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GOVERNING MEDICINE Theory and Practice EDITED by Andrew Gray & Stephen Harrison G “Gray and Harrison Have Assembled an Impressive Array of Authors to Analyse The

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GOVERNING MEDICINE Theory and Practice EDITED by Andrew Gray & Stephen Harrison G “Gray and Harrison Have Assembled an Impressive Array of Authors to Analyse The GOVERNING MEDICINE Theory and Practice EDITED BY Andrew Gray & Stephen Harrison G “Gray and Harrison have assembled an impressive array of authors to analyse the changing role of the medical profession. The contributions range from historical OVERNING analyses of the relationship between government and doctors, to detailed examination of the implementation of clinical governance in the NHS. All offer important insights into an issue that lies at the heart of contemporary debates in health policy.” CHRIS HAM, PROFESSOR OF HEALTH POLICY AND MANAGEMENT, UNIVERSITY OF BIRMINGHAM This book brings together a range of detailed explorations of the theory, practice and prospects of clinical governance by some of the most eminent practitioners and researchers in the United Kingdom. Since New Labour’s institution of clinical governance through its White Paper in 1997, there has been a good deal of M debate about the history, theory and practice of clinical governance and the governance of clinical care. EDICINE Divided into three parts, the book focuses on the core areas of: N Medicine, Autonomy and Governance N Evidence, Science and Medicine N Realizing Clinical Governance Starting with the differing definitions of the term clinical governance, the contributors discuss the relationship of medicine and governance, the challenges that evidence-based medicine makes upon clinical practice and move on to suggest possible futures for clinical governance. Written by a team of experienced academics and practitioners, this book is aimed at reflective health professionals, as well as students and academics in the fields of health policy, health services management, social policy and public policy. Gray & Harrison Cover design Hybert Design GOVERNING Andrew Gray is Emeritus Professor of Public Sector Management and Visiting Professorial Fellow at the Centre for Clinical Management at the University of Durham. He has published widely on the subject of clinical governance. Stephen Harrison is Professor of Social Policy at the University of Manchester. MEDICINE His academic interests are in health policy analysis, medical-managerial politics, • and participation and democracy in health care. www.hybertdesign.com Contributors Marian Barnes, Andy Bilson, David Byrne, Barbara Coyle, Pieter Degeling, Theory and Practice Tracy Finch, Rob Flynn, Andrew Gray, Stephen Harrison, Rick Iedema, John Kennedy, Fergus Macbeth, Frances Mair, Sharyn Maxwell, Carl May, Michael Moran, Maggie Mort, Nancy Redfern, Chandra Vanu Som, Jane Stewart, Barbara Telfer, Stephen Watkins, Sue White. www.openup.co.uk GOVERNING MEDICINE: Theory and Practice GOVERNING MEDICINE: Theory and Practice Edited by Andrew Gray and Stephen Harrison Open University Press Open University Press McGraw-Hill Education McGraw-Hill House Shoppenhangers Road Maidenhead Berkshire England SL6 2QL email: [email protected] world wide web: www.openup.co.uk and Two Penn Plaza, New York, NY 10121-2289, USA First published 2004 Copyright # The Editors and Contributors, 2004 All rights reserved. Except for the quotation of short passages for the purposes of criticism and review, no part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form, or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publisher or a licence from the Copyright Licensing Agency Limited. Details of such licences (for reprographic reproduction) may be obtained from the Copyright Licensing Agency Ltd of 90 Tottenham Court Road, London, W1T 4LP. A catalogue record of this book is available from the British Library ISBN 0 335 21435 5 (pb) 0 335 21436 3 (hb) Library of Congress Cataloging-in-Publication Data CIP data applied for Typeset by YHT Ltd., London Printed in the UK by Bell & Bain Ltd., Glasgow Contents Acknowledgement vii Contributors viii 1: Governing Medicine: An Introduction 1 Andrew Gray PART 1: MEDICINE, AUTONOMY AND GOVERNANCE 9 2: `Soft Bureaucracy', Governmentality and Clinical Governance: Theoretical Approaches to Emergent Policy 11 Rob Flynn 3: Governing Doctors in the British Regulatory State 27 Michael Moran 4: Medicine and Government: Partnership Spurned? 37 Stephen Watkins 5: Medicine and Management: Autonomy and Authority in the National Health Service 51 Stephen Harrison 6: Practitioner Perspectives on Objectives and Outcomes of Clinical Governance: Some Evidence from Wales 60 Pieter Degeling, John Kennedy, Fergus Macbeth, Barbara Telfer, Sharyn Maxwell and Barbara Coyle PART 2: EVIDENCE, SCIENCE AND MEDICINE 79 7: Evidence-Based: What Constitutes Valid Evidence? 81 David Byrne 8: Limits of Governance: Interrogating the Tacit Dimensions of Clinical Practice 93 Andy Bilson and Sue White vi GOVERNING MEDICINE: THEORY AND PRACTICE 9: Telemedicine and Clinical Governance: Controlling Technology, Containing Knowledge 107 Maggie Mort, Carl May, Tracy Finch and Frances Mair 10: Affect, Anecdote and Diverse Debates: User Challenges to Scienti®c Rationality 122 Marian Barnes PART 3: REALIZING CLINICAL GOVERNANCE 133 11: What Counts is What Works: Postgraduate Medical Education and Clinical Governance 135 Nancy Redfern and Jane Stewart 12: Developing the Human Resource Dimension of Clinical Governance 152 Chandra Vanu Som 13: Restructuring Clinical Governance to Maximize its Developmental Potential 163 Pieter Degeling, Sharyn Maxwell and Rick Iedema 14: Governing Medicine: Governance, Science and Practice 180 Stephen Harrison References 188 Index 209 Acknowledgement This book is the third and ®nal publication produced by a series of ®ve seminars on clinical governance held at various locations in the North of England in 2000 and 2001. The previous publications were both special issues of journals: `Clinical Governance' in Journal of Management in Medicine, 2002, 15/3, and `Clinical Governance: Early Studies' in Clinical Governance: An In- ternational Journal, 2003, 8/1. Both were also edited by Andrew Gray and Stephen Harrison. They and the participants wish to acknowledge the support of the Economic and Social Research Council which sponsored the series and the then Bradford, County Durham and Darlington, Leeds, Manchester and Stockport health authorities for accommodating the seminars. Contributors Dr Marian Barnes is Reader in Social Policy at the University of Birming- ham. She is author of Building a Deliberative Democracy: An Evaluation of Two Citizens' Juries (Institute for Public Policy Research) and numerous other books and articles. Dr Andy Bilson is Professor of Social Work in the Department of Social Work at the University of Central Lancashire. Professor David Byrne is Professor of Sociology and Social Policy at the University of Durham. He is author of numerous texts on theory and research methods, including Complexity Theory and the Social Sciences: An Introduction (Routledge) and Social Exclusion (Open University Press). Barbara Coyle is Research Associate at the Centre for Clinical Management Development at the University of Durham. Professor Pieter Degeling is Professor of Clinical Management and Di- rector of the Centre for Clinical Management Development at the University of Durham. He has published widely internationally and is currently engaged on extensive research and development projects funded by the NHS on clinical management. Dr Tracy Finch is Senior Research Associate in the Centre for Health Ser- vices Research, University of Newcastle upon Tyne. Professor Rob Flynn is Professor of Sociology at the University of Salford. He is author of several books about NHS management and professionals, in- cluding Structures of Control in Health Management (Routledge) and (with Gareth Williams and Sue Pickard) Markets and Networks: Contracting in Com- munity Health Services (Open University Press). Professor Andrew Gray (Editor) is Emeritus Professor of Public Sector Management at the University of Durham and, among other freelance posi- tions, Visiting Professorial Fellow at the Centre for Clinical Management Development at the University of Durham, Vice Chairman of Durham and Chester-le-Street Primary Care Trust and Editor of the Blackwell Journal, CONTRIBUTORS ix Public Money and Management. His other publications with Stephen Harrison on clinical governance include two special issues of journals: Journal of Management in Medicine, 2002, 15/3 and Clinical Governance: An International Journal, 2003, 8/1, both of which (as with most of the chapters of this volume) drew on an ESRC seminar series organized by the editors in 2000±01. Other recent publications include Collaboration in Public Services: The Challenge for Evaluation (Transaction). Professor Steve Harrison (Editor) is Professor of Social Policy at the University of Manchester. He was formerly Professor of Health Policy and Politics at the University of Leeds. His academic interests are in health policy analysis, medical±managerial politics, and participation and democracy in health care. He has published widely in books and articles. His other pub- lications with Andrew Gray on clinical governance include two special issues of journals: Journal of Management in Medicine, 2002, 15/3 and Clinical Gov- ernance: an International Journal, 2003, 8/1 (described as `unputdownable' by the Deputy Chief Medical Of®cer), both of which (as with most of the chapters of this volume) drew on an ESRC seminar series organized by the editors in 2000±01. Rick Iedema is Senior Lecturer, Faculty of Medicine and Centre for Clinical Governance Research, University
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