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Governing healthcare: Finding meaning in a clinical practice guideline for the management of non-specific low back pain

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  • Wilson, Nicky
  • Pope, Catherine
  • Roberts, Lisa
  • Crouch, Robert

Abstract

Clinical practice guidelines produced by NICE – the National Institute for Health and Care Excellence – are seen as key mechanisms to regulate and standardise UK healthcare practice, but their development is known to be problematic, and their adoption and uptake variable. Examining what a guideline or health policy means to different audiences, and how it means something to those communities, provides new insight about interpretive discourses. In this paper we present a micro-analysis of the response of healthcare professionals to publication of a single NICE guideline in 2009 which proposed a re-organisation of professional services for chronic non-specific low back pain. Adopting an interpretive approach, we seek to understand both the meaning of the guideline and the socio-political events associated with it. Drawing on archived policy documents related to the development and publication of the guideline, texts published in professional journals and on web-sites, and semi-structured interview data from professionals associated with the debate, we identify a key discourse that positions the management of chronic non-specific low back pain within physician jurisdiction. We examine the emergence of this discourse through policy-related symbolic artifacts taking the form of specific languages, objects and acts. This discourse effectively resisted and displaced the service reorganisation proposed by the guideline and, in so doing, ensured medical hegemony within practice and professional organisations concerned with the management of non-specific low back pain.

Suggested Citation

  • Wilson, Nicky & Pope, Catherine & Roberts, Lisa & Crouch, Robert, 2014. "Governing healthcare: Finding meaning in a clinical practice guideline for the management of non-specific low back pain," Social Science & Medicine, Elsevier, vol. 102(C), pages 138-145.
  • Handle: RePEc:eee:socmed:v:102:y:2014:i:c:p:138-145
    DOI: 10.1016/j.socscimed.2013.11.055
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    References listed on IDEAS

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    1. Rhodes, Lorna A. & McPhillips-Tangum, Carol A. & Markham, Christine & Klenk, Rebecca, 1999. "The power of the visible: the meaning of diagnostic tests in chronic back pain," Social Science & Medicine, Elsevier, vol. 48(9), pages 1189-1203, May.
    2. May, Carl & Doyle, Helen & Chew-Graham, Carolyn, 1999. "Medical knowledge and the intractable patient: the case of chronic low back pain," Social Science & Medicine, Elsevier, vol. 48(4), pages 523-534, February.
    3. Schubert, Cornelius, 2011. "Making sure. A comparative micro-analysis of diagnostic instruments in medical practice," Social Science & Medicine, Elsevier, vol. 73(6), pages 851-857, September.
    4. Spyridonidis, Dimitrios & Calnan, Michael, 2011. "Opening the black box: A study of the process of NICE guidelines implementation," Health Policy, Elsevier, vol. 102(2), pages 117-125.
    5. Moreira, Tiago, 2005. "Diversity in clinical guidelines: the role of repertoires of evaluation," Social Science & Medicine, Elsevier, vol. 60(9), pages 1975-1985, May.
    6. Armstrong, David, 2002. "Clinical autonomy, individual and collective: the problem of changing doctors' behaviour," Social Science & Medicine, Elsevier, vol. 55(10), pages 1771-1777, November.
    7. Jutel, Annemarie & Nettleton, Sarah, 2011. "Towards a sociology of diagnosis: Reflections and opportunities," Social Science & Medicine, Elsevier, vol. 73(6), pages 793-800, September.
    8. Mizrachi, Nissim & Shuval, Judith T., 2005. "Between formal and enacted policy: changing the contours of boundaries," Social Science & Medicine, Elsevier, vol. 60(7), pages 1649-1660, April.
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