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      Integrating or disintegrating effects of customised care the role of professions beyond NPM

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          Abstract

          Purpose

          This paper aims to describe the integrating and disintegrating effects of professional actions in customised care.

          Designmethodologyapproach

          Using a qualitative case study, the authors examine the work practices and cultures of three Swedish child and adolescent psychiatric care units CAP charged with providing customised care in collaboration with other organisations. The authors conducted 62 interviews, made 11 halfday observations, and shadowed employees for two days.

          Findings

          The social embeddedness of action is crucial to understanding the professions' integratingdisintegrating activities. In the internal social context of CAP, the professions adapt to productivityenhancing new public management NPM principles, resulting in integrating effects between the different professions and administrative management in the CAP units. However, CAP exercises professional dominance over the cooperating organisations. Thus, in the external social context, CAP's resistance to customised care principles exacerbates the disintegration problems among the different organisations.

          Practical implications

          The study concludes that, contrary to findings in many other studies, neither the professional logic nor NPMcustomised care reforms determine the actions of professionals. In this case, the institutionalisation of some NPM methods blocks the adoption of customised care practices.

          Originalityvalue

          Contrary to the widely accepted idea that resource restriction is a main source of conflict between management and the professions, the professions accept and adapt to resource restrictions, even at the expense of deemphasising the practices of customised care. Thus, since professionals choose different operational strategies depending on the social context, the success of a normative reform measure may depend in part on its social context.

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          Most cited references23

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          Patient-centredness: a conceptual framework and review of the empirical literature.

          A 'patient-centred' approach is increasingly regarded as crucial for the delivery of high quality care by doctors. However, there is considerable ambiguity concerning the exact meaning of the term and the optimum method of measuring the process and outcomes of patient-centred care. This paper reviews the conceptual and empirical literature in order to develop a model of the various aspects of the doctor-patient relationship encompassed by the concept of 'patient-centredness' and to assess the advantages and disadvantages of alternative methods of measurement. Five conceptual dimensions are identified: biopsychosocial perspective; 'patient-as-person'; sharing power and responsibility; therapeutic alliance; and 'doctor-as-person'. Two main approaches to measurement are evaluated: self-report instruments and external observation methods. A number of recommendations concerning the measurement of patient-centredness are made.
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            The Professionalization of Everyone?

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              Theorizing the Micro-politics of Resistance: New Public Management and Managerial Identities in the UK Public Services

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                Author and article information

                Contributors
                Journal
                jhom
                10.1108/jhom
                Journal of Health Organization and Management
                Emerald Publishing
                1477-7266
                1 June 2011
                : 25
                : 6
                : 658-676
                Affiliations
                Gothenburg Research Institute, Gteborg, Sweden
                School of Technology and Society, University of Skvde, Skvde, Sweden
                Article
                0250250604.pdf 0250250604
                10.1108/14777261111178547
                22256664
                a2f20f20-3088-4641-a91b-23a9c036d6b8
                © Emerald Group Publishing Limited
                History
                Categories
                research-article, Research paper
                cat-HSC, Health & social care
                cat-HMAN, Healthcare management
                Custom metadata
                yes
                yes
                included

                Health & Social care
                Sweden,Interorganizational cooperation,Customised care,Disintegration,Patient care,Health services,Integration,New public management,Professions

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