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Ophav

 Ophav:
Arnfred, Morten Rousing1, Forfatter
Bundgaard, Helle2, Vejleder
Tilknytninger:
1Det Samfundsvidenskabelige Fakultet, Københavns Universitet, København, Danmark, diskurs:7001              
2Institut for Antropologi, Det Samfundsvidenskabelige Fakultet, Københavns Universitet, København, Danmark, diskurs:7008              
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Indhold

Ukontrollerede emneord: Akkreditering, audit kultur, New Public Management
 Abstract: The thesis is an ethnographic exploration of an accreditation process carried out by Joint Commission International (JCI) in a Danish public hospital. The thesis deals both with the final stages of preparation for the inspectors’ visit, the actual week of the visit, and the aftermath of the visit. The theoretical aim of the thesis is to crystallize two different “quality perspectives”, which co-exist in the organization.
In the thesis, it is discussed how “audit cultures” have been described and conceptualized in the anthropological literature. It is argued that the concept of “scientism” offers the best way to understand global audit cultures. The thesis describes the “audit explosion” that led to the proliferation of audit technologies in the public sector, before presenting Joint Commission International’s accreditation model, as a concrete example of such an audit technology. It is described how the model works and how the standards at the core of the model are constructed. The thesis argues that the model abstracts from the the hospitals core output - the diagnosis and treatment of patients – and focuses on the organizational system surrounding it.
The thesis goes on to analyze the organizational changes at the hospital that was brought on by the implementation of the accreditation model. It then describes a concrete accreditation visit by Joint Commission International. It is argued that the accreditation model deeply affects the everyday life at the hospital by institutionalizing a dominating quality perspective. The problem arises because this perspective is not as well-founded and holistic as its promoters like to think.
In the three main analytical chapters of the thesis the managers’, doctors’ and nurses’ perspectives on accreditation and quality, are analyzed. The thesis argues, that the managers view accreditation as a powerful management tool to regulate the hospitals work with quality. The doctors are more skeptical and feel that the model lacks a focus on the core output of the hospital, and takes up too many resources. Finally, the nurses feel that accreditation process produces a “fake” image of the everyday life at the hospital. Overall, a systematic approach to the work with quality is supported among the employees, but many are skeptical about the narrow focus of the model and the many ressources and time it monopolizes.
The thesis proposes two different quality perspectives: The “risk management perspective”, which focuses on what not to do and the “core output perspective”, which focuses on diagnosis and treatment and therefore what should be done. The thesis argues that these two perspectives should be highlighted in the organization and that a balance should ultimately be found between the two, so that the risk management perspective does not take up too many resources, thereby removing the focus on the core output.
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Filer

Navn:
Speciale(6).pdf (Hovedtekst)
Bemærkninger:
-
Tilgængelighed:
Offentlig
Mime-type / størrelse:
application/pdf / 840KB
Copyright dato:
2013-10-18
Copyright information:
De fulde rettigheder til dette materiale tilhører forfatteren.
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Basal

Bogmærk denne post: https://diskurs.kb.dk/item/diskurs:52949:2
 Type: Speciale
Alternativ titel: Et antropologisk studie af akkreditering af et offentligt hospital
Alternativ titel: When the Americans Come
Alternativ titel: An anthropological study of accreditation of a Danish public hospital
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Detaljer

Sprog: Danish - dan
 Datoer: 2013-06-07
 Sider: -
 Publiceringsinfo: København : Københavns Universitet
 Indholdsfortegnelse: 1 INDLEDNING1
Audit kulturer3
Policy i praksis .8
Social teknologi, akkreditering og kvalitet 9
Appropriering, performance og kald10
Fra intension til konsekvens .11
Specialets opbygning 12
2 METODE.14
Afdelingen.15
Ledelseskonsulent og medicinstuderende16
Interview og deltagerobservation.17
Anonymisering19
3 AKKREDITERINGSMODELLEN20
”The audit explosion” 20
Joint commission international 23
Standardmanualen.25
Akkrediteringsafgørelsen .26
Akkrediteringsbesøget .28
Akkrediteringsmodellens kvalitetsperspektiv .29
4 AKKREDITERING I AKTION32
Akkreditering kommer til Danmark32
Amerikanerne kommer! .36
Forberedelse 37
”Denne uge er ikke realistisk” 40
Det korte besøg .42
Konklusion44
4 LEDELSENS PERSPEKTIV45
Skøn versus standarder 47
Implementering af kvalitetstiltag på afdelingen50
Har man nået et mætningspunkt?51
Konklusion54
5 LÆGERNES PERSPEKTIV 56
Hvad er pensum? .57
Hvor er kerneydelsen?.58
Rygdækning og dokumentation .62
Kvalitetsmåling i et lægeperspektiv .67
Konklusion71
6 SYGEPLEJERSKERNES73
PERSPEKTIV.73
For patienternes skyld.76
Fokus og fastholdelse .81
Konklusion84
7 KONKLUSION85
Risikostyrings-perspektiv .87
Kerneydelses-perspektiv 88
Håndtering 89
LITTERATUR.90
Abstract 94
Bilag 1: JCIs liste over fordele ved akkreditering .96
Bilag 2: Eksempler på standarder 97
Bilag 3: Akkrediteringsbesøgets trin99
 Note: -
 Type: Speciale
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