Clinical governance and governmentality

Flynn, Rob

doi:10.1080/13698570220137042

Cited by 157 publications

(156 citation statements)

References 30 publications

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“…Previous research notes that cultural and behavioural reluctance present threats to top-level managers and boards trying to implement hospital governance (Flynn, 2002;Hackett et al, 1999). Physicians perceive hospital governance as threatening to their professional freedom and as a new top-down vehicle to impose managerialism, which increases the likelihood of goal conflicts.…”

Section: Joint Effect Of Strategic Priorities and Use Of Pms On Hospimentioning

confidence: 99%

“…Work rules and standardised procedures, with their emphasis on prescriptive guidance, are then developed, communicated, and tightly controlled (Langfield-Smith, 2007). In this respect, safety, quality assurance, and operating productivity can be captured by routine PMS (Flynn, 2002). The mechanistic logic behind the diagnostic use of PMS suggests that it supports operations priority.…”

Section: Joint Effect Of Strategic Priorities and Use Of Pms On Hospimentioning

confidence: 99%

“…Adopting or improving hospital governance mechanisms, which physicians may perceive to be a threat to their professional freedom (Flynn, 2002;Hackett et al, 1999), necessitates more intense communication, dialogue, and coordination among physicians and managers to mitigate goal and relationship conflicts. The conflict could be aggravated when top-level managers with an administrative background try to implement this governance priority.…”

Section: Hypothesis 5 a Three-way Interaction Among Partnership Priomentioning

confidence: 99%

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Examining the joint effects of strategic priorities, use of management control systems, and personal background on hospital performance

Harlez

Malagueño

2016

Management Accounting Research

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This study aims to respond to recent calls for a better understanding of the factors that support the effectiveness of formal control practices in hospitals. Based on survey data from 117 top-level managers in Belgian hospitals KeywordsPerformance measurement systems; strategic priorities; personal background; hospital performance; interactive use IntroductionHospitals face growing regulatory and competitive pressures to develop management control systems (Cardinaels and Soderstrom, 2013). However, formal management control systems (MCS) are seen to be problematic in hospitals (Aidemark and Funck, 2009).Questions about the use of monetary incentives for goal congruence, the power of physicians and nurses over operational processes, various priorities imposed by a large diversity of influential stakeholders, and austere budgets that constrain expansion and restructuring combine to create unparalleled complexities for the effective use of MCS (Abernethy et al., 2007). Previous research in management accounting thus calls for a better understanding of MCS in hospitals (e.g., Bai et al., 2010;King and Clarkson, 2015), especially factors that influence the effectiveness of formal performance measurement systems (PMS) (Ballantine et al., 1998;Cardinaels and Soderstrom, 2013). 2Over the past two decades, the literature on MCS in hospitals has emphasised the importance of aligning the use of MCS with hospital strategies (e.g., Aidemark and Funck, 2009;Ballantine et al., 1998;Chilingerian and Sherman, 1987;Wardhani et al., 2009), an alignment that should lead to positive organisational outcomes, such as hospital performance 2 Management control systems are defined as "formal, information-based routines and procedures managers use to maintain or alter patterns in organisational activities" (Simons, 1995, p. 5). Formal performance measurement systems are an essential aspect of formal management control systems (Chenhall, 2005;Henri, 2006). 3( King et al., 2010). Inherent in these arguments is the implicit assumption that the individual behaviour of clinicians dominating the core operations of a hospital can be controlled towards the successful achievement of hospital strategies. However, several management accounting studies (e.g., Abernethy and Stoelwinder, 1991, 1995;Jones, 2002) report that regular conflicts between the professional objectives of administrators and clinicians curtail the effectiveness of MCS. Coombs (1987, p.391) notes that bureaucratic control mechanisms attempted by administrators have "the potential to substantially affect the motivations and practices of a relatively cohesive and powerful occupational group who frequently defend their professional autonomy quite effectively". Therefore, our knowledge of how PMS are effectively used to support hospital strategies remains incomplete and fragmented.In the hospital management literature, significant attention has concentrated on the role of "doctor managers" (i.e., managers with a clinical background) in the management team and the implication...

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Section: Joint Effect Of Strategic Priorities and Use Of Pms On Hospimentioning

confidence: 99%

Section: Joint Effect Of Strategic Priorities and Use Of Pms On Hospimentioning

confidence: 99%

Section: Hypothesis 5 a Three-way Interaction Among Partnership Priomentioning

confidence: 99%

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Examining the joint effects of strategic priorities, use of management control systems, and personal background on hospital performance

Harlez

Malagueño

2016

Management Accounting Research

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“…This is followed by a critical reflection on the findings through the lens of governmentality, taking into account discursive techniques of governing. As many authors have shown (Flynn 2002;Corbridge 2005;Shore 2011), the combination of governance and governmentality -two approaches to analytically capture the activity of governing -can be fruitfully combined.…”

Section: Governing Diversity: Linkages Of Immigrant Integration and Rmentioning

confidence: 99%

Part of the problem or of the solution? The involvement of religious associations in immigrant integration policy

Mattes

2017

ozp

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Across Europe we see faith-based organizations (FBOs) getting involved in the policy field of immigrant integration. The interweaving of the policy fields of religion politics and immigrant integration is particularly delicate in systems of religionstate cooperation. Here, FBOs and state actors build on each other to fulfil certain tasks. This paper explores how FBOs are involved in the field of immigrant integration and which techniques of government are being used. Drawing on empirical case studies from Austria, Germany and Switzerland, the paper shows that religious communities fulfil multiple roles as civil society actors, as religious representatives or as migrant associations. While similarities occur due to comparable structures and institutions, observed differences are the consequence of different constellations of suspicion and trust between FBOs and state actors. Schlüsselwörter Integrationspolitik, religiöse Diversität, Governance, Gouvermentalität, Islam in Europa Acknowledgement I want to thank Sieglinde Rosenberger for her helpful comments on a previous version of this article. Her analytical way of thinking, her ability to be critical beyond the sake of criticism and her fine sense for the issues of our time are always inspiring. Keywords

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“…Value-based understandings of professionalism have ceded to normative discourses 'from above' which socialise and reshape individual identities around organisational requirements (Burgess & Currie, 2013;Evetts, 2011;Flynn, 2002;Muzio & Kirkpatrick, 2011). Understandings of autonomous professional practice are reduced to the ability to follow logical rule-following (McKee et al, 2013).…”

Section: Preference For a 'Control And Command' Modelmentioning

confidence: 99%

Professionalism and person-centredness: developing a practice-based approach to leadership within NHS maternity services in the UK

Deery

Fisher

2016

Health Sociology Review

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AcknowledgementsThis work was supported by the Health Foundation, an independent charity working to improve the quality of health care in the UK under Grant 4421/4048. The authors are grateful to the participating midwives, obstetricians and childbearing women.The authors declare that there are no conflicts of interest regarding the publication of this paper. *corresponding author2 Abstract This paper, based on data taken from in-depth interviews with senior midwives and obstetricians and conducted as part of a critical ethnographic study, argues for a greater appreciation of person-centred, value-led midwifery practice. The paper begins with a discussion of the way midwifery practice is shaped by encoded and embodied knowledge. The paper subsequently focuses on an emergent practice based leadership using an adapted Aristotelian conceptual framework derived from MacIntyre (2007). Professional dissonance is highlighted as a difficulty experienced by repositioned managers who are also expected to be leaders in their field. Using data gathered from in-depth interviews it is contended that establishing person-centred care might be better achieved through the development of practice based leadership (rather than solely by adherence to organisational requirements). This type of leadership could potentially nurture a professional environment that promotes qualities, such as agency, commitment and high levels of competence among midwives. Such leadership is central to UK government priorities and is applicable to a global practice development agenda.

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Clinical governance and governmentality

Cited by 157 publications

References 30 publications

Examining the joint effects of strategic priorities, use of management control systems, and personal background on hospital performance

Examining the joint effects of strategic priorities, use of management control systems, and personal background on hospital performance

Part of the problem or of the solution? The involvement of religious associations in immigrant integration policy

Professionalism and person-centredness: developing a practice-based approach to leadership within NHS maternity services in the UK

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