The Consultant-Client Relationship: A Systems-Theoretical Perspective

The aim of this paper is to explain consulting failure from a systems-theoretical perspective and to provide a new framework for analysing consultant–client relationships. By drawing on Luhmann’s systems theory, clients and consultants are conceptualised as two autopoietic communication systems that operate according to idiosyncratic logics. They are structurally coupled through a third system, the so-called “contact system”, which constitutes a separate discourse. Due to their different logics no transfer of meaning between the three discourses is possible. This contradicts the traditional notion of consulting as a means of providing solutions to the client’s problems: neither is the consultant able to understand the client’s problems nor is it possible to transfer any solutions into the client system. Instead, consulting interventions only cause perturbations in the client system. Consequently, the traditional functions of consulting are called into question. The paper discusses the implications of this analysis with relation to the traditional approach to consulting, and presents a tentative framework for a systemic concept of consulting

Problematisation and regulation: bodies, risk, and recovery within the context of Neonatal Abstinence Syndrome

Background Neonatal Abstinence Syndrome (NAS) is an anticipated effect of maternal drug use during pregnancy. Yet it remains a contested area of policy and practice. In this paper, we contribute to ongoing debates about the way NAS is understood and responded to, through different treatment regimes, or logics of care. Our analysis examines the role of risk and recovery discourses, and the way in which the bodies of women and babies are conceptualised within these. Methods Qualitative interviews with 16 parents (9 mothers, 7 fathers) and four focus groups with 27 health and social care professionals based in Scotland. All the mothers were prescribed opioid replacement therapy and parents were interviewed after their baby was born. Data collection explored understandings about the causes and consequences of NAS and experiences of preparing for, and caring for, a baby with NAS. Data were analysed using a narrative and discursive approach. Results Parent and professional accounts simultaneously upheld and subverted logics of care which govern maternal drug use and the assessment and care of mother and baby. Despite acknowledging the unpredictability of NAS symptoms and the inability of the women who are opioid-dependent to prevent NAS, logics of care centred on ‘proving’ risk and recovery. Strategies appealed to the need for caution, intervening and control, and obscured alternative logics of care that focus on improving support for mother-infant dyads and the family as a whole. Conclusion Differing notions of risk and recovery that govern maternal drug use, child welfare and family life both compel and trouble all logics of care. The contentious nature of NAS reflects wider socio-political and moral agendas that ultimately have little to do with meeting the needs of mothers and babies. Fundamental changes in the principles, quality and delivery of care could improve outcomes for families affected by NAS

Contracting with General Dental Services: a mixed-methods study on factors influencing responses to contracts in English general dental practice

Background: Independent contractor status of NHS general dental practitioners (GDPs) and general medical practitioners (GMPs) has meant that both groups have commercial as well as professional identities. Their relationship with the state is governed by a NHS contract, the terms of which have been the focus of much negotiation and struggle in recent years. Previous study of dental contracting has taken a classical economics perspective, viewing practitioners’ behaviour as a fully rational search for contract loopholes. We apply institutional theory to this context for the first time, where individuals’ behaviour is understood as being influenced by wider institutional forces such as growing consumer demands, commercial pressures and challenges to medical professionalism. Practitioners hold values and beliefs, and carry out routines and practices which are consistent with the field’s institutional logics. By identifying institutional logics in the dental practice organisational field, we expose where tensions exist, helping to explain why contracting appears as a continual cycle of reform and resistance. Aims: To identify the factors which facilitate and hinder the use of contractual processes to manage and strategically develop General Dental Services, using a comparison with medical practice to highlight factors which are particular to NHS dental practice. Methods: Following a systematic review of health-care contracting theory and interviews with stakeholders, we undertook case studies of 16 dental and six medical practices. Case study data collection involved interviews, observation and documentary evidence; 120 interviews were undertaken in all. We tested and refined our findings using a questionnaire to GDPs and further interviews with commissioners. Results: We found that, for all three sets of actors (GDPs, GMPs, commissioners), multiple logics exist. These were interacting and sometimes in competition. We found an emergent logic of population health managerialism in dental practice, which is less compatible than the other dental practice logics of ownership responsibility, professional clinical values and entrepreneurialism. This was in contrast to medical practice, where we found a more ready acceptance of external accountability and notions of the delivery of ‘cost-effective’ care. Our quantitative work enabled us to refine and test our conceptualisations of dental practice logics. We identified that population health managerialism comprised both a logic of managerialism and a public goods logic, and that practitioners might be resistant to one and not the other. We also linked individual practitioners’ behaviour to wider institutional forces by showing that logics were predictive of responses to NHS dental contracts at the dental chair-side (the micro level), as well as predictive of approaches to wider contractual relationships with commissioners (the macro level) . Conclusions: Responses to contracts can be shaped by environmental forces and not just determined at the level of the individual. In NHS medical practice, goals are more closely aligned with commissioning goals than in general dental practice. The optimal contractual agreement between GDPs and commissioners, therefore, will be one which aims at the ‘satisfactory’ rather than the ‘ideal’; and a ‘successful’ NHS dental contract is likely to be one where neither party promotes its self-interest above the other. Future work on opportunism in health care should widen its focus beyond the self-interest of providers and look at the contribution of contextual factors such as the relationship between the government and professional bodies, the role of the media, and providers’ social and professional networks. Funding: The National Institute for Health Research Health Services and Delivery Research programme

The Consultant-Client Relationship: A Systems-Theoretical Perspective

The aim of this paper is to explain consulting failure from a systems-theoretical perspective and to provide a new framework for analysing consultant–client relationships. By drawing on Luhmann’s systems theory, clients and consultants are conceptualised as two autopoietic communication systems that operate according to idiosyncratic logics. They are structurally coupled through a third system, the so-called “contact system”, which constitutes a separate discourse. Due to their different logics no transfer of meaning between the three discourses is possible. This contradicts the traditional notion of consulting as a means of providing solutions to the client’s problems: neither is the consultant able to understand the client’s problems nor is it possible to transfer any solutions into the client system. Instead, consulting interventions only cause perturbations in the client system. Consequently, the traditional functions of consulting are called into question. The paper discusses the implications of this analysis with relation to the traditional approach to consulting, and presents a tentative framework for a systemic concept of consulting.Consulting; Consultant-Client Relation; Consulting Failure; Systems Theory

Fantasies of subjugation: a discourse theoretical account of British policy on the European Union

The decision by the UK government to hold a referendum on Britain’s membership of the European Union (EU) marks an important development in policy towards the EU. Policy changes of this kind must be understood in the historical and political context in which they occur. This includes the framing of the policy issues within public discourse. In the UK, policies are formed in a discursive environment which is overwhelmingly hostile towards the EU. Debates are structured by a predominantly Euroskeptic discourse which emphasizes the UK’s separation and heterogeneity from the rest of the EU. Drawing on the logics of critical explanation, this article examines the structure and affective power of Euroskeptic discourses which dictate the terms of the EU debate. It presents a case study of the recent EU treaty revision process, culminating in the Treaty of Lisbon. In so doing, it enables a deeper understanding of recent policy developments

Semantic Matchmaking as Non-Monotonic Reasoning: A Description Logic Approach

Matchmaking arises when supply and demand meet in an electronic marketplace, or when agents search for a web service to perform some task, or even when recruiting agencies match curricula and job profiles. In such open environments, the objective of a matchmaking process is to discover best available offers to a given request. We address the problem of matchmaking from a knowledge representation perspective, with a formalization based on Description Logics. We devise Concept Abduction and Concept Contraction as non-monotonic inferences in Description Logics suitable for modeling matchmaking in a logical framework, and prove some related complexity results. We also present reasonable algorithms for semantic matchmaking based on the devised inferences, and prove that they obey to some commonsense properties. Finally, we report on the implementation of the proposed matchmaking framework, which has been used both as a mediator in e-marketplaces and for semantic web services discovery