As part of the 1989 NHS review, the government made participation in audit compulsory for the medical profession.
Prior to this time, medical audit has been fragmented, implemented by « top-down » initiatives promoted by professional bodies as well as by localized « bottom-up » exercises undertaken by committed individuals.
The paper uses evidence gained from four case studies of the implementation of medical audit in acute hospitals post 1989, to argue that during the early stages of implementation of medical audit individualistic tendencies have, to some extent inadvertently, been given their head.
This has not resulted in stronger external management of medical activities, as the government appeared initially to intend, but rather in locally determined medical audit activity, focused on technical process and medical management.
However examining medical audit in the wider context of the total package of NHS reforms and of concurrent changes in medical management, suggests that medical interests, and the individualism that is characteristic of medical organisation, will become diluted and less segregated in the future.
Mots-clés Pascal : Evaluation, Coût, Organisation, Médecin, Hôpital, Etude cas, Multidisciplinaire, Gestion, Qualité, Soin, Royaume Uni, Audit médical, Administration, NHS, Réforme, Pouvoir médical
Mots-clés Pascal anglais : Evaluation, Costs, Organization, Physician, Hospital, Case study, Multidisciplinary, Management, Quality, Care, United Kingdom, Medical audit, Administration, NHS, Reform, Doctor power
Notice produite par :
ENSP - Ecole nationale de la santé publique (devenue EHESP)
Cote : 94/12 V
Code Inist : 002B30A04D. Création : 09/06/1995.