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Controlled by Knowledge: A Study of two Clinical pathways in Mental Healthcare
Karlstad University, Faculty of Economic Sciences, Communication and IT.
2012 (English)Doctoral thesis, monograph (Other academic)
Abstract [en]

Standardisation of professional work is a major policy concern to ensure quality and efficiency of services and a number of hospitals are now focusing on the use of clinical pathways as an important tool to standardise their work. This study sheds light on the processes set in motion when notions of standardisation meet local practice. In order to gain insight into what clinical pathways mean for professional work in mental health care, the focus of the study was to explore the contexts in which standardisation by “rule production” takes place.

Two empirical cases from Norwegian mental health care show how dedicated professionals are in charge of carrying out the standardisation work, strongly influenced by a steering framework of defined governmental policies where employee involvement and responsibility ensured loyalty to the idea.  Along with a “package” of ideas, new bodies and techniques, clinical pathways contribute to the institutionalisation of prima facie knowledge in demonstrating that evidence basing is linked to steering and control of employees.

Thus, professional autonomy is threatened in an insidious way: through the institutionalisation of evidence-based knowledge as ‘prima facie’ knowledge in combination with professionals who standardise and control their own work. The thesis therefore concludes that the control of professional work has now become a complex and sophisticated process where professional work is “controlled by knowledge”.

Place, publisher, year, edition, pages
Karlstad: Karlstad University Press, 2012. , 215 p.
Karlstad University Studies, ISSN 1403-8099 ; 2012:19
Keyword [en]
Organisation theory, scientific bureaucratic medicine, health policy, governance, New Public Management, regulatory tools, control, management, standardisation, rule production, instrumentation, clinical pathways, lean, work, professions, professionals, autonomy, discretion, power, knowledge, legitimacy, evidence based medicine, mental health care, hospital, child and youth psychiatry, psychiatrist, psychologist, jurisdiction, legitimacy, soft bureaucracy, hybridisation
National Category
Work Sciences
Research subject
Working Life Science
URN: urn:nbn:se:kau:diva-12937ISBN: 978-91-7063-423-9OAI: diva2:516168
Public defence
2012-06-01, Andersalen 11D121, Karlstads universitet, Karlstad, 13:15 (Swedish)
Available from: 2012-05-09 Created: 2012-04-16 Last updated: 2012-05-29Bibliographically approved

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