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

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

Walkrounds in practice : corrupting or enhancing a quality improvement intervention? A qualitative study

Background : Walkrounds, introduced as Leadership (or Executive) WalkRounds,™ are a widely advocated model for increasing leadership engagement in patient safety to improve safety culture, but evidence for their effectiveness is mixed. In the English National Health Service (NHS), hospitals have been strongly encouraged to make use of methods closely based on the walkrounds approach. A study was conducted to explore how walkrounds are used in practice and to identify variations in implementation that might mediate their impact on safety and culture. Methods : The data, collected from 82 semistructured interviews in the English NHS, were drawn from two components of a wider study of culture and behavior around quality and safety in the English system. Analysis was based on the constant comparative method. Findings : Our analysis highlights how local, pragmatic adjustments to the walkrounds approach could radically alter its character and the way in which it is received by those at the front line. The modification and expansion of walkrounds to increase the scope of knowledge produced could increase the value that executives draw from them. However, it risks replacing the main objectives of walkrounds—specific, actionable knowledge about safety issues, and a more positive safety culture and relationship between ward and board—with a form of surveillance that could alienate frontline staff and produce fallible insights. Conclusion : The study's findings suggest some plausible explanations for the mixed evidence for walkrounds' effectiveness in creating a safety culture. On a practical level, they point to critical questions that executives must ask themselves in practicing interventions of this nature to ensure that adaptations align rather than conflict with the intervention's model of change

Additional file 4: of The ECOUTER methodology for stakeholder engagement in translational research

ECOUTER conceptual schema-second order constructs. Description of data: Output of second order data analysis (DOCX 13 kb

Additional file 4: of The ECOUTER methodology for stakeholder engagement in translational research

ECOUTER conceptual schema-second order constructs. Description of data: Output of second order data analysis (DOCX 13 kb

Additional file 1: Figure S1. of The ECOUTER methodology for stakeholder engagement in translational research

ECOUTER mindmap. Image of final mindmap created during conference ECOUTER event (DOCX 226 kb

Additional file 3: of The ECOUTER methodology for stakeholder engagement in translational research

Analysis of participant contributions in an ECOUTER-first order constructs. Output of first order data analysis (DOCX 17 kb

Principles of Authorship and Good Practice Tips

As researchers in all fields are well aware, authoring academic papers is a vital part of our academic currency. Authorship is often used as an indication of academic ‘worth’, and thus allocation of authorship is often a contentious issue, particularly on collaborative projects. In SAPPHIRE, most of our papers arise from large research projects which often involve multiple researchers (academic staff and contracted research associates and assistants) in different roles – as principal investigators, co-investigators, data collectors, data analysts and project managers, not to mention all the other tasks involved in the actual drafting and re-drafting of reports and academic papers. Almost every paper we produce has, quite rightly, multiple authors. Keen to avoid the anxieties and potential for discord disagreements over authorship could generate, we recognised the need, as a research group, to have a more transparent and consistent approach to reaching these decisions. While a number of relevant authorship codes of conduct exist, including our own University’s Research Code of Conduct, we felt that as a group we would benefit from developing more detailed guidance for operationalizing such codes in a transparent, robust and ethically defensible way. So, we have embarked on a process of developing a set of ‘Authorship Principles’ and accompanying ‘Good Practice Tips’