Patients' Voices, Rights and Responsibilities: On Implementing Social Audit in Primary Health Care

This paper reports on an interpretive research project which examines the feasibility of implementing social audit within the general medical practice setting. The study aims to communicate patients' voices to aid evaluation of the potential contribution of social audit to the public health sector and also addresses particular conceptual problems which arise when attempting to implement social audit within this environment. The fieldwork focuses on one general health practice in Lanarkshire (in southern central Scotland). Consultative focus group discussions and individual interviews were carried out with a sample of twenty two patients. Patients were most concerned with health service organisational and delivery issues. Overall, the results suggest patients are enthusiastic about the ideas and process of the social audit. Patients were able to demonstrate a capacity for grasping accountability issues and balanced reasoning. There was an acute awareness of the constraints which exist in the public services. Patients addressed the broad rights and responsibilities issues, and highlighted the possible pitfalls of relying on a representational mechanism for ensuring their voices were heard. The study concludes that an involved and negotiative dialogue process of implementing social audit could provide beneficial understanding and ideas to the organisation which may be further researched.

[1]  J. Broadbent,et al.  Recent Financial and Administrative Changes in GP Practices in the UK: Initial Experiences and Effects , 1994 .

[2]  A. Likierman.  Ethical dilemmas for accountants: A United Kingdom perspective , 1989 .

[3]  Julian Tudor Hart.  Clinical and economic consequences of patients as producers. , 1995, Journal of public health medicine.

[4]  J. Broadbent,et al.  Recent financial and administrative changes in the NHS: A critical theory analysis , 1991 .

[5]  T A Sheldon,et al.  Supporting consumer involvement in decision making: what constitutes quality in consumer health information? , 1996, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[6]  J. Broadbent,et al.  Financial Controls And Schools: Accounting In 'Public' And 'private' Spheres , 1994 .

[7]  Georges Enderle.  In Search of a Common Ethical Ground: Corporate Environmental Responsibility from the Perspective of Christian Environmental Stewardship , 1997 .

[8]  G. Watt.  All together now: why social deprivation matters to everyone , 1996, BMJ.

[9]  Rolland Munro,et al.  Accountability and the New Commercial Agenda , 1993 .

[10]  A. Maynard.  Rationing health care , 1996, BMJ.

[11]  H. Willmott,et al.  Ethical statements as smokescreens for sectional interests: The case of the UK accountancy profession , 1994 .

[12]  Sue Llewellyn,et al.  Managing the Boundary , 1994 .

[13]  M. Power.  The Audit Explosion , 1994 .

[14]  R. Gray,et al.  Corporate social reporting : accounting and accountability , 1987 .

[15]  Simon Zadek.  The social audit of traidcraft plc , 1993 .

[16]  Llewellyn,et al.  GP Fundholders: Agents of Change , 1997 .

[17]  Eleanor Chelimsky.  Comparing and Contrasting Auditing and Evaluation , 1985 .

[18]  Michael Dietrich,et al.  THE DEVELOPMENT OF PRINCIPAL–AGENT, CONTRACTING AND ACCOUNTABILITY RELATIONSHIPS IN THE PUBLIC SECTOR: CONCEPTUAL AND CULTURAL PROBLEMS , 1996 .

[19]  L. Doyal,et al.  Need for moral audit in evaluating quality in health care. , 1992, Quality in health care : QHC.

[20]  P. A. Bird.  Accountability, standards in financial reporting , 1973 .

[21]  Shann Turnbull,et al.  The Need for Stakeholder Councils in Social Audits , 1995 .

[22]  Eleanor Chelimsky.  Thoughts for a New Evaluation Society , 1997 .

[23]  Robert W. Scapens,et al.  STRUCTURATION THEORY IN MANAGEMENT ACCOUNTING. , 1990 .

[24]  D. Buchanan,et al.  When Two Worlds Collide , 1997 .

[25]  M. Gelber.  Eco‐balance: An environmental management tool used in Germany , 1995 .

[26]  Simon Zadek,et al.  Balancing Performance, Ethics, and Accountability , 1998 .

[27]  M. R. Mathews,et al.  Socially Responsible Accounting , 1993 .

[28]  D. Donnison.  Act Local: Social Justice from the Bottom Up , 1994 .

[29]  R. Scapens,et al.  Accounting systems and systems of accountability — understanding accounting practices in their organisational contexts , 1985 .

[30]  Michael Power,et al.  Making things auditable , 1996 .

[31]  R. Gray,et al.  Struggling with the praxis of social accounting: Stakeholders, accountability, audits and procedures , 1997 .

[32]  C. Medawar.  The social audit: A political view , 1976 .

[33]  R. D. Hines,et al.  Financial accounting: In communicating reality, we construct reality , 1988 .

[34]  S. Llewellyn,et al.  THE IMPACT OF FUNDHOLDING ON PRIMARY HEALTH CARE: ACCOUNTS FROM SCOTTISH GPS , 1996 .

[35]  David M. Fetterman,et al.  Empowerment evaluation : knowledge and tools for self-assessment & accountability , 1996 .

[36]  H Bastian,et al.  Raising the standard: practice guidelines and consumer participation. , 1996, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[37]  J. Broadbent,et al.  Redesigning Fourth generation Evaluation , 1996 .