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"A manager in the minds of doctors" : a comparison of new modes of control in European hospitals
(2013)
Background: Hospital governance increasingly combines management and professional self-governance. This article maps the new emergent modes of control in a comparative perspective and aims to better understand the relationship between medicine and management as hybrid and context-dependent. Theoretically, we critically review approaches into the managerialism-professionalism relationship; methodologically, we expand cross-country comparison towards the meso-level of organisations; and empirically, the focus is on processes and actors in a range of European hospitals.
Methods: The research is explorative and was carried out as part of the FP7 COST action IS0903 Medicine and Management, Working Group 2. Comprising seven European countries, the focus is on doctors and public hospitals. We use a comparative case study design that primarily draws on expert information and document analysis as well as other secondary sources.
Results: The findings reveal that managerial control is not simply an external force but increasingly integrated in medical professionalism. These processes of change are relevant in all countries but shaped by organisational settings, and therefore create different patterns of control: (1) ‘integrated’ control with high levels of coordination and coherent patterns for cost and quality controls; (2) ‘partly integrated’ control with diversity of coordination on hospital and department level and between cost and quality controls; and (3) ‘fragmented’ control with limited coordination and gaps between quality control more strongly dominated by medicine, and cost control by management.
Conclusions: Our comparison highlights how organisations matter and brings the crucial relevance of ‘coordination’ of medicine and management across the levels (hospital/department) and the substance (cost/quality-safety) of control into perspective. Consequently, coordination may serve as a taxonomy of emergent modes of control, thus bringing new directions for cost-efficient and quality-effective hospital governance into perspective.
The paper is aimed at contributing to an empirically grounded understanding of the psychosocial dynamics that underlie the relation between heteronormative images of masculinity, internalized heterosexism and health behavior of gay men in the global North. It is based on a qualitative interview study that focuses on the consequences of the internalization of dominant images of masculinity for the identity constructions of gay men and their HIV-related sexual risk behavior in Germany. In the paper it will be argued that 1) the tension between the authoritative image of masculinity that is determined by heteronormative discourses one the one hand and the gendered self-image that is shaped and threatened by connotations of a non-masculine homosexuality on the other constitutes a decisive issue of gay identity constructions, 2) a higher sexual risk behavior can be understood as a possible consequence of the internalization of masculine images and its impact on the self-esteem, if the self-image does not match the male ideal, and 3) this may include a paradoxical desire for the imagined masculinity that is experienced as violent with regard to one’s own psychodynamics. Finally, perspectives on gay masculinities that may transgress dominant heteronormative modes of subjectification are discussed.
We analyze the relations between ethnographic data and theory through an examination of materiality in research practices, arguing that data production is a form of material theorizing. This entails reviewing and (re-)applying practice-theoretical discussions on materiality to questions of ethnography, and moving from understanding theory primarily as ideas to observing theorizing in all steps of research practice. We introduce “pocketing” as a heuristic concept to analyze how and when ethnographic data materializes: the concept defines data’s materiality relationally, through the affective and temporal dimensions of practice. It is discussed using two examples: in a study on everyday architectural experience where ethnographic data materialized as bodies affected by architecture; and in a study on digital cooperation where research data’s materialization was distributed over time according to the use of a company database. By conceptualizing data’s materiality as practice-bound, “pocketing” facilitates understanding the links between data and theory in ethnographic data production.
Interview with Dario Azzellini, author of The Business of War and the new documentary film, Comuna Under Construction. What is it about Venezuela that is so interesting? Since 2003 I have practically lived in Venezuela. What motivates me is that I am interested in the social transformation process happening here. It’s a different type of revolution, a new left that draws from all the experiences of the 60s, 70s, 80s and 90s. ...
Let me start with a reminiscence: a few weeks ago, I was sitting in one of my preferred cafés in Paris, le Café Odéon- Théâtre de l’Europe, a vivid place near the Jardin de Luxembourg in the heart of the university quarter. I realised that the waiter was wearing a shirt with the letters "Defend Paris", which he explained to be a statement against the forces that make Paris an uneasy place to live, a defiance against the powerful and social injustice. With a mixture of rebellion and idealism, he added that he understands himself as part of a "Reclaim Your City" Movement, thus representing what is central for urban citizenship today: a republican defence against forces that make a metropolitan city a trademark to be sold to people who can afford it, but increasingly less a home for ordinary people who want to live in the city. Walking through the streets, passing a small jewelry shop, a place of distinguished understatement showing a picture of Meghan Markle wearing "rose"-earrings displayed in the window, the term "zombie urbanism" came to my mind – a term used by Jonny Aspen, professor at the Institute of Urbanism and Landscape in Oslo (See Bjerkeset and Aspen (forthcoming 2020) and here), to describe a cliché-like way of dealing with urban environment by developers and designers – a "staged urbanism", in which urban features are used as a means for selling, marketing and branding. This kind of city-marketing can prove quite successful: whereas the burning of Notre Dame mobilised hundreds of millions of donations within a short period of time, the burning of the National Museum in Rio de Janeiro soon after, extinguishing 200 years of documentation of cultural memory, mobilised only 225.000 Euros (state 1.4.2019). ...
The Muskoka Initiative – or the Maternal, Newborn and Child Health (MNCH) Initiative has been a flagship foreign policy strategy of the Harper Conservatives since it was introduced in 2010. However, the maternal health initiative has been met with a number of key criticisms in relation to its failure to address the sexual and reproductive health needs of women in the Global South2. In this article, I examine these criticisms and expose the prevalent and problematic discourse employed in Canadian policy papers and official government speeches pertaining to the MNCH Initiative. I examine the embodiment of the MNCH and how these references to women’s bodies as “walking wombs” facilitate: the objectification and ‘othering’ of women as mothers and childbearers; a discourse of ‘saving mothers’ in a paternalistic and essentialist language; and the purposeful omission of gender equality. Feminist International Relations (IR) and post-colonial literature, as well as critical/feminist Canadian foreign policy scholarship are employed in this paper to frame these critiques.
The focus of this contribution is on the mode of capitalism within the industrialized sectors of "emerging markets". Particularly in the context of the rise of the BRIC (Brazil, Russia, India and China) this question has gained considerable importance, also for the development of the world economy as a whole. The core question is whether the type of capitalism within these economies is similar to the capitalist variety of the triad, or diverges in more or less permanent ways. The article gives a preliminary answer to this question, by developing a rough sketch of a "BRIC" model of capitalism and illustrating this model with the case of Brazil. In terms of theory, the article extends the Comparative Capitalism (CC) perspective to the BRICs. On the one side, the focus is on the classical questions of CC, i.e. the determinants of economic development and the differences to other types of capitalism, on the other side the relationship between these varieties and social inequality. It argues that the "state-permeated market economies" of the BRICs rely on clans as a mode of social coordination. As demonstrated by the case of Brazil, this type of capitalism can be quite successful, but is based on a highly unequal distribution of economic and political resources.
Voting advice applications (VAAs) are online tools providing voting advice to their users. This voting advice is based on the match between the answers of the user and the answers of several political parties to a common questionnaire on political attitudes. To visualize this match, VAAs use a wide array of visualisations, most popular of which are the two-dimensional political maps. These maps show the position of both the political parties and the user in the political landscape, allowing the user to understand both their own position and their relation to the political parties. To construct these maps, VAAs require scales that represent the main underlying dimensions of the political space. This makes the correct construction of these scales important if the VAA aims to provide accurate and helpful voting advice. This paper presents three criteria that assess if a VAA achieves this aim. To illustrate their usefulness, these three criteria—unidimensionality, reliability and quality—are used to assess the scales in the cross-national EUVox VAA, a VAA designed for the European Parliament elections of 2014. Using techniques from Mokken scaling analysis and categorical principal component analysis to capture the metrics, I find that most scales show low unidimensionality and reliability. Moreover, even while designers can—and sometimes do—use certain techniques to improve their scales, these improvements are rarely enough to overcome all of the problems regarding unidimensionality, reliability and quality. This leaves certain problems for the designers of VAAs and designers of similar type online surveys.
Depth hermeneutics—as developed by LORENZER within the framework of the Frankfort School's program of critical social research—represents a methodological and systematic approach to psychoanalytic research. The new ways and means by which a neo-Nazi utilises his visit to the Auschwitz Memorial to arouse further anti-Semitism are to be investigated by means of a scene-by-scene interpretation of his filmed appearances—first as a good-mooded tourist, then as a volatile right-wing extremist, as competent expert, and as rebellious adolescent. The aim is to demonstrate how the meaning of these role plays develops within the tension between a manifest and a latent significance. The results of this process of interpretations form the basis for clarifying the question: what patterns of socialisation are used by this "yuppie-neo-Nazi" to fascinate particularly adolescents?? In conclusion, the way in which through his post-modern film-production the producer turns Auschwitz into a test-ground where the neo-Nazi can do "a merry dance on the volcano", is analysed.