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Dialogues and dialetics: Limits to clinician–manager interaction in healthcare organizations

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  • MacIntosh, Robert
  • Beech, Nic
  • Martin, Graeme

Abstract

This paper examines clinician–manager interactions within healthcare organizations in the UK and contrasts the notions of dialetics and dialogues within such interactions. We draw particularly on Bakhtin’s work on dialogue to frame our focal research question, which considers the extent to which clinician–manager interactions are dialogic. Using data drawn from a thirty-two month study of five UK healthcare organizations we suggest that clinician-manager interactions are more dialectic than dialogic in their orientation. Further, we suggest that, despite the appearance of dialogical possibility between clinicians and non-clinicians, the tendency to dialectic positioning reinforces opposition between these groups and we conclude that local, rather than system-wide interventions, offer the best means of disrupting these dialectics and fostering productive dialogues.

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  • MacIntosh, Robert & Beech, Nic & Martin, Graeme, 2012. "Dialogues and dialetics: Limits to clinician–manager interaction in healthcare organizations," Social Science & Medicine, Elsevier, vol. 74(3), pages 332-339.
    • Handle: RePEc:eee:socmed:v:74:y:2012:i:3:p:332-339
    DOI: 10.1016/j.socscimed.2011.03.014
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    References listed on IDEAS

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    1. Miller, Tina & Boulton, Mary, 2007. "Changing constructions of informed consent: Qualitative research and complex social worlds," Social Science & Medicine, Elsevier, vol. 65(11), pages 2199-2211, December.
    2. Degeling, Pieter & Zhang, Kai & Coyle, Barbara & Xu, Lingzhong & Meng, Qingyue & Qu, Jiangbin & Hill, Michael, 2006. "Clinicians and the governance of hospitals: A cross-cultural perspective on relations between profession and management," Social Science & Medicine, Elsevier, vol. 63(3), pages 757-775, August.
    3. Goldenberg, Maya J., 2006. "On evidence and evidence-based medicine: Lessons from the philosophy of science," Social Science & Medicine, Elsevier, vol. 62(11), pages 2621-2632, June.
    4. Waring, Justin J. & Bishop, Simon, 2010. "Lean healthcare: Rhetoric, ritual and resistance," Social Science & Medicine, Elsevier, vol. 71(7), pages 1332-1340, October.
    5. 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.
    6. Haridimos Tsoukas, 2009. "A Dialogical Approach to the Creation of New Knowledge in Organizations," Organization Science, INFORMS, vol. 20(6), pages 941-957, December.
    7. Brown, Brian & Crawford, Paul & Nerlich, Brigitte & Koteyko, Nelya, 2008. "The habitus of hygiene: Discourses of cleanliness and infection control in nursing work," Social Science & Medicine, Elsevier, vol. 67(7), pages 1047-1055, October.
    8. Katz, Arlene M. & Shotter, John, 1996. "Hearing the patient's 'voice': Toward a social poetics in diagnostic interviews," Social Science & Medicine, Elsevier, vol. 43(6), pages 919-931, September.
    9. Farmer, Jane & Kilpatrick, Sue, 2009. "Are rural health professionals also social entrepreneurs?," Social Science & Medicine, Elsevier, vol. 69(11), pages 1651-1658, December.
    10. van der Geer, Eric & van Tuijl, Harrie F.J.M. & Rutte, Christel G., 2009. "Performance management in healthcare: Performance indicator development, task uncertainty, and types of performance indicators," Social Science & Medicine, Elsevier, vol. 69(10), pages 1523-1530, November.
    11. Broom, Alex & Adams, Jon & Tovey, Philip, 2009. "Evidence-based healthcare in practice: A study of clinician resistance, professional de-skilling, and inter-specialty differentiation in oncology," Social Science & Medicine, Elsevier, vol. 68(1), pages 192-200, January.
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    2. Chiarello, Elizabeth, 2013. "How organizational context affects bioethical decision-making: Pharmacists' management of gatekeeping processes in retail and hospital settings," Social Science & Medicine, Elsevier, vol. 98(C), pages 319-329.
    3. Moore, Helen & Gillespie, Alex, 2014. "The caregiving bind: Concealing the demands of informal care can undermine the caregiving identity," Social Science & Medicine, Elsevier, vol. 116(C), pages 102-109.

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