What would you ideally do if there were no targets? An ethnographic study of the unintended consequences of top-down governance in two clinical settings

Advances in Health Sciences Education : Theory and Practice
Jon Allard, Alan Bleakley

Abstract

Top-down policy directives, such as targets and their associated protocols, may be driven politically rather than clinically and can be described as macro-political texts. While targets supposedly provide incentives for healthcare services, they may unintentionally shape practices of accommodation rather than implementation, deflecting practitioners from providing optimal care. Live work activities were observed for two six months periods in a UK NHS Emergency Department and a Mental Health Ward using video and field notes ethnography, with post hoc unstructured interviews for clarification and verification. Sixty-four practitioners were consented. Data were treated as narratives, analysed thematically and theorised using cultural-historical activity theory. The ideal text of patient-centred team working shaped by top-down, politically inspired targets was disrupted, where targets produced unintended consequences. Bottom-up strategies of making meaning of targets in a local context generated sub-texts of resistance, rationalization, and even duplicity that had paradoxical positive effects in generating collaboration and democratic habits. Throughput pressures generated both cross-team conflicts and intra-team identification. Wh...Continue Reading

References

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Citations

Sep 6, 2019·Advances in Health Sciences Education : Theory and Practice·Damian J CastanelliMargaret Bearman
Jan 5, 2019·Yakugaku zasshi : Journal of the Pharmaceutical Society of Japan·Noriko HoshikawaTakako Moriyasu

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