Professional autonomy and surveillance: the case of public reporting in cardiac surgery.
Professional autonomy has come under greater scrutiny due to managerialism, consumerism, information and communication technologies (ICT), and the changing composition of professions themselves. This scrutiny is often portrayed as a tension between professional and managerial logics. Recently, medical autonomy has increasingly been shaped in terms of transparency, where publication of clinical performance (via ICT) might be a more pervasive form of surveillance. Such transparency may have the potential for a more explicit managerial logic but is contested by clinicians. This paper applies notions of surveillance to public reporting of cardiac surgery, involving the online publication of mortality rates of named surgeons. It draws on qualitative data from a case-study of cardiac surgeons in one hospital, incorporating interviews with health care managers and national policymakers in England. We examine how managerial logics are mediated by professional autonomy, generating patterns of enrolment, resistance and reactivity to public reporting. The managerial 'gaze' of public reporting is becoming widespread but the surgical specialty is accommodating it, leading to a re-assertion of knowledge, based on professional definitions. The paper assesses whether this form of surveillance is challenging to or being assimilated by the medical profession, thereby recasting the profession itself.
['Exworthy|Mark|M|0000-0003-4791-7513', 'Gabe|Jonathan|J|0000-0002-3765-4935', 'Jones|Ian R|IR|0000-0002-1682-9134', 'Smith|Glenn|G|']
D006348:Cardiac Surgical Procedures D004739:England D006761:Hospitals D006801:Humans D017009:Professional Autonomy D000079204:Public Reporting of Healthcare Data D036301:Qualitative Research D066231:Surgeons D000066477:Work Performance
autonomy surveillance public reporting surgeons medical profession