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McDonaldization or Commercial Re-stratification: Corporatization and the multimodal organisation of English doctors

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  • Waring, Justin
  • Bishop, Simon

Abstract

This paper investigates transitions in the social organisation of medicine found in the extended opportunities for private corporations to own, manage and deliver public healthcare services in the English National Health Service. It follows recent calls to explain the reconstruction of medical work without reducing analysis to either the structures of organisational control or the strategic resistance of doctors. Accordingly, the paper considers how doctors interact, mediate and co-create new organisational environments. Central to our analysis are the variable sources of power that influence whether doctors acquiesce, resist or re-create change. Drawing on ethnographic research carried out between 2006 and 2010 in two Independent Sector Treatment Centres – private providers of public healthcare - the paper shows how doctors' responses to bureaucratic and commercial structures reflect their own structured forms of power, which have variable value within this new commercial environment. These include clinical experience and specialist knowledge, but also social and economic influence. Building on established sociological debates, these divergent sources of power explain how for some doctors the expansion of private healthcare might involve more extreme forms of McDonaldization, while for others it might involve opportunities for Commercial Re-stratification.

Suggested Citation

  • Waring, Justin & Bishop, Simon, 2013. "McDonaldization or Commercial Re-stratification: Corporatization and the multimodal organisation of English doctors," Social Science & Medicine, Elsevier, vol. 82(C), pages 147-155.
    • Handle: RePEc:eee:socmed:v:82:y:2013:i:c:p:147-155
    DOI: 10.1016/j.socscimed.2012.12.023
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    References listed on IDEAS

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    1. Turner, Simon & Allen, Pauline & Bartlett, Will & Pérotin, Virginie, 2011. "Innovation and the English National Health Service: A qualitative study of the independent sector treatment centre programme," Social Science & Medicine, Elsevier, vol. 73(4), pages 522-529, August.
    2. Ovretveit, John, 1996. "Beyond the public-private debate: the mixed economy of health," Health Policy, Elsevier, vol. 35(1), pages 75-93, January.
    3. Kitchener, Martin & Caronna, Carol A. & Shortell, Stephen M., 2005. "From the doctor's workshop to the iron cage? Evolving modes of physician control in US health systems," Social Science & Medicine, Elsevier, vol. 60(6), pages 1311-1322, March.
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    Citations

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    Cited by:

    1. Waring, Justin & Roe, Bridget & Crompton, Amanda & Bishop, Simon, 2020. "The contingencies of medical restratification across inter-organisational care networks," Social Science & Medicine, Elsevier, vol. 263(C).
    2. Johan Alvehus & Sanna Eklund & Gustaf Kastberg, 2020. "Organizing Professionalism – New Elites, Stratification and Division of Labor," Public Organization Review, Springer, vol. 20(1), pages 163-177, March.
    3. Waring, Justin & Bishop, Simon & Clarke, Jenelle & Roe, Bridget, 2023. "Becoming active in the micro-politics of healthcare re-organisation: The identity work and political activation of doctors, nurses and managers," Social Science & Medicine, Elsevier, vol. 333(C).
    4. Archer, Julian & Nunn, Suzanne & Regan de Bere, Sam, 2017. "The McDonaldization of appraisal? Doctors’ views of the early impacts of medical revalidation in the United Kingdom," Health Policy, Elsevier, vol. 121(9), pages 994-1000.
    5. Harris, Rebecca & Mosedale, Sarah & Garner, Jayne & Perkins, Elizabeth, 2014. "What factors influence the use of contracts in the context of NHS dental practice? A systematic review of theory and logic model," Social Science & Medicine, Elsevier, vol. 108(C), pages 54-59.
    6. Cascón-Pereira, Rosalía & Chillas, Shiona & Hallier, Jerry, 2016. "Role-meanings as a critical factor in understanding doctor managers' identity work and different role identities," Social Science & Medicine, Elsevier, vol. 170(C), pages 18-25.
    7. Racko, Girts, 2017. "Bureaucratization and medical professionals’ values: A cross-national analysis," Social Science & Medicine, Elsevier, vol. 180(C), pages 76-84.
    8. Sabina Siebert & Stacey Bushfield & Graeme Martin & Brian Howieson, 2018. "Eroding ‘Respectability’: Deprofessionalization Through Organizational Spaces," Work, Employment & Society, British Sociological Association, vol. 32(2), pages 330-347, April.
    9. Elyesa KOYTAK, 2020. "Meslek Sosyolojisinde Teorik Yaklaşımlar," Journal of Economy Culture and Society, Istanbul University, Faculty of Economics, vol. 0(1), pages 1-27, September.

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