Medical dominance is a recurring theme in sociological analyses of healthcare work. One example of a theoretical framework by which the medical profession is said to dominate other healthcare occupations is Turner's (1995: 138) enumeration of the modes of subordination, limitation and exclusion. As Elston (1991) has noted, however, such frameworks tend to be rather speculative and there is not a great deal of evidence on how these strategies are exercised, for example, at a micro-level. There is also a tendency to portray healthcare occupations as monolithic entities, without acknowledging differences within healthcare occupations, and the relationships between them, which can arise in different clinical locales. Through a micro-level analysis of the practice of intensive care, using ethnographic data collected on three intensive care units (ICUs) in England, this paper proposes a hitherto unidentified strategyincorporation -for medical dominance at a micro-level. Paradoxically, an enhanced position for both intensive care medicine and intensive care nursing arises, relative to proximal healthcare groups. The argument of this paper is that within the ICU an occupational boundary (doctor-nurse) is obscured, while an organisational boundary which differentiates the ICU from the wider hospital is reinforced. Overall, the power relationship between medicine and nursing in intensive care is not 'zero-sum': the influence of both groups in the wider hospital is increased by this strategy of incorporation.

PurposeThis paper analyses participatory budgeting (PB) in two Indonesian indigenous communities, illustrating how the World Bank sponsored neo-liberal model of “technical rational” PB is overshadowed by local values and wisdom, consisting of sophisticated, pre-existing rationalities for public participation.Design/methodology/approachAdopting a qualitative and interpretive case study approach, the study draws on data from semi-structured interviews with key stakeholders and periods of participant observation. The paper utilises Weber's characterisations of rationality to analyse the PB process in indigenous communities.FindingsThe co-existence of both formal (technical) and substantive rationalities leads two Indonesian indigenous communities to execute participatory budgeting pragmatically. The formal budgetary mechanisms (Musrenbang), cascaded down from central and local governments, are melded with, and co-exist alongside, a tradition of public participation deriving from local cultural values and wisdom (Rembug warga). Reciprocal relationships and trust based on a pre-existing substantive rationality result in community members adapting budget practices while also preserving their local culture and resisting the encroachment of neo-liberal initiatives. The paper offers deeper analysis of the unintended consequences of attempting to implement technical rational accounting reforms and practices in indigenous settings.Originality/valueThe paper provides important insights into the way the interplay between formal and substantive rationality impacts on accounting and budgeting practices in indigenous communities. Our study also presents a unique case in emerging economy contexts in which neoliberal initiatives have been outmanoeuvred in the process of preserving indigenous values and wisdom. The informal participatory mechanism (Rembug warga) retained the community trust that neoliberalism systematically erodes.

The practice of medicine is often represented as a dualism: is medicine a 'science' or an 'art'? This dualism has been long-lasting, with evident appeal for the medical profession. It also appears to have been rhetorically powerful, for example in enabling clinicians to resist the encroachment of 'scientific' evidencebased medicine into core areas of medical work such as individual clinical judgement. In this article I want to make the case for a more valid conceptualisation of medical practice: that it is a 'craft' activity. The case I make is founded on a theoretical synthesis of the concept of craft, combined with an analysis of ethnographic observations of routine medical practice in intensive care. For this context the craft aspects of medical work can be seen in how biomedical and other types of knowledge are used in practice, the embodied skills and practical judgement of practitioners and the technological and material environment. These aspects are brought together in two conceptual dimensions for 'craft': first, the application of knowledge; second, interaction with the material world. Some practical and political implications of a 'craft' metaphor for medical practice are noted.

This study was undertaken to determine the extent of empirical evidence on the role of organizational factors in the critical care literature and to categorize these factors. Studies evaluating organizational factors were identified through electronic and hand searching of the critical care literature. Sixty-three publications relating to 54 different studies were identified. The studies were grouped into eight main categories: staffing, teamwork, volume and pressure of work, protocols, admission to intensive care, technology, structure, and error. Studies evaluating organizational factors exist in the critical care literature, and there is evidence that the number is increasing each year. Results indicate that organizational factors may have an impact on mortality after case mix adjustment. Some areas have been investigated more thoroughly than others and are ripe for systematic review. Variation in case mix adjusted hospital mortality after intensive care is an old theme. This study has shown that emerging data will help us understand mortality differences and deliver better outcomes for patients.

This article is intended as a contribution to our understanding of what it means to gain and retain ‘social access’ in workplace ethnography, in particular examining the role of gossip. Several difficulties encountered in attempting to gain such access within a health care setting are analysed – these difficulties having arisen after formal, physical access had been successfully negotiated. The analysis reveals the importance of participation in workplace gossip and the length of time spent in the field as facilitators of social access. The implications of participating in gossip are discussed in relation to the ethics of ethnographic methodology, in particular drawing a distinction from qualitative interviews.