving this form of transparency, in which self‐interested regulators, the media, lawyers, and even some patient organisations are fuelling transparency in a wider culture of blame.

A relatively small number of people were interviewed, so further research testing the findings would be useful.

Transparency has some perverse effects on doctors' practice.

Rising levels of blame has perverse consequences for patient care, as doctors are practicing more defensively as a result, as well as significant financial implications for NHS funding.

Transparent forms of regulation are assumed to be beneficial and yet little research has examined its effects in practice. In this paper we highlight a number of perverse effects of transparency in practice.

This paper seeks to identify the instances of informal knowledge sharing at the “backstage” of the clinical environment and to demonstrate their contribution to organisational learning and patient safety.

The approach takes the form of an ethnographic study in two Day Surgery Units in the UK National Health Service undertaken over three months in various clinical and non‐clinical settings. The observations recorded the instances of communication and knowledge sharing, as well as taking into account the wider socio‐cultural and organisational context.

The study identified situations of informal knowledge sharing. These were characterised by degrees of homogeneity/heterogeneity and patency/privacy. Focusing on three sites – staff lounge, storeroom, and theatre corridor, the paper elaborates the context and content of knowledge sharing, and the contributions to clinical practice, service function and learning.

Backstage knowledge sharing is premised on shared understanding, trust and mutuality and situational opportunity. This contrasts with more formal models of learning advocated in policy. Services managers might embrace, rather than replace, these relationships, whilst emphasising the need for knowledge to be shared more widely amongst peers and service leaders.

To date, little research in the area of patient safety has considered the contribution of informal learning at the “backstage”. This is an important, if taken‐for‐granted, part of everyday practice and makes a “hidden” contribution to organisational learning.

The purpose of this paper is to explore approaches to the regulation of healthcare complaints and disciplinary processes.

A literature review was conducted across Medline, Sociological Abstracts, Web of Science, Google Scholar and the health, law and social sciences collections of Informit, using terms tapping both the complaints process and regulation generally.

A total of 118 papers dealing with regulation of health complaints or disciplinary proceedings were located. The review reveals a shift away from self-regulation towards greater external oversight, including innovative regulatory approaches including “networked governance” and flexible or “responsive” regulation. It reports growing interest in adoption of strategic and responsive approaches to health complaints governance, by rejecting traditional legal forms in favor of more strategic and responsive forms, taking account of the complexity of adverse health events by tailoring responses to individual circumstances of complainants and their local environments.

The challenge of how to collect and harness complaints data to improve the quality of healthcare at a systemic level warrants further research. Scope also exists for researching health complaints commissions and other “meta-regulatory” bodies to explore how to make these processes fairer and better able to meet the complex needs of complainants, health professionals, health services and society.

Health service effectiveness continues to be limited by misaligned objectives between policy makers and frontline clinicians. While capturing the discretion workers inevitably exercise, the concept of “street-level bureaucracy” has tended to artificially separate policy makers and workers. The purpose of this paper is to understand the role of social-organizational context in aligning policy with practice.

This mixed-method participatory study focuses on a locally developed tool to implement an Australia-wide strategy to engage and respond to mental health services for parents with mental illness. Researchers: completed 69 client file audits; administered 64 staff surveys; conducted 24 interviews and focus groups (64 participants) with staff and a consumer representative; and observed eight staff meetings, in an acute and sub-acute mental health unit. Data were analyzed using content analysis, thematic analysis and descriptive statistics.

Based on successes and shortcomings of the implementation (assessment completed for only 30 percent of clients), a model of integration is presented, distinguishing “assimilist” from “externalist” positions. These depend on the degree to which, and how, the work environment affords clinicians the setting to coordinate efforts to take account of clients’ personal and social needs. This was particularly so for allied health clinicians and nurses undertaking sub-acute rehabilitative-transitional work.

A new conceptualization of street-level bureaucracy is offered. Rather than as disconnected, it is a process of mutual influence among interdependent actors. This positioning can serve as a framework to evaluate how and under what circumstances discretion is appropriate, and to be supported by managers and policy makers to optimize client-defined needs.

The language used by National Health Service (NHS) “commissioning” managers when discussing their roles and responsibilities can be seen as a manifestation of “identity work”, defined as a process of identifying. This paper aims to offer a novel approach to analysing “identity work” by triangulation of multiple analytical methods, combining analysis of the content of text with analysis of its form.

Fairclough's discourse analytic methodology is used as a framework. Following Fairclough, the authors use analytical methods associated with Halliday's systemic functional linguistics.

While analysis of the content of interviews provides some information about NHS Commissioners' perceptions of their roles and responsibilities, analysis of the form of discourse that they use provides a more detailed and nuanced view. Overall, the authors found that commissioning managers have a higher level of certainty about what commissioning is not rather than what commissioning is; GP managers have a high level of certainty of their identity as a GP rather than as a manager; and both GP managers and non‐GP managers oscillate between multiple identities depending on the different situations they are in.

This paper offers a novel approach to triangulation, based not on the usual comparison of multiple data sources, but rather based on the application of multiple analytical methods to a single source of data. This paper also shows the latent uncertainty about the nature of commissioning enterprise in the English NHS.