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  • Author or Editor: Mike Dent x
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This article compares the impact of New Public Management (NPM) on the health systems and especially hospitals of the UK, Germany and Italy. It asks how far recent policy and organisational changes reflect variations on the NPM theme and a transition towards new patterns of governance. Are all three countries on a similar trajectory or not? What do these comparisons of the three systems tell us about governance? The article draws on the work of Hood and colleagues to construct a tripartite typology of governance (‘enforced self-regulation’, ‘juridified self-regulation’ and ‘managerial regulation’) to distinguish between regimes within a ‘new instititutionalist’ framework.

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This chapter reviews recent developments in user involvement practices across a range of European health care systems in terms of their implications for the medical profession and regulation of its practitioners. It will review the dominant models of user involvement, from Arnstein (1969) ‘ladder of participation’ onwards within Europe. The chapter will be particularly concerned with the growing linkages between user involvement in its various guises and the governance and regulation of European health care and medicine. The analysis will critically examine the variations in user involvement from ‘choice’ to ‘co-production’ and the range of ways they have been implemented in various European countries, with particular attention to England, Italy and Denmark. The discussion will focus on the implications for the medical profession as much as for the patients themselves.

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This chapter examines from a neo-Weberian perspective the management and leadership of health and social care support workers in the United Kingdom and the wider European context. It sets out the evolution of the management and organisation of health support work consequent on the introduction of New Public Management, illustrating this with reference to the mainstream case of redefining of the professional jurisdiction of the nursing profession that occurred in the latter decades of the twentieth century. Concerns over the organisation and management of support workers under the New Public Management more recently led to a greater emphasis on professional regulation and leadership within a management discourse, under the auspices of the New Public Governance. This has resulted in a consideration of the support workers becoming more professionalised, or semi-professionalised, as a means of ensuring effective management by recruiting support workers with the appropriate values in a process of ‘responsibilisation’.

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The four articles following this introduction originated from the 7th International Research Conference on Dilemmas for Human Services. The articles cover a range of topics which illuminate some of the problems associated with the concept of governance and New Public Management (NPM). While the problem of governance has led to more flexible relationships between government and the governed, for example through Third Way dialogues or the Social Investment State, in certain circumstances NPM is still clearly present. In addition, such variation is also evident when international comparisons are made, with constitutional and institutional precedents playing a significant role in governance structures.

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International perspectives

There are significant variations in how healthcare systems and health professionals are regulated globally. One feature that they increasingly have in common is an emphasis on the value of including members of the public in quality assurance processes. While many argue that this will help better serve the public interest, others question how far the changing regulatory reform agenda is still dominated by medical interests.

Bringing together leading academics worldwide, this collection compares and critically examines the ways in which different countries are regulating healthcare in general, and health professions in particular, in the interest of users and the wider public. It is the first book in the Sociology of Health Professions series.

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