Clinical guidelines and clinical autonomy: exploring the missing link
Journal of Health Organization and Management
ISSN: 1477-7266
Article publication date: 2 November 2021
Issue publication date: 25 March 2022
Abstract
Purpose
This paper aims at understanding how clinical guidelines' use in the labour process relates to clinical autonomy, that is, the self-control medical professionals exercise over medical practice.
Design/methodology/approach
Drawing on a qualitative case study research strategy, this paper explores how medical professionals use clinical guidelines in the labour process in one public general hospital of the Greek National Health System. Supplemented by an extensive study of documents, semi-structured interviews were conducted with 33 doctors of several specialties.
Findings
The analysis shows (1) how clinical autonomy, as a self-control structure, mediates the use of clinical guidelines as a knowledge tool in the labour process, and (2) how employing clinical guidelines as a means towards coordinating medical work, but also towards regulating and standardising medical practice, is exercising pressure on the individualistic character of clinical autonomy.
Originality/value
Advancing the analytic value of workplace control structures, this paper contributes novel theoretical understanding of emerging tendencies characterising medical work organisation and clinical autonomy, and explains how medical professionals' non-adherence to clinical practice guidelines (CPGs) relates to CPGs' role as a resource to medical practice. Finally, this research proposes a more critical approach to health policy towards addressing the challenges associated with centrally introducing clinical guidelines in healthcare organisations.
Keywords
Acknowledgements
The author would like to thank associate editor Mitchell Sarkies and the three anonymous reviewers for their valuable guidance in the revision of this article. She would also like to thank the attendees at the 31st EGOS Colloquium in Athens for their constructive comments on an earlier version of this work. Last but not least, special thanks go to the study participants who generously shared their work experiences with the author.
Citation
Andri, M. (2022), "Clinical guidelines and clinical autonomy: exploring the missing link", Journal of Health Organization and Management, Vol. 36 No. 3, pp. 351-367. https://doi.org/10.1108/JHOM-11-2020-0438
Publisher
:Emerald Publishing Limited
Copyright © 2021, Emerald Publishing Limited