Abstract
This paper seeks to determine the value of theoretical ideal-types of medical control. Whilst ideal types (such as the iron cage and gaze) need revision in their application to medical settings, they remain useful in describing and explaining patterns of control and autonomy in the medical profession. The apparent transition from the cage to the gaze has often been over-stated since both types are found in many contemporary health reforms. Indeed, forms of neo-bureaucracy have emerged alongside surveillance of the gaze. These types are contextualised and elaborated in terms of two empirical examples: the management of medical performance and financial incentives for senior hospital doctors in England. Findings point towards the reformulation of medical control, an on-going re-stratification of the medical profession, and the internalisation of managerial discourses. The cumulative effect involves the medical profession’s ability to re-cast and enhance its position (vis-à-vis managerial interests).
 Keywords: medical profession, medical control, iron cage, gaze
Highlights
This paper seeks to determine the value of theoretical ideal-types of medical control
The paper is organised in three sections. It summarises the main arguments of the two ideal-types: the “cage” and the “gaze.” These ideal-types need elaboration to enable their application to the context of the medical profession
The paper outlines two empirical examples of medical performance and financial incentives relating to medical pay in the English National Health Service (NHS)
Summary
The classic version of the iron cage thesis posits a system of hierarchical control which is marked by direct supervision of workers and formal rules. The start of the demise the Weberian iron cage is not precise but the advent of neo-liberal policies, such as new public management (NPM) in the latter half of the twentieth century has been considered a precipitating factor (Ferlie, Lynn & Pollitt, 2005). This must be viewed alongside a raft of other contemporary developments such as the crisis in the welfare state (of Western democracies), the advent of new forms of information communication technologies (ICT), and shifting cultural values (including disillusionment with hierarchy and a growing acceptance of consumerism and market-based approaches) (Exworthy, Powell, & Mohan, 1999). The bureaucratic controls may not have disappeared but rather have been transformed and even intensified (Farrell & Morris, 2003)
Sign-in/Register to view highlights & summary 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.
