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Does patient-centred care mean risk aversion and risk ignoring? Unintended consequences of NPM reforms

Artikel i vetenskaplig tidskrift
Författare Thomas Andersson
Roy Liff
Publicerad i International Journal of Public Sector Management
Volym 25
Nummer/häfte 4
Sidor 260-271
ISSN 0951-3558
Publiceringsår 2012
Publicerad vid Gothenburg Research Institute (GRI)
Sidor 260-271
Språk en
Ämnesord Patient-centred care, New Public Management, Risk tradeoffs, Risk substitution, Risk transformation
Ämneskategorier Företagsekonomi

Sammanfattning

Purpose - This article describes the results of efforts to improve patient-centred care (PCC) in psychiatric health care. Design/Methodology/Approach - Using the methodology of a qualitative case study, we studied three Swedish child and adolescent psychiatric care (CAP) units in order to describe how patient-centred actions are performed. We conducted 62 interviews, made 11 half-day observations, and shadowed employees for two days. Findings - The article shows that the increased focus on accountability for unit performance and medical risks results in unintended consequences. The patient’s medical risk is transformed to a personal risk for the psychiatrist and the resource risk is transformed to a personal risk for the unit manager. Patients become risk objects for both psychiatrists and unit managers, which create an alignment between them to try to send patients elsewhere. New Public Management (NPM) reforms may consequently lead to the institutionalization of unintended health care practices. Practical implications – The article shows that accountability pressure to reduce patient risk may create new risks for patients. Originality/value – The study uses theoretical concepts of risk tradeoffs (risk substitution and risk transformation), which were developed for the macro level, to explain the unintended consequences of NPM reforms at the micro level.

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