School of Health Sciences, Bangor University, United Kingdom.
Department of Applied Health Research, UCL, United Kingdom.
Soc Sci Med. 2021 May;277:113882. doi: 10.1016/j.socscimed.2021.113882. Epub 2021 Mar 26.
Medical leaders occupy a prominent position in healthcare policy in many countries, both in terms of the governance of quality and safety within healthcare organisations, and in broader system-wide governance. There is evidence that having doctors on hospital boards is associated with higher quality services. What is not known is how they have this effect. Analysing data collected from observations, interviews and documents from 15 healthcare providers in England (2014-2019), we elaborate the role of medical directors in healthcare governance as 'translation work', 'diplomatic work', and 'repair work'. Our study highlights the often enduring emotional effects of repeated structural changes to clinical services. It also contributes to theories of professional restratification, showing the work of medical directors as regional 'political elites', and as 'corporate elites' in publicly-funded healthcare systems.
医疗领导者在许多国家的医疗政策中占据着突出的地位，无论是在医疗组织内部的质量和安全治理方面，还是在更广泛的全系统治理方面。有证据表明，让医生进入医院董事会与更高质量的服务有关。但目前尚不清楚他们是如何产生这种影响的。我们通过对 2014 年至 2019 年期间从英国 15 家医疗保健机构收集的观察、访谈和文件数据进行分析，详细阐述了医疗主任在医疗保健治理中的作用，包括“翻译工作”、“外交工作”和“修复工作”。我们的研究强调了临床服务反复结构性变革对情感的持久影响。它还为专业再分层理论做出了贡献，展示了医疗主任作为区域“政治精英”和公共资助医疗体系中的“企业精英”的工作。
