November 2nd, 2014
The growing “McDonaldisation” of healthcare in the UK is leaving many doctors with “an underlying sense of powerlessness”, research has warned.
Those with limited experience and influence feel they have little choice but to accept more commercialisation and bureaucracy, according to an academic study.
By contrast, marketisation is also giving rise to a “corporate elite” of doctors.
Professor Justin Waring, of Nottingham University Business School, who led the research, said: “Bureaucratic and market logics are transforming all kinds of expert work, resulting in ever more rationalised and standardised practices and identities.
“In the field of healthcare this process of ‘McDonaldisation’ is leading to a more explicit emphasis on commercial viability and profit — what we might call ‘McMedicine’.
“Our study shows how doctors’ reactions to the new way of doing things vary and how those reactions reflect individuals’ standing in terms of the power they wield.
“We detected an underlying sense of powerlessness among inexperienced doctors who lack the influence and esteem of their more senior peers.
“They accept greater bureaucratisation and commercialisation largely because they see few alternatives to marketisation at a time of economic uncertainty.
“Meanwhile, a growing ‘corporate elite’ of doctors who hold medical-management positions are enthusiastic in advocating ‘new’ ways of working to increase operational productivity and, in turn, to advance their own financial positions and careers.
“However, one crucial question that’s inevitably raised by the elevated status and motivations of such an elite is precisely whose interests they really serve.”
The three-year study, carried over by academics from the School’s Centre for Health Innovation, Leadership and Learning (CHILL), focused on scores of frontline staff, including medics and managers.
As an illustration of the “hyper-rationalisation” of procedures, executives often referred to doctors as “technicians” whose work needed better organising to prevent waste.
One manager remarked: “Medicine always has this human aspect to it, but in general, of course, it’s a production process – the same as every product and process.”
A few senior clinicians resisted greater bureaucracy, but employees of lesser standing accepted marketisation as possibly the only option for their careers.
Professor Waring said: “There’s no doubt that a mixed economy offers private companies a chance to transform the organisation and delivery of public healthcare.
“But it seems the corporatisation of healthcare values certain professional resources more than others in relation to their contribution to accumulating capital.
“As a result, the future is likely to involve more extreme forms of McDonaldisation for some employees and quite different opportunities for others.”
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