Abstract
PurposeThe purpose of this paper is to empirically explore and conceptualize how healthcare professionals and managers give shape to the increasing call for compassionate care as an alternative for system-based quality management systems. The research demonstrates how quality rebels craft deviant practices of good care and how they account for them.Design/methodology/approachEthnographic research was conducted in three Dutch hospitals, studying clinical groups that were identified as deviant: a nursing ward for infectious diseases, a mother–child department and a dialysis department. The research includes over 120 h of observation, 41 semi-structured interviews and 2 focus groups.FindingsThe research shows that rebels’ quality practices are an emerging set of collaborative activities to improving healthcare and meeting (individual) patient needs. They conduct “contexting work” to achieve their quality aims by expanding their normative work to outside domains. As rebels deviate from hospital policies, they are sometimes forced to act “under the radar” causing the risk of groupthink and may undermine the aim of public accounting.Practical implicationsThe research shows that in order to come to more compassionate forms of care, organizations should allow for more heterogeneity accompanied with ongoing dialogue(s) on what good care yields as this may differ between specific fields or locations.Originality/valueThis is the first study introducing quality rebels as a concept to understanding social deviance in the everyday practices of doing compassionate and good care.
Highlights
Quality improvement in healthcare is increasingly concerned with the standardization of professional behaviour and organizational routines
We present the “quality rebel” as an example of deviant practitioners that aim to provide optimal care in original and locally resonant ways
The set of performance indicators is central to quality regulation in hospitals, yet it is accompanied by many more sets of performance indicators developed by, among others, patient associations and healthcare insurers
Summary
Quality improvement in healthcare is increasingly concerned with the standardization of professional behaviour and organizational routines. Starting with the “discovery” of practice variation in the 1970s, methods such as clinical guidelines, accreditation, quality registries and performance indicators have been developed to make healthcare practices increasingly measurable, comparable and governable (Bonde et al, 2018; Wallenburg, Quartz and Bal, 2019; Weggelaar-Jansen et al, 2018). This “system” approach to healthcare has been fostered by the release of the “Institute of Medicine (2000)” report in and its numerous follow-up accounts about the importance of improving quality of care through building organization-based systems of quality control and improvement.
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