Between surveillance and subjectification: professionals and the governance of quality and patient safety in English hospitals

Social Science & Medicine
Graham MartinMary Dixon-Woods

Abstract

Two understandings of the dynamics of power developed by Foucault have been extensively used in analyses of contemporary healthcare: disciplinary power and governmentality. They are sometimes considered alternative or even contradictory conceptual frameworks. Here, we seek to deploy them as complementary ways of making sense of the complexities of healthcare organisation today. We focus on efforts to improve quality and safety in three UK hospitals. We find a prominent role for disciplinary power, including a panoptic gaze that is to some extent internalised by professionals. We suggest, however, that the role of disciplinary power relies for its impact on complementary strategies that are more akin to governmentality. These strategies foster organisational contexts that are receptive to disciplinary work. More fundamentally, we find that both disciplinary power and governmentality work on subjectivities in rather a different manner from that suggested by conventional accounts. We offer an alternative, less individualised and more socialised, understanding of the way in which power acts upon subjectivity and behaviour in professional contexts.

References

Jul 5, 2005·Social Science & Medicine·Rick IedemaChristine Jorm
Dec 3, 2009·Health Affairs·Robert M Wachter
Jan 21, 2011·Social Science & Medicine·Graham P Martin, Mark Learmonth
Feb 5, 2011·BMJ : British Medical Journal·Amirta BenningRichard Lilford
Sep 21, 2011·Sociology of Health & Illness·Dino NumeratoGiovanni Fattore
Jun 8, 2013·BMJ Quality & Safety·Kaveh G Shojania, Mary Dixon-Woods

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Citations

Aug 16, 2015·Journal of Health and Social Behavior·Graham P MartinMary Dixon-Woods
Oct 27, 2017·Sociology of Health & Illness·Euan SadlerChristopher McKevitt
Dec 21, 2017·Journal of Health Services Research & Policy·Joanne GreenhalghNick Black
Oct 27, 2018·Tropical Medicine & International Health : TM & IH·Samuel AkechUNKNOWN Clinical Information Network authors
Jan 7, 2016·Palliative & Supportive Care·Laura Cottrell, Wendy Duggleby
Jun 1, 2020·Sociology of Health & Illness·Catherine M MontgomeryLouise Locock
Feb 15, 2020·Wellcome Open Research·Mary Dixon-WoodsGraham Martin
Sep 19, 2020·Global Qualitative Nursing Research·Eleni Siouta, Ulf Olsson
Mar 3, 2019·Journal of Health Services Research & Policy·Graham MartinMary Dixon-Woods

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