Division of Midwifery, School of Health Sciences, University of Nottingham, Floor 12 Tower Building, University Park, Nottingham NG7 2RD, United Kingdom.
Soc Sci Med. 2018 May;205:64-71. doi: 10.1016/j.socscimed.2018.04.004. Epub 2018 Apr 6.
For more than two decades, international healthcare crises and ensuing political debates have led to increasing professional governance and regulatory policy reform. Governance and policy reforms, commonly representing a shift from embodied trust in professionals to state enforceable trust, have challenged professional power and self-regulatory privileges. However, controversy remains as to whether such policies do actually shift the balance of power and what the resulting effects of policy introduction would be. This paper explores the roll-out and operationalisation of revalidation as medical regulatory reform within a United Kingdom National Health Service hospital from 2012 to 2013, and its impact upon professional power. Revalidation policy was subject to the existing governance and management structures of the organisation, resulting in the formal policy process being shaped at the local level. This paper explores how the disorganised nature of the organisation hindered rather than facilitated robust processes of professional governance and regulation, fostering formalistic rather than genuine professional engagement with the policy process. Formalistic engagement seemingly assisted the medical profession in retaining self-regulatory privileges whilst maintaining professional power over the policy process. The paper concludes by challenging the concept of state enforceable trust and the theorisation that professional groups are effectively regulated and controlled by means of national and organisational objectives, such as revalidation.
二十多年来，国际医疗保健危机和随之而来的政治辩论导致了专业治理和监管政策改革的增加。治理和政策改革通常代表着从对专业人员的体现信任向国家可执行信任的转变，这对专业权力和自我监管特权提出了挑战。然而，对于这些政策是否真的改变了权力平衡以及政策引入会产生什么影响，仍存在争议。本文探讨了 2012 年至 2013 年期间，在英国国民保健制度医院中，作为医疗监管改革的再认证是如何推出和运作的，以及其对专业权力的影响。再认证政策受制于组织现有的治理和管理结构，导致正式政策过程在地方层面形成。本文探讨了组织的无序性质如何阻碍而不是促进了强有力的专业治理和监管过程，助长了形式主义而非真正的专业参与政策过程。形式主义的参与似乎有助于医学专业人员在保留自我监管特权的同时，对政策过程保持专业权力。本文最后质疑了国家可执行信任的概念以及专业团体通过国家和组织目标（如再认证）得到有效监管和控制的理论化。
