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

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  • Martin, Graham P.
  • Leslie, Myles
  • Minion, Joel
  • Willars, Janet
  • Dixon-Woods, Mary

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.

Suggested Citation

  • Martin, Graham P. & Leslie, Myles & Minion, Joel & Willars, Janet & Dixon-Woods, Mary, 2013. "Between surveillance and subjectification: Professionals and the governance of quality and patient safety in English hospitals," Social Science & Medicine, Elsevier, vol. 99(C), pages 80-88.
    • Handle: RePEc:eee:socmed:v:99:y:2013:i:c:p:80-88
    DOI: 10.1016/j.socscimed.2013.10.018
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    References listed on IDEAS

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    1. Iedema, Rick & Flabouris, Arthas & Grant, Susan & Jorm, Christine, 2006. "Narrativizing errors of care: Critical incident reporting in clinical practice," Social Science & Medicine, Elsevier, vol. 62(1), pages 134-144, January.
    2. Martin, Graham P. & Learmonth, Mark, 2012. "A critical account of the rise and spread of ‘leadership’: The case of UK healthcare," Social Science & Medicine, Elsevier, vol. 74(3), pages 281-288.
    3. Ferlie, Ewan & Mcgivern, Gerry & FitzGerald, Louise, 2012. "A new mode of organizing in health care? Governmentality and managed networks in cancer services in England," Social Science & Medicine, Elsevier, vol. 74(3), pages 340-347.
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    2. McGivern, Gerry & Nzinga, Jacinta & English, Mike, 2017. "‘Pastoral practices’ for quality improvement in a Kenyan clinical network," Social Science & Medicine, Elsevier, vol. 195(C), pages 115-122.

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