A sociological ethnographic study of clinical governance implementation in one NHS Hospital Trust

Emerald - 2009
KarenStaniland1
1University of Salford, Salford, UK

Tóm tắt

PurposeThis study aims to give an account of how stakeholders in one NHS Hospital Trust responded to the clinical governance initiative, the effects on quality improvement and the practical accomplishment of legitimacy.Design/methodology/approachSociological new institutionalism theory was utilised to explain the political and ceremonial conformity that marked the clinical governance process. A case study was employed using ethnographic methods. The qualitative data were obtained by documentary analysis, observation of meetings and ward activity and 28 semi‐structured interviews. A grounded theory approach was adopted in the analysis of the interviews.FindingsErrors and inconsistencies were found in Trust documentation and reporting systems were poor. In practice clinical governance was inadequately understood and the corporate goals not shared. Nevertheless, during the same period the Trust obtained recognition for having appropriate structures and systems in place resulting in external legitimacy.Research limitations/implicationsThe results only relate to the Trust considered but the study has identified that, although the organization responded to isomorphic governmental pressures in the production of appropriate institutional documentation, the impact of clinical governance to improve the quality in practice was found to be inconsistent.Practical implicationsThe Trust promoted and endorsed clinical governance success but the lack of organizational processes and knowledge management equally promoted its failure by denying the resources to implement the desired actions.Originality/valueWhilst the study identified that clinical governance had been a “ceremonial success”, it is argued that the practical accomplishment in the improvement of quality of care for patients will remain a paper exercise until organizational and practice issues are addressed.

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Tài liệu tham khảo

Charmaz, K. (2006), Constructing Grounded Theory, Sage Publications, London.

Currie, G. and Suhomlinova, O. (2006), “The impact of institutional forces upon knowledge sharing in the UK NHS: the triumph of professional power and the inconsistency of policy”, Public Administration, Vol. 84 No. 1, pp. 1‐30.

Davies, C. (2003), “Some of our concepts are missing: reflections on the absence of a sociology of organizations in Sociology of Health and Illness”, Sociology of Health & Illness, Vol. 25, Silver Anniversary Issue, pp. 172‐90.

Denzin, N. and Lincoln, Y. (2000), Handbook of Qualitative Research, 2nd ed., Sage Publications, London.

Department of Health (1998), A First Class Service: Quality in the New NHS, Department of Health, Leeds.

Department of Health (1999), Making a Difference: Strengthening the Nursing, Midwifery and Health Visiting Contribution to Health and Social Care, HMSO, London.

Department of Health (2000), The NHS Plan: A Plan for Investment, A Plan for Reform (Cmnd 4818‐1), HMSO, Norwich.

Department of Health (2003), “Essence of care: patient focused benchmarks for clinical governance”, available at: www.dh.gov.uk/en/AdvanceSearchResult/index.htm?searchTerms=Essence+of+care+benchmarks (accessed 17 March 2009).

Dingwall, R. (2009), “The inevitability of professions”, in Currie, G., Ford, J., Harding, N. and Learmonth, M. (Eds), Public Services Management, Routledge, London, pp. 71‐85.

Donaldson, L. (2000), “Clinical governance – a mission to improve”, British Journal of Clinical Governance, Vol. 5 No. 1, pp. 1‐8.

Donaldson, L. (2001), “Clinical governance: making quality count”, Journal of Clinical Excellence, Vol. 2, pp. 199‐202.

Donaldson, L. and Gray, J.A.M. (1998), “Clinical governance: a quality duty for health organizations”, Quality in Health Care, Vol. 7, Suppl. 1, pp. S37‐S44.

Easterby‐Smith, M. and Lyles, M.A. (Eds) (2003), The Blackwell Handbook of Organizational Learning and Knowledge Management, Blackwell Publishing Ltd, Oxford.

Halligan, A. and Donaldson, L.J. (2001), “Implementing clinical governance: turning vision into reality”, British Medical Journal, Vol. 322 No. 7299, pp. 1413‐17.

Meyer, J.W. and Rowan, B. (1977), “Institutionalized organizations: formal structure as myth and ceremony”, American Journal of Sociology, Vol. 83 No. 2, pp. 41‐4.

Powell, W. and DiMaggio, P. (1991), The New Institutionalism in Organizational Analysis, The University of Chicago Press, Chicago, IL.

Scally, G. and Donaldson, L. (1998), “Clinical governance and the drive for quality improvement in the new NHS in England”, British Medical Journal, Vol. 317 No. 7150, pp. 61‐5.

Scott, W.R., Ruef, M., Mendel, P.J. and Caronna, C. (2000), Institutional Change and Healthcare Organization: From Professional Dominance to Managed Care, The University of Chicago Press, Chicago, IL.

Staniland, K. (2008), “Clinical governance and nursing – a sociological analysis”, unpublished PhD thesis, University of Salford, Salford.

Strauss, A. and Corbin, J. (1998), Basics in Qualitative Research: Grounded Theory Procedures and Techniques, Sage, Newbury Park, CA.

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