Perceived Autonomy and Work Satisfaction amongst Psychiatrists in the NHS

Schulz, Rockwell; Girard, Chris; Harrison, Sarah; Sims, A.C.P.

doi:10.1108/02689239110144415

Cited by 4 publications

(7 citation statements)

References 5 publications

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“…Although professional autonomy may be conceived of as having several dimensions (Freidson 1970, Tolliday 1978, Schulz and Harrison 1986, Elston 1991), the dimensions that are central to these analyses concern the ability of individual physicians to determine their own clinical practices and to evaluate their own performance, in both cases without normally having to account to others. It is possible that autonomy relates positively to professional job satisfaction and ability to cope (see, for instance Schulz et al . 1991, Akre et al .…”

Section: Introductionmentioning

confidence: 99%

“…Although professional autonomy may be conceived of as having several dimensions (Freidson 1970, Tolliday 1978, Schulz and Harrison 1986, Elston 1991, the dimensions that are central to these analyses concern the ability of individual physicians to determine their own clinical practices and to evaluate their own performance, in both cases without normally having to account to others. It is possible that autonomy relates positively to professional job satisfaction and ability to cope (see, for instance Schulz et al 1991, Akre et al 1997, Kapur et al 1999, but in the sociological literature, questions about autonomy lie at the heart of what it is to be a professional (Freidson 1970, Johnson 1972. This literature, however, manifests less agreement about how to conceptualise such challenges to autonomy.…”

Section: Introductionmentioning

confidence: 99%

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Autonomy and bureaucratic accountability in primary care: what English general practitioners say

Harrison

Dowswell

2002

Sociology Health & Illness

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Clinical autonomy has long been seen as conceptually central to the analysis of the occupational status of the medical profession, though the implications for this of recent developments in health care managerialism have been disputed by theorists. In particular, the question has arisen as to whether 'restratification', that is, the active involvement of physicians in this process, should be construed as medical élites exerting control over the rank and file in order to protect the profession as a whole, or as an incursion from outside it. This paper uses interview data from 49 general medical practitioners in Northern England. It investigates their perceptions of how current government policies, and the new institutions and governance arrangements that they have created impact on physicians' ability to set their own limits and to judge their own work. We found a clear acceptance by GPs of the need to discharge 'bureaucratic accountability', in particular to maintain records of their clinical decisions. This provides the possibility of external surveillance of medical work, and thus implies a clear reduction in autonomy over the content of medical work on the part of rank-and-file GPs, who may regret this situation but offer little resistance to it. Our findings illustrate a form of restratification; the most frequently reported immediate source of pressure to modify casenote recording was the Primary Care Group (PCG), an organisation constitutionally dominated by physicians acting in a managerial capacity. Nevertheless, the agendas of PCGs are largely driven by central government and our study thus provides further evidence of the intermediary or contingent (rather than independent) character of professional autonomy.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Autonomy and bureaucratic accountability in primary care: what English general practitioners say

Harrison

Dowswell

2002

Sociology Health & Illness

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“…This article is derived from work conducted by some of the present authors in Germany and England [20,24]. This showed that peer review of cases by psychiatrists functioned to make visible the quality of care and helped to predict psychiatrist satisfaction and perceptions of clinical autonomy.…”

Section: Hypothesismentioning

confidence: 99%

“…There exists an official policy priority for the closure of long-stay psychiatric hospitals and their replacement by community care, in which both health care (the responsibility of the NHS) and social care (the responsibility of local government authorities) are integrated. While this policy seems largely to be supported by psychiatrists [24], there is a feeling among both health and social care workers that the available resources are inadequate [25]. Some of the Former Soviet Union Psychiatric care, along with most health services, was highly centralized and hierarchical within the former USSR [19].…”

Section: Englandmentioning

confidence: 99%

Management and Psychiatrists' Job Satisfaction: Evidence from England, Germany, the Former USSR and China

Schulz¹,

Girard

Enikeev³

et al. 1993

Jnl of Management in Medicine

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Begins from the premiss that job satisfaction among caring professionals is important not only for its own sake, but also for its effect on service outcomes. Presents empirical results, from four very different countries, which suggest that management‐influenced variables can help to ameliorate job dissatisfaction arising from factors such as resource constraints. Develops the thesis that cross‐cultural comparisons are a valid instrument for assessing the effect of management efforts which contribute to psychiatric satisfaction and feelings of autonomy. Establishes the need for more cross‐national investigation of the relationship of management to worker job satisfaction.

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“…There is widespread academic agreement on the need to maintain a certain degree of autonomy for healthcare professionals in order to improve not only their ability to cope with everyday challenges, but also as a fundamental aspect of their personal performance and motivation (Harrison and Dowswell, 2002). The demands of autonomy and responsibility for the clinical units stem from those benefits that have been empirically demonstrated in the professional field (Schulz et al 1991, Akre et al 1997, Kapur et al 1999. The main focus of these analyses has been on the ability of professionals and clinical units to determine or establish their own clinical strategies and the assessment of their own performance.…”

Section: Autonomy and Responsibilitymentioning

confidence: 99%