The Iron Cage and the Gaze: Interpreting Medical Control in the English Health System

Exworthy, Mark

doi:10.7577/pp.944

Cited by 15 publications

(17 citation statements)

References 48 publications

(57 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These two groups reflected, respectively, internal and external sources of (apparent) control over surgeons. The former has been seen as a direct challenge to clinicians (Exworthy , Harrison and Pollitt ) whereas the latter sought to effect change through market‐based mechanisms (Checkland et al . ).…”

Section: Methodsmentioning

confidence: 99%

“…in the operating theatre), public reporting enables external agents to glean a picture of doctors' practice in order to control it. These ‘softwares' rely less on bureaucratic techniques of direct control and more on transforming agents (doctors) as ‘calculable selves' (Miller ) and an extension of the ‘gaze' of panoptic control (Exworthy , Reed ). Although this might represent a shift (back) towards internalised disciplines of performance ( cf .…”

Section: Medical Autonomy and Surveillancementioning

confidence: 99%

“…In some cases, medical autonomy has been examined in isolation (Thomas and Hewitt ) but recent developments have meant that these issues have effectively coalesced under the broad title of transparency (Levay and Waks ). Although transparency seeks ‘to open practices to public scrutiny' (McGivern and Fischer : 289), it can introduce surveillance as a loss of autonomy and a form of control of the (medical) profession (Exworthy ). However, it also introduces the possibility that the medical profession might accommodate it and (in some cases) enhance its legitimacy and status by it.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Professional autonomy and surveillance: the case of public reporting in cardiac surgery

Exworthy

Gabe

Jones

et al. 2019

Sociology Health & Illness

Self Cite

View full text Add to dashboard Cite

Professional autonomy has come under greater scrutiny due to managerialism, consumerism, information and communication technologies (ICT), and the changing composition of professions themselves. This scrutiny is often portrayed as a tension between professional and managerial logics. Recently, medical autonomy has increasingly been shaped in terms of transparency, where publication of clinical performance (via ICT) might be a more pervasive form of surveillance. Such transparency may have the potential for a more explicit managerial logic but is contested by clinicians. This paper applies notions of surveillance to public reporting of cardiac surgery, involving the online publication of mortality rates of named surgeons. It draws on qualitative data from a case‐study of cardiac surgeons in one hospital, incorporating interviews with health care managers and national policymakers in England. We examine how managerial logics are mediated by professional autonomy, generating patterns of enrolment, resistance and reactivity to public reporting. The managerial ‘gaze' of public reporting is becoming widespread but the surgical specialty is accommodating it, leading to a re‐assertion of knowledge, based on professional definitions. The paper assesses whether this form of surveillance is challenging to or being assimilated by the medical profession, thereby recasting the profession itself.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Medical Autonomy and Surveillancementioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Professional autonomy and surveillance: the case of public reporting in cardiac surgery

Exworthy

Gabe

Jones

et al. 2019

Sociology Health & Illness

Self Cite

View full text Add to dashboard Cite

show abstract

“…For example, clinical management Information Systems (IS) often respond to the managerialist logic of performance and efficiency in health care resource management and clinical practice (Currie & Guah, 2007;Doolin, 2004). The introduction of these systems creates tension with medical professionalism by disrupting established patterns of work (Boonstra & Van Offenbeek, 2010;Nicolini, 2006;Petrakaki, Barber, & Waring, 2012) and challenging the professional autonomy of clinicians (Abraham & Junglas, 2011;Davidson & Chismar, 2007;Doolin, 2004;Exworthy, 2015;Exworthy et al, 2003). To date, very few studies have focused on IT innovations that promote PCC as well as managerialism.…”

Section: Institutional Logics and It Innovation In Health Carementioning

confidence: 99%

Clinical managers' identity at the crossroad of multiple institutional logics in it innovation: The case study of a health care organization in England

Bernardi

Exworthy

2019

Information Systems Journal

Self Cite

View full text Add to dashboard Cite

Clinical managers play a crucial role in securing the implementation and sustainability of information technology (IT) innovation in health care. Yet, not all clinical managers are willing and able to support IT innovation, particularly when the institutional logics of an IT innovation challenge their professional practice. We investigate how clinical managers use their hybrid identities to reconcile differences among competing institutional logics that affect IT innovation. Based on three examples of IT innovation (telehealth for obstructive sleep apnoea, telehealth for heart failure, and electrocardiograms) in a health care organization in England, we identify three roles in IT innovation (innovation advocate, innovation broker, and innovation laggard) that clinical managers enacted in response to three degrees of conflict between institutional logics (no conflict, moderate conflict, and high conflict), respectively. We make the following contributions. First, we demonstrate how clinical managers' perception of their hybrid role in relation to their professional identity influences their response to the conflicting institutional demands of IT innovation. We conclude that clinical managers' fragmented identities can compromise their ability to effectively manage IT innovation in health care. Second, our findings raise implications for understanding the role of professionals' hybrid identities in the implementation of digital transformation at the intersection of multiple institutional logics.

show abstract

“…Healthcare managerialism utilises a mixture of 'hard' and 'soft' forms of administrative bureaucratic power which operate on institutional structures and human subjectivities via performance monitoring and appraisal mechanisms -such as standard and target setting, audit and appraisal -while simultaneous seeking to retain the appearance of devolved discretion and control over decision making 6 processes at a local level, primarily due to the highly specialised nature of professional forms of expertise (Courpasson 2000, Sheaff et al 2003, Checkland et al 2007, Checkland and Harrison 2010, Exworthy 2015. In this article, I argue that such managerial discourses have proliferated throughout the health and social care sphere in the UK in the last two decades, and have become increasingly inculcated within professional regulatory systems, as the state has acted legislatively under a modernising agenda to minimise costs and risks by supporting greater managerial involvement in the governance of public services (Baldwin 2004, Saks 2014).…”

Section: Risk-based Medical Regulationmentioning

confidence: 99%

Risk-based regulation and reforms to fitness to practise tribunals in the United Kingdom: Serving the public interest?

Chamberlain

2016

Health, Risk & Society

View full text Add to dashboard Cite

In this paper I outline recent policy reforms to the General Medical Council and how these are designed to promote greater public confidence in its management of the patient complaint and fitness to practise tribunal process. I explore how in spite of a decade of reform, potential for bias remains in relation to how issues of race and ethnicity, disability, age, class, gender and English language proficiency, intersect with complaint making and case progression. I draw on reviews of and data from the General Medical Council to examine the key issues surrounding the representativeness of the medical tribunal process, in terms of members age, gender and race and ethnicity. I note that, as in other high-income countries, there is a tendency within the UK for the risk-focused regulatory system to focus its reforming agenda on the more effective performance management of cost and risk, rather than on inculcating a more diverse patient presence and biographical profile within the day-today operation of regulatory regimes. I argue that this might unintentionally lead to the promotion of an optimism bias within riskfocused regulatory systems, potentially leading to a failure to communicate realistic perceptions of medical risk to patients and their families, and in doing so perhaps serving to further exacerbate the situation when instances of medical error and negligence occur. I conclude that current regulatory reforms in the UK are unlikely as a result to as fully promote the public interest and patient safety as they intend.

show abstract

The Iron Cage and the Gaze: Interpreting Medical Control in the English Health System

Cited by 15 publications

References 48 publications

Professional autonomy and surveillance: the case of public reporting in cardiac surgery

Professional autonomy and surveillance: the case of public reporting in cardiac surgery

Clinical managers' identity at the crossroad of multiple institutional logics in it innovation: The case study of a health care organization in England

Risk-based regulation and reforms to fitness to practise tribunals in the United Kingdom: Serving the public interest?

Contact Info

Product

Resources

About