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Professional autonomy and surveillance: the case of public reporting in cardiac surgery

Exworthy, Mark, Gabe, Jonathan and Jones, Ian ORCID: 2019. Professional autonomy and surveillance: the case of public reporting in cardiac surgery. Sociology of Health and Illness 41 (6) , pp. 1040-1055. 10.1111/1467-9566.12883

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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 casestudy 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.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Social Sciences (Includes Criminology and Education)
Publisher: Wiley
ISSN: 0141-9889
Date of First Compliant Deposit: 21 February 2019
Date of Acceptance: 28 January 2019
Last Modified: 06 May 2023 05:14

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