Medical audit: threat or opportunity for the medical profession. A comparative study of medical audit among medical specialists in general hospitals in the Netherlands and England, 1970–1999

Herk, Rhodee van; Klazinga, Niek; Schepers, Rita; Casparie, A. F.

doi:10.1016/s0277-9536(00)00458-5

Cited by 11 publications

(5 citation statements)

References 21 publications

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“…The CCMS, in consultation with the specialty associations, formulated new requirements to improve training quality, such as a minimal number of hospital beds and the number of patient contacts. External peer-reviewed site-visit programs for teaching hospitals were introduced to monitor and assess the quality of local training programs (van Herk et al 2001). Although these measures enhanced the formalization of the medical training system, it was also widely recognized that many of the requirements were not met in daily practice (Klazinga 1996).…”

Section: Establishing a Self-regulatory Structure For Medical Educationmentioning

confidence: 99%

Negotiating Authority: A Comparative Study of Reform in Medical Training Regimes

Helderman¹,

Bont²,

Scheele³

et al. 2012

Journal of Health Politics, Policy and Law

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Recently the medical profession has faced increasing outside pressure to reform postgraduate medical training programs to better equip young doctors for changing health care needs and public expectations. In this paper, we explore the impact of reform on professional self-governance by conducting a comparative historicalinstitutional analysis of postgraduate medical training reform in Britain and the Netherlands. In both countries, the medical training regime has shifted from professional self-regulation to co-regulation. Yet, there are notable differences in each country that cannot be solely explained by diverging institutional contexts. They also result from the strategic actions by the actors involved. Based on an assessment of the recent literature on institutional transformation, this paper shows how strategic actions set negotiating authority processes into motion, producing new and sometimes surprising institutional arrangements that can have profound effects on the distribution and allocation of authority in the medical training regime. The paper stresses the need to study the interactions between political context, the properties of institutions and negotiating authority processes, as they are crucially important to understanding institutional transformation.

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Section: Establishing a Self-regulatory Structure For Medical Educationmentioning

confidence: 99%

Negotiating Authority: A Comparative Study of Reform in Medical Training Regimes

Helderman¹,

Bont²,

Scheele³

et al. 2012

Journal of Health Politics, Policy and Law

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show abstract

“…This can be seen as a way to manipulate or influence any practice, thus restricting autonomy [37,38]. Those that are more positive about audit argue that properly designed, constructed and implemented audit cycles are the best option to enhance the work of a LREC [34,36,39].…”

Section: How Does An Audit Cycle Promote the Work Of Lrecs?mentioning

confidence: 99%

“…Audit seeks to examine and verify to what extent a situation, process or performance conforms to predetermined standards or criteria [33,37]. Since LRECs are expected to follow certain international regulations, this seems appropriate.…”

Section: How Does An Audit Cycle Promote the Work Of Lrecs?mentioning

confidence: 99%

“…Monitoring is concerned with the continuous overseeing of the implementation of an activity to ensure that inputs, schedules, targets and other actions required are proceeding according to a particular plan. Whereas, evaluation is any activity undertaken to assess the operation and impact of public policies and the action programmes introduced to implement those policies [33,37]. In comparison with evaluative practice, which often generates conflict and ambiguity, auditing an organisation, like a LREC, is not merely a collection of technical tasks, but also a programmatic idea that must be ethically and scientifically sound [39][40][41][42].…”

Section: How Does An Audit Cycle Promote the Work Of Lrecs?mentioning

confidence: 99%

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Understanding the structure and practices of research ethics committees through research and audit: a study from Mexico

et al. 2005

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“…Managed care means healthcare services comprehensively organized as a means of controlling the costs of the provision of services (Fairfield et al, 1997(Fairfield et al, : 1823. The control of costs involves the administrative control of medical work and the auditing of physicians' clinical decisions (Hansson, 2000;Herk et al, 2001). The traditional 'closed' medical encounter has ceased to be a relationship protected from external control and is now managed through a variety of administrative procedures, e.g.…”

mentioning

confidence: 99%

Physicians as ‘Organic Intellectuals’

Filc

2006

Acta Sociologica

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Since the early 1980s, healthcare systems in welfare states have undergone a process of transformation, with the convergence towards different forms of managed care as one of its central characteristics. The process has also brought about changes within the medical profession. Most physicians, and some sociologists, understand the transformation as a process of deprofessionalization. This article presents an alternative explanation, understanding changes as a process of redistribution of power and resources within the profession, and as a change in the relationship between the medical profession and the hegemonic bloc.The medical profession: physicians as intellectuals?During the past two decades, the organization of health care has changed profoundly throughout the world. One of the changes, the convergence towards managed care, may be highlighted as the main approach to organizing health care as a means of curbing costs and the resulting transformations in the nature of the medical profession. Some scholars have suggested that these transformations reduce the power of the medical profession, and explain them in terms of deprofessionalization or proletarization (Haug, 1988;Ritzer and Walczak, 1988;McKinlay and Stoeckle, 1988;White, 2000). Deprofessionalization means that medicine at least partially loses the four defining traits by which it is considered a profession: monopoly over skills, autonomy, distance from the working class and 'power over' other occupations and even over society as a whole (Freidson, 1970;Larson, 1977Larson, , 1990 Abbot, 1988). The medical profession enjoys a monopoly over specialized skills, skills that demand an extensive body of theoretical and practical knowledge. Monopoly gives the medical profession the right to declare both lay evaluation and competition by other healthcare providers illegitimate. Mastery of this specific knowledge requires a lengthy formal education that involves the transmission of a body of theory as well as a set of skills. This process also involves socialization into a selfidentified group, which shares a corpus of values regulating professional performance, usually organized into a code of ethics (Larson, 1977). Autonomy refers to the profession's controlling power over the different aspects of its work: the ways in which the work is done, working pace, working hours, etc. (Freidson, 1970;Tousijn, 2002). In order to preserve both their autonomy and their monopoly over skills, professionals need formal organizations such as professional societies. The latter bear the power and the right to set standards of behavior and competence. Professions succeed in maintaining their power of control and their freedom thanks to their relationship with the state, which usually

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Medical audit: threat or opportunity for the medical profession. A comparative study of medical audit among medical specialists in general hospitals in the Netherlands and England, 1970–1999

Cited by 11 publications

References 21 publications

Negotiating Authority: A Comparative Study of Reform in Medical Training Regimes

Negotiating Authority: A Comparative Study of Reform in Medical Training Regimes

Understanding the structure and practices of research ethics committees through research and audit: a study from Mexico

Physicians as ‘Organic Intellectuals’

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