The meaning of quality work from the general practitioner's perspective: an interview study

BACKGROUND: The quality of health care and its costs have been a subject of considerable attention and lively discussion. Various methods have been introduced to measure, assess, and improve the quality of health care. Many professionals in health care have criticized quality work and its methods as being unsuitable for health care. The aim of the study was to obtain a deeper understanding of the meaning of quality work from the general practitioner's perspective. METHODS: Fourteen general practitioners, seven women and seven men, were interviewed with the aid of a semi-structured interview guide about their experience of quality work. The interviews were tape-recorded and transcribed verbatim. Data collection and analysis were guided by a phenomenological approach intended to capture the essence of the statements. RESULTS: Two fundamentally different ways to view quality work emerged from the statements: A pronounced top-down perspective with elements of control, and an intra-profession or bottom-up perspective. From the top-down perspective, quality work was described as something that infringes professional freedom. From the bottom-up perspective the statements described quality work as a self-evident duty and as a professional attitude to the medical vocation, guided by the principles of medical ethics. Follow-up with a bottom-up approach is best done in internal processes, with the profession itself designing structures and methods based on its own needs. CONCLUSIONS: The study indicates that general practitioners view internal follow-up as a professional obligation but external control as an imposition. This opposition entails a difficulty in achieving systematism in follow-up and quality work in health care. If the statutory standards for systematic quality work are to gain a real foothold, they must be packaged in such a way that general practitioners feel that both perspectives can be reconciled

More than a method? Organisational ethnography as a way of imagining the social

© 2016 Informa UK Limited, trading as Taylor & Francis Group. The authors–two anthropologists and an organisational theorist, all organisational ethnographers–discuss their understanding and practices of organisational ethnography (OE) as a way of imagining and reflect on how similar this understanding may be for young organisational researchers and students in particular. The discussion leads to the conclusion that OE may be regarded as a methodology but that it has a much greater potential when it is reclaiming its roots: to become a mode of doing social science on the meso-level. The discussion is based on an analysis of both historical material and the contemporary learning experiences of teaching OE as more than a method to our students

Eclipsing adaptation : the translation of the US MBA model in China

The aim of this article is to explore how business schools in China have acted upon calls for greater adaptation of the US MBA model. Scandinavian institutionalism’s concept of translation as a process was employed to make sense of how such normative demands for translation have been accommodated across five case studies. Our findings demonstrate that the normative pressures for adaptation of the MBA on the basis of cultural relativism are not sufficient for significant adaptation. In contrast to other studies of the circulation of ideas and models we found that packaging changed slightly, but form and practice remained largely unchanged. Our conclusion is that the influence of market logic has eclipsed the normative calls for adaptation, resulting in the copying and adoption of the US MBA model

Professions and the Pursuit of Transparency in Healthcare: Two Cases of Soft Autonomy

Contemporary professions are increasingly challenged to open up to scrutiny from the outside. Earlier research is focused on two main types of responses and consequences: colonization by a managerial logic of self-monitoring and decoupling of auditing and professional practice. his paper describes a different type of response which implies that professionals get actively involved in monitoring their own activities, without losing their professional autonomy. Two cases from Swedish healthcare were investigated: accreditation at a hospital laboratory and the national quality registries. In both cases, professional involvement took the form of translation and negotiation in expert networks, restrained by a certain resistance towards external monitoring, but driven by an interest in legitimizing and developing professional work. he resulting situation is characterized as a 'soft autonomy' which combines professional internalization of originally non-professional auditing ideas with maintained professional control over evaluation criteria