A new mode of organizing in health care? Governmentality and managed networks in cancer services in England.

We explore the argument that a new mode of health care organizing is emerging which moves beyond the established professional dominance versus New Public Management (NPM) debate. We review Foucault's work on 'governmentality', as applied to health care organizations. We specify two specific Foucauldian themes (the power/knowledge nexus in Evidence Based Medicine (EBM); and the technologies of the clinical managerial self) to analyse organizing in the English cancer services field. We introduce two qualitative case studies of Managed Cancer Networks. We suggest their governance can be fruitfully seen through a 'governmentality' lens. We consider implications for developing Foucauldian analysis of health care organizations.

[1]  M. Reed From the cage to the gaze? The dynamics of organisational control in late modernity , 1999 .

[2]  Tiago Moreira,et al.  Technogovernance: evidence, subjectivity, and the clinical encounter in primary care medicine. , 2006, Social science & medicine.

[3]  A. Langley Strategies for Theorizing from Process Data , 1999 .

[4]  Governing Medicine: Theory and Practice , 2004 .

[5]  B. Sibbald,et al.  Governmentality by Network in English Primary Healthcare , 2004 .

[6]  Arthas Flabouris,et al.  Narrativizing errors of care: critical incident reporting in clinical practice. , 2006, Social science & medicine.

[7]  K. Starkey,et al.  Afterword: Deconstructing Organization – Discipline and Desire , 1998 .

[8]  C. Ceci Nursing, knowledge and power: a case analysis. , 2004, Social science & medicine.

[9]  M. Dean,et al.  Governmentality: Power and Rule in Modern Society , 1999 .

[10]  Bill Doolin,et al.  Power and resistance in the implementation of a medical management information system , 2004, Inf. Syst. J..

[11]  N. Rose,et al.  Governing economic life , 1990 .

[12]  Rick Iedema,et al.  The Undecided Space of Ethics in Organizational Surveillance , 2010 .

[13]  Shoshana Zuboff,et al.  In the Age of the Smart Machine: The Future of Work and Power , 1989 .

[14]  S. Timmermans,et al.  Evidence-based medicine and the reconfiguration of medical knowledge. , 2004, Journal of health and social behavior.

[15]  Ewan Ferlie,et al.  Playing tick-box games: Interrelating defences in professional appraisal , 2007 .

[16]  Alan D. Schrift,et al.  Discipline and Punish , 2013 .

[17]  P. Miller Governing the present , 2008 .

[18]  K. Starkey,et al.  Foucault, management and organization theory : from panopticon to technologies of self , 2000 .

[19]  Caroline Waks,et al.  Professions and the Pursuit of Transparency in Healthcare: Two Cases of Soft Autonomy , 2009 .

[20]  Bruce Wood,et al.  Policy Emergence and Policy Convergence: The Case of ‘Scientific-Bureaucratic Medicine’ in the United States and United Kingdom , 2002 .

[21]  Eric Mykhalovskiy,et al.  The problem of evidence-based medicine: directions for social science. , 2004, Social science & medicine.

[22]  R. Flynn 'Soft bureaucracy', governmentality and clinical governance: theoretical approaches to emergent policy , 2004 .

[23]  Stephen Timmons A failed panopticon: surveillance of nursing practice via new technology , 2003 .

[24]  S. Clegg,et al.  Power and Organizations , 2006 .

[25]  J. Waring Adaptive regulation or governmentality: patient safety and the changing regulation of medicine. , 2007, Sociology of health & illness.

[26]  T. Greenhalgh,et al.  Best research--for what? Best health--for whom? A critical exploration of primary care research using discourse analysis. , 2008, Social science & medicine.

[27]  M. Foucault The Birth of the Clinic , 1963 .

[28]  L. Engwall,et al.  Regulation and organizations : international perspectives , 1999 .

[29]  Liisa Kurunmäki,et al.  A hybrid profession—the acquisition of management accounting expertise by medical professionals , 2004 .

[30]  Hans Hasselbladh,et al.  Webs of Knowledge and Circuits of Communication: Constructing Rationalized Agency in Swedish Health Care , 2007 .

[31]  J. Waring Constructing and re-constructing narratives of patient safety. , 2009, Social science & medicine.

[32]  Andrew Pettigrew,et al.  The New Public Management in Action , 1996 .

[33]  R. Fleming Equity and Excellence: liberating the NHS , 2010 .

[34]  A. Pettigrew,et al.  Studying Organizational Change and Development: Challenges for Future Research , 2001 .

[35]  E. Ferlie,et al.  Networks in health care : a comparative study of their management, impact & performance , 2010 .

[36]  S. Dopson,et al.  Knowledge to Action? Evidence-Based Health Care in Context , 2005 .