title: Between surveillance and subjectification: professionals and the governance of quality and patient safety in English hospitals.
abstract: 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.
authors.affiliation: University of Leicester, Department of Health Sciences, 22-28 Princess Road West, Leicester LE1 6TP, United Kingdom. Electronic address: graham.martin@le.ac.uk.
authors.forename: Graham P
authors.initials: GP
authors.lastname: Martin
authors.affiliation: Johns Hopkins University, Armstrong Institute, 750 Pratt Street East, Baltimore, MD 21202, United States.
authors.forename: Myles
authors.initials: M
authors.lastname: Leslie
authors.affiliation: University of Bristol, School of Social and Community Medicine, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, United Kingdom.
authors.forename: Joel
authors.initials: J
authors.lastname: Minion
authors.affiliation: University of Leicester, Department of Health Sciences, 22-28 Princess Road West, Leicester LE1 6TP, United Kingdom.
authors.forename: Janet
authors.initials: J
authors.lastname: Willars
authors.affiliation: University of Leicester, Department of Health Sciences, 22-28 Princess Road West, Leicester LE1 6TP, United Kingdom.
authors.forename: Mary
authors.initials: M
authors.lastname: Dixon-Woods
mesh_terms: D004739:England; D006779:Hospitals, Public / Q000458:organization & administration*; D006801:Humans; D008505:Medical Staff, Hospital / Q000523:psychology*; D061214:Patient Safety / Q000592:standards*; D011209:Power, Psychological; D011582:Psychological Theory; D011787:Quality of Health Care / Q000592:standards*
keywords: Acute care; Agency; Foucault; Governmentality; Panopticon; Professionalism; Quality and safety; United Kingdom