Abstract
We explain social and organisational processes influencing health professionals in a Kenyan clinical network to implement a form of quality improvement (QI) into clinical practice, using the concept of ‘pastoral practices’. Our qualitative empirical case study, conducted in 2015–16, shows the way practices constructing and linking local evidence-based guidelines and data collection processes provided a foundation for QI. Participation in these constructive practices gave network leaders pastoral status to then inscribe use of evidence and data into routine care, through championing, demonstrating, supporting and mentoring, with the support of a constellation of local champions. By arranging network meetings, in which the professional community discussed evidence, data, QI and professionalism, network leaders also facilitated the reconstruction of network members' collective professional identity. This consequently strengthened top-down and lateral accountability and inspection practices, disciplining evidence and audit-based QI in local hospitals. By explaining pastoral practices in this way and setting, we contribute to theory about governmentality in health care and extend Foucauldian analysis of QI, clinical networks and governance into low and middle income health care contexts.
Highlights
There has been excitement about the potential of quality improvement (QI) for enhancing global health and calls for a ‘quality revolution’ in health care (Kruk et al, 2016)
We show how the exercise of ‘pastoral power’ and construction of ‘governmentality’ (Foucault, 2007) through complementary ‘pastoral practices’ (Waring and Martin, 2017) facilitated QI within a Kenyan clinical network
While research has used the concept of governmentality to explain clinical networks (Ferlie et al, 2012, 2013; Flynn, 2002), we provide a more agentic explanation of how governmentality is constructed by focusing on pastoral practices, while extending Foucauldian analysis of clinical network and QI into low and middle income countries (LMICs) contexts
Summary
There has been excitement about the potential of quality improvement (QI) for enhancing global health and calls for a ‘quality revolution’ in health care (Kruk et al, 2016). Developing the application of governmentality and pastoral power in health care further, Waring and Martin (2017) describe four ‘pastoral practices’ shaping identities and behaviours in clinical networks: (1) ‘Constructive practices’, identifying and re-coding rationalities, translating the ‘scripture’ of evidence in a way relevant and comprehensible to local communities; (2) ‘Inscription practices’, involving ‘sermon’ like communication and framing, encouraging network members to internalise re-coded discourses; (3) ‘Collective practices, whereby ‘pastors’ shape and frame subjectivities for the wider ‘flock’, defining and reinforcing collective boundaries This encourages communities to collectively control behaviours, extending Foucault's concept of ‘technologies of the self’ to ‘technologies of the collective’. We analyse governmentality in a Kenyan clinical network using theory about pastoral practices
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
