IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v74y2012i3p332-339.html
   My bibliography  Save this article

Dialogues and dialetics: Limits to clinician–manager interaction in healthcare organizations

Author

Listed:
  • MacIntosh, Robert
  • Beech, Nic
  • Martin, Graeme

Abstract

This paper examines clinician–manager interactions within healthcare organizations in the UK and contrasts the notions of dialetics and dialogues within such interactions. We draw particularly on Bakhtin’s work on dialogue to frame our focal research question, which considers the extent to which clinician–manager interactions are dialogic. Using data drawn from a thirty-two month study of five UK healthcare organizations we suggest that clinician-manager interactions are more dialectic than dialogic in their orientation. Further, we suggest that, despite the appearance of dialogical possibility between clinicians and non-clinicians, the tendency to dialectic positioning reinforces opposition between these groups and we conclude that local, rather than system-wide interventions, offer the best means of disrupting these dialectics and fostering productive dialogues.

Suggested Citation

  • MacIntosh, Robert & Beech, Nic & Martin, Graeme, 2012. "Dialogues and dialetics: Limits to clinician–manager interaction in healthcare organizations," Social Science & Medicine, Elsevier, vol. 74(3), pages 332-339.
    • Handle: RePEc:eee:socmed:v:74:y:2012:i:3:p:332-339
    DOI: 10.1016/j.socscimed.2011.03.014
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953611001614
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2011.03.014?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Waring, Justin J. & Bishop, Simon, 2010. "Lean healthcare: Rhetoric, ritual and resistance," Social Science & Medicine, Elsevier, vol. 71(7), pages 1332-1340, October.
    2. Brown, Brian & Crawford, Paul & Nerlich, Brigitte & Koteyko, Nelya, 2008. "The habitus of hygiene: Discourses of cleanliness and infection control in nursing work," Social Science & Medicine, Elsevier, vol. 67(7), pages 1047-1055, October.
    3. Katz, Arlene M. & Shotter, John, 1996. "Hearing the patient's 'voice': Toward a social poetics in diagnostic interviews," Social Science & Medicine, Elsevier, vol. 43(6), pages 919-931, September.
    4. Farmer, Jane & Kilpatrick, Sue, 2009. "Are rural health professionals also social entrepreneurs?," Social Science & Medicine, Elsevier, vol. 69(11), pages 1651-1658, December.
    5. Miller, Tina & Boulton, Mary, 2007. "Changing constructions of informed consent: Qualitative research and complex social worlds," Social Science & Medicine, Elsevier, vol. 65(11), pages 2199-2211, December.
    6. Degeling, Pieter & Zhang, Kai & Coyle, Barbara & Xu, Lingzhong & Meng, Qingyue & Qu, Jiangbin & Hill, Michael, 2006. "Clinicians and the governance of hospitals: A cross-cultural perspective on relations between profession and management," Social Science & Medicine, Elsevier, vol. 63(3), pages 757-775, August.
    7. Armstrong, David, 2002. "Clinical autonomy, individual and collective: the problem of changing doctors' behaviour," Social Science & Medicine, Elsevier, vol. 55(10), pages 1771-1777, November.
    8. van der Geer, Eric & van Tuijl, Harrie F.J.M. & Rutte, Christel G., 2009. "Performance management in healthcare: Performance indicator development, task uncertainty, and types of performance indicators," Social Science & Medicine, Elsevier, vol. 69(10), pages 1523-1530, November.
    9. Broom, Alex & Adams, Jon & Tovey, Philip, 2009. "Evidence-based healthcare in practice: A study of clinician resistance, professional de-skilling, and inter-specialty differentiation in oncology," Social Science & Medicine, Elsevier, vol. 68(1), pages 192-200, January.
    10. Haridimos Tsoukas, 2009. "A Dialogical Approach to the Creation of New Knowledge in Organizations," Organization Science, INFORMS, vol. 20(6), pages 941-957, December.
    11. Goldenberg, Maya J., 2006. "On evidence and evidence-based medicine: Lessons from the philosophy of science," Social Science & Medicine, Elsevier, vol. 62(11), pages 2621-2632, June.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Moore, Helen & Gillespie, Alex, 2014. "The caregiving bind: Concealing the demands of informal care can undermine the caregiving identity," Social Science & Medicine, Elsevier, vol. 116(C), pages 102-109.
    2. Currie, Graeme & Dingwall, Robert & Kitchener, Martin & Waring, Justin, 2012. "Let’s dance: Organization studies, medical sociology and health policy," Social Science & Medicine, Elsevier, vol. 74(3), pages 273-280.
    3. Chiarello, Elizabeth, 2013. "How organizational context affects bioethical decision-making: Pharmacists' management of gatekeeping processes in retail and hospital settings," Social Science & Medicine, Elsevier, vol. 98(C), pages 319-329.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Perrotta, Manuela & Geampana, Alina, 2020. "The trouble with IVF and randomised control trials: Professional legitimation narratives on time-lapse imaging and evidence-informed care," Social Science & Medicine, Elsevier, vol. 258(C).
    2. Nigam, Amit, 2012. "Changing health care quality paradigms: The rise of clinical guidelines and quality measures in American medicine," Social Science & Medicine, Elsevier, vol. 75(11), pages 1933-1937.
    3. Nurul Fadly Habidin & Nurul Aifaa Shazali & Naimah Ali & Nur Afni Khaidir & Osman Jusoh, 2016. "The impact of lean healthcare practice on healthcare performance: the mediating role of supply chain innovation in Malaysian healthcare industry," International Journal of Critical Accounting, Inderscience Enterprises Ltd, vol. 8(1), pages 79-93.
    4. Chandler, Clare I.R. & Mangham, Lindsay & Njei, Abanda Ngu & Achonduh, Olivia & Mbacham, Wilfred F. & Wiseman, Virginia, 2012. "‘As a clinician, you are not managing lab results, you are managing the patient’: How the enactment of malaria at health facilities in Cameroon compares with new WHO guidelines for the use of malaria ," Social Science & Medicine, Elsevier, vol. 74(10), pages 1528-1535.
    5. Baeza, Juan I. & Boaz, Annette & Fraser, Alec, 2016. "The roles of specialisation and evidence-based practice in inter-professional jurisdictions: A qualitative study of stroke services in England, Sweden and Poland," Social Science & Medicine, Elsevier, vol. 155(C), pages 15-23.
    6. Anders Melander & Tomas Mullern & David Anderssson & Fredrik Elgh & Malin Löfving, 2022. "Bridging the Knowledge Gap in Collaborative Research—in Dialogues We Trust," Systemic Practice and Action Research, Springer, vol. 35(5), pages 655-677, October.
    7. Timmermans, Stefan & Almeling, Rene, 2009. "Objectification, standardization, and commodification in health care: A conceptual readjustment," Social Science & Medicine, Elsevier, vol. 69(1), pages 21-27, July.
    8. Lorino, Philippe & Mourey, Damien & Schmidt, Géraldine, 2017. "Goffman's theory of frames and situated meaning-making in performance reviews. The case of a category management approach in the French retail sector," Accounting, Organizations and Society, Elsevier, vol. 58(C), pages 32-49.
    9. Elizabeth Quinlan & Susan Robertson & Ann-Marie Urban & Isobel M Findlay & Beth Bilson, 2020. "Ameliorating Workplace Harassment among Direct Caregivers in Canada’s Healthcare System: A Theatre-Based Intervention," Work, Employment & Society, British Sociological Association, vol. 34(4), pages 626-643, August.
    10. Hervé Dumez & Etienne Minvielle, 2020. "Le système hospitalier français dans la crise Covid-19," Working Papers hal-03053359, HAL.
    11. Katz, Arlene M. & Alegría, Margarita, 2009. "The clinical encounter as local moral world: Shifts of assumptions and transformation in relational context," Social Science & Medicine, Elsevier, vol. 68(7), pages 1238-1246, April.
    12. Chaojie Liu & Timothy Bartram & Sandra G. Leggat, 2020. "Link of Patient Care Outcome to Occupational Differences in Response to Human Resource Management: A Cross-Sectional Comparative Study on Hospital Doctors and Nurses in China," IJERPH, MDPI, vol. 17(12), pages 1-14, June.
    13. Querubin S. Yap & Jon K. Webber, 2015. "Developing Corporate Culture In A Training Department: A Qualitative Case Study Of Internal And Outsourced Staff," Review of Business and Finance Studies, The Institute for Business and Finance Research, vol. 6(1), pages 43-56.
    14. Kirmayer, Laurence J., 2012. "Cultural competence and evidence-based practice in mental health: Epistemic communities and the politics of pluralism," Social Science & Medicine, Elsevier, vol. 75(2), pages 249-256.
    15. Brunswicker, Sabine & Bilgram, Volker & Fueller, Johann, 2017. "Taming wicked civic challenges with an innovative crowd," Business Horizons, Elsevier, vol. 60(2), pages 167-177.
    16. May, Carl & Rapley, Tim & Moreira, Tiago & Finch, Tracy & Heaven, Ben, 2006. "Technogovernance: Evidence, subjectivity, and the clinical encounter in primary care medicine," Social Science & Medicine, Elsevier, vol. 62(4), pages 1022-1030, February.
    17. Stella Wright & Wilfred McSherry, 2014. "Evaluating the Productive Ward at an acute NHS trust: experiences and implications of releasing time to care," Journal of Clinical Nursing, John Wiley & Sons, vol. 23(13-14), pages 1866-1876, July.
    18. Walshe, Catherine & Chew-Graham, Carolyn & Todd, Chris & Caress, Ann, 2008. "What influences referrals within community palliative care services? A qualitative case study," Social Science & Medicine, Elsevier, vol. 67(1), pages 137-146, July.
    19. Lukas D. Filser & Fábio Francisco Silva & Otávio José Oliveira, 2017. "State of research and future research tendencies in lean healthcare: a bibliometric analysis," Scientometrics, Springer;Akadémiai Kiadó, vol. 112(2), pages 799-816, August.
    20. Selma KOL & Mustafa METE, 2022. "Evaluation Of Patients' Attitudes To Traditional And Complementary Medicine A Case Of A Medical Center In Istanbul," Eurasian Eononometrics, Statistics and Emprical Economics Journal, Eurasian Academy Of Sciences, vol. 22(22), pages 34-52, September.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:74:y:2012:i:3:p:332-339. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.