Titre :
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Talking contracts and taking care : managers and professionals in the British National Health Service internal market. (2000)
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Auteurs :
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L. GRIFFITHS ;
D. HUGHES ;
School of Health Science. University of Wales. Swansea. Singleton Park. Swansea Wales. GBR
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Type de document :
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Article
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Dans :
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Social science and medicine (vol. 51, n° 2, 2000)
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Pagination :
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209-222
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Langues:
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Anglais
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Mots-clés :
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Profession santé
;
Personnel hospitalier
;
Système santé
;
Soins
;
Evaluation
;
Homme
;
Grande Bretagne
;
Royaume Uni
;
Europe
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Résumé :
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[BDSP. Notice produite par INIST SR0x2iBZ. Diffusion soumise à autorisation]. This paper draws on audio-recordings of a Health Authority's contract monitoring meetings with hospital providers to examine the nature of interactions between managers and clinical professionals in the British National Health Service internal market. It describes how managers and professionals arrive at a working division of labour, which acknowledges their respective spheres of expertise, but also leaves a space where definitions are contested. There is an interplay of competing managerial and professional discourses which construct problems and proposed solutions in fundamentally non-commensurable ways. Yet only rarely do managers or professionals mount challenges in ways that bring them on to the territory of the other group ; rather each group seeks to frame problems to mesh with its special domain of competence. Managers seek to push back the boundaries of professional control by constructing a language and set of practices which will govern the contracting process. But they remain reliant on professionals to mediate between the requirements of contracting and the realities of clinical work. Clinical arguments continue to have high perceived legitimacy for managers, and will often be taken up by hospital managers in negotiations with their Health Authority counterparts. (...)
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