Clinical actions and financial constraints: the limits to rationing intensive care

Lapsley, Irvine; Melia, Kath M.

doi:10.1111/1467-9566.00273

Cited by 8 publications

(4 citation statements)

References 26 publications

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“…[20][21][22] Over a 16-week period from January to May 2005, the authors conducted semistructured interviews, 1 hour in length, with 37 medical and public health professionals in the greater Pittsburgh area who played a decision-making role in vaccine allocation, whether from an administrative or direct care perspective. Investigators used preprepared questions to inquire about a person's initial and evolving awareness about the vaccine shortage and its institutional implications, and about the design, implementation, communication, and social acceptance of local vaccine rationing policy.…”

Section: Methodsmentioning

confidence: 99%

“…20,22 People's ability to call on prior relationships provides a high degree of flexibility and innovation with which to handle local contingencies. If, however, a group exists at the fringes of personal and professional networks, then they may have less opportunity to advocate for their needs or present aid to others in need.…”

Section: Informal Arrangements and Relationships Facilitated Providermentioning

confidence: 99%

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Influenza Vaccine Scarcity 2004–05: Implications for Biosecurity and Public Health Preparedness

Schoch-Spana

Fitzgerald

Kramer

2005

Biosecurity and Bioterrorism: Biodefense Strategy, Practice, an

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In the event of a bioterrorist event or a pandemic flu outbreak, it might be necessary to ration vaccine or other treatments. In this article, researchers examine how medical and public health decision makers negotiated the unanticipated 2004-05 influenza vaccine shortage, using the regional hospital system headquartered in Pittsburgh, Pennsylvania, as the focal study site. This account of that case study describes the circumstances that contributed to the national and local vaccine shortage; the improvisation by health policymakers, hospital administrators, physicians, and nurses to prevent influenza cases despite the shortfall; and some of the legal, fiscal, logistical, social, and political pressures that local health professionals faced in deciding who should receive the limited supply of influenza vaccine. This instance of an acute vaccine shortage provided an opportunity to examine the practical and ethical dilemmas of managing medical resources during a public health emergency.

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Section: Methodsmentioning

confidence: 99%

Section: Informal Arrangements and Relationships Facilitated Providermentioning

confidence: 99%

Influenza Vaccine Scarcity 2004–05: Implications for Biosecurity and Public Health Preparedness

Schoch-Spana

Fitzgerald

Kramer

2005

Biosecurity and Bioterrorism: Biodefense Strategy, Practice, an

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“…Lapsley and Melia (2001: 739–40) observed that intensive care teams are ‘tight‐knit’. Central to my analysis of this tight‐knit team is the firm physical boundary, which separates an ICU from other areas of the hospital.…”

Section: Introductionmentioning

confidence: 99%

Boundaries obscured and boundaries reinforced: incorporation as a strategy of occupational enhancement for intensive care

Carmel

2006

Sociology Health & Illness

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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.

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“…Second, by developing a typology of professional responses to competing accountabilities, the study provides an analytical stepping stone for future research. While existing studies have provided examples of how frontline professionals seek to challenge budgetary limits and allocative decisions (e.g., Lapsley & Melia, 2001; Russell & Greenhalgh, 2014), the sociological literature on priority setting and rationing has yet to develop shared conceptualisations of how frontline professionals deal with distributive dilemmas. Third, the study brings the sociological debate on priority setting and rationing up to date with current developments in the medical field.…”

Section: Introductionmentioning

confidence: 99%

Good conduct in a context of rationing: A case study of how frontline professionals deal with distributive dilemmas of novel gene therapies

Wadmann

Hauge

Navne

2023

Sociology Health & Illness

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Classical dilemmas of how to distribute limited resources have been rekindled by the rise of advanced, high-cost therapies. Building on a case study of a novel gene therapy in neuropaediatric care, this article explores the dilemmas that explicit priority setting can create for frontline professionals and develops a typology of professionals' responses to these dilemmas. Despite political attempts to centralise priority setting and spare health professionals from having to consider treatment costs at the 'bedside', this study shows that concern for economic efficiency and budget control nonetheless need to be handled and balanced against other accountabilities in the daily work of frontline professionals. Contributing to the sociological debate on priority setting and rationing, this study develops an analytical perspective attuned to the relational aspects of frontline work and the challenges related to the balancing of diverging ideas of good conduct. Further, focussing on an empirical field at the forefront of genomic medicine, this study brings the sociological debate on

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Clinical actions and financial constraints: the limits to rationing intensive care

Cited by 8 publications

References 26 publications

Influenza Vaccine Scarcity 2004–05: Implications for Biosecurity and Public Health Preparedness

Influenza Vaccine Scarcity 2004–05: Implications for Biosecurity and Public Health Preparedness

Boundaries obscured and boundaries reinforced: incorporation as a strategy of occupational enhancement for intensive care

Good conduct in a context of rationing: A case study of how frontline professionals deal with distributive dilemmas of novel gene therapies

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