“The new patient”: the emergence of a political persona

Abstract

Purpose The purpose of this paper is to explore how the patient comes to be seen as a solution to governance problems. Design/methodology/approach 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. Findings 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. Research limitations/implications 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. Practical implications 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. Originality/value 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.

Patients’ Conceptualizations of Responsibility for Healthcare: A Typology for Understanding Differing Attributions in the Context of Patient Safety

“…While the participants interviewed for this study all received treatment “free at the point of care” within the English NHS, in fee-paying health systems (in the United Kingdom and elsewhere), responsibility may well be constructed differently. In such cases, patients might be more likely to position themselves as consumers (Bergen and Stivers 2013; Pedersen and Kjær 2017), with implications for how they construct their own and hospital staff’s responsibilities. Further research is needed to understand the effects of these different factors in the field of patient safety and in healthcare more broadly.…”

“…The typology we present demonstrates how, when patients attribute responsibility to staff and/or to patients, they frame these attributions in terms of the basis and the contingency of responsibility. This offers a new framework for understanding patients' engagement-or not-with the emerging role of "responsibilized patient" (Pedersen and Kjaer 2017) and their expectations of hospital staff. In addition to contributing to the theoretical understanding of responsibility, there are implications for practice in the field of patient safety and healthcare more broadly.…”

“…For example, definitions of safety often differ between patients and clinicians (Scott, Dawson, and Jones 2012), while a “shifting locus of responsibility” (Armstrong 2014:171) recognizes patients’ agency and concomitant responsibilities within healthcare in general and safety in particular. In addition to managing health risks and making appropriate use of healthcare services (Kitson et al 2013; May et al 2014; Pedersen and Kjær 2017), these responsibilities include engaging in safety-creating behaviors, such as challenging healthcare professionals and alerting them to the patients’ needs (De Brún et al 2016; Rhodes et al 2016; World Health Organization 2009:189–98).…”

“…Patients’ stories variously attribute responsibility to professionals, to patients, and to a mix of both, with attributions framed in terms of (1) the basis of responsibility and/or (2) the contingency of responsibility . We outline these dimensions of responsibility in a typology and consider the implications for the emerging role of the “responsibilized patient” (Pedersen and Kjær 2017:94) and patient participation in safety work.…”

Patient involvement and institutional logics: A discussion paper

“…Here, patient involvement is considered a political and social phenomenon creating new mentalities, such as a new normative understanding of patients and patient behaviour. In this perspective, patient involvement initiatives appear as the implementation of subtle forms of governmental control of patients and healthcare professionals (Järvinen & Mik‐Meyer, ; Karlsen & Villadsen, ; Kjær & Reff, ; Pedersen & Kjær, ).…”