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Colleges, literature and working group week 4
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Colleges, literature and working group week 4
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Week 4Lecture 4.1 The politics of quality work
Concept professional (Freidson, 1970): a professional has skills based on theoretical knowledge;
acquired these skills through formal education and the skills were formally assessed by examination; has
a code of professional conduct and is a member of professional organization; provide service for the
public good.
Concept professional (Noordegraaf 2011): a professional can lead innovation in care; can enforce
evidence-based guidelines; can account for quality of care.
What matters for professional autonomy:
Technical error (work-related, wrong stitch). Normative error (not reporting errors, organization of care)
There is an interaction between professionals and managers.
Lecture 4.2 Quality work = political
Three concepts of politics:
Politics/power of discipline
Power -> positive -> discipline (stimulate good behavior). For this course.
Power -> negative -> deny freedom.
Politics/power of definition
The power to define an event as a problem of societal concern to be acted upon by officials/agencies. An
event is defined as a problem of societal concern to be acted upon by officials/agencies. Driving drunk.
The power to select a target agent from a multiple of possible realities. A target agent is selected from a
multiple of possible realities. Transport, architecture.
Politics/power of things
A table in a room invites a patient to sit down and tell his story.
Professionals exercise power by claiming expertise and defining disease. Managers exercise power by
paperwork and defining organizing standards.
Lecture 4.3 The politics of quality of work at a healthcare organization /
Lecture 4.4 and 4.5 The politics of defining and measuring quality of care (guest speaker)
National health care institute: 4 tasks
1. Advise on the contents of the basic benefits package – effectiveness and costs of new medicines
2. Evaluate the basic benefits package – do professionals follow recommendations in guidelines
3. Encourage improvements in health care quality – quality standards, indicators
4. Implement funding for the Zvw and Wlz
Who gets what, when and how?
Defining quality standards -> what is good care?
Defining quality indicators -> how to measure good care?
Quality of care domains: effective, safe (clinical), efficient, patient-centered, timely, equitable
(organization). Multidimensional and contextual and subjective.
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