Legitimacy Chasing its Own Tail: Theorizing Clinical Governance through a Critique of Instrumental Reason

Brown, Patrick R (2008) Legitimacy Chasing its Own Tail: Theorizing Clinical Governance through a Critique of Instrumental Reason. Social Theory and Health, 6 (2). pp. 184-199. ISSN 1477-8211. (The full text of this publication is not currently available from this repository. You may be able to access a copy if URLs are provided)

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Clinical governance was introduced in The New NHS: Modern, Dependable in 1997. Through changing structures and systems around the management of risk, knowledge and performance, the policy essentially seeks to mould the working culture of the NHS, yet there is inconclusive evidence as to its success, with many studies suggesting its impact has been highly limited. While modifying the system and structures within which practitioners operate is straightforward, cultures of shared norms and values cannot be so easily, or indeed successfully, shaped. Applying Habermasian social theory as an analytical framework, clinical governance is seen as responding to a constructed legitimacy crisis following NHS dysfunctions such as Bristol Royal Infirmary. Paradoxically, this misnomer has led to a policy that undermines its own legitimation among the professionals it seeks to control through its separation of purposive-rational interests from norms and values. Thus, a reliance on sanctions rather than norms to orient the actions of individuals working within the NHS elicits superficial rather than substantive compliance, undermining the effectiveness of auditing/accountability mechanisms. Whereas intra-organizational trust is more efficient in managing transactions, clinical governance, as it functions currently, represents a form of control which is not only more expensive, but ultimately ineffective and self-defeating.

Item Type: Article
Uncontrolled keywords: clinical governance, legitimacy, Habermas, policy, trust-control dialectic, norms
Subjects: H Social Sciences > HB Economic Theory
H Social Sciences > HM Sociology
R Medicine > R Medicine (General) > R723 Medical ethics
Divisions: Faculties > Social Sciences > School of Social Policy Sociology and Social Research > Centre for Health Services Studies
Depositing User: Patrick Brown
Date Deposited: 07 Mar 2009 12:41
Last Modified: 14 Feb 2013 15:34
Resource URI: https://kar.kent.ac.uk/id/eprint/14679 (The current URI for this page, for reference purposes)
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