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Does patient-centred care mean risk aversion and risk ignoring?: Unintended consequences of NPM reforms
University of Skövde, School of Technology and Society.ORCID iD: 0000-0002-1989-2745
Gothenburg Research Institute, Göteborg, Sweden.
2012 (English)In: International Journal of Public Sector Management, ISSN 0951-3558, E-ISSN 1758-6666, Vol. 25, no 4, 260-271 p.Article in journal (Refereed) Published
Abstract [en]

Purpose – This article aims to describe and analyze the results of efforts to improve patient-centered care (PCC) in psychiatric healthcare.

Design/methodology/approach – Using the methodology of a qualitative case study, the authors studied three Swedish child and adolescent psychiatric care (CAP) units in order to describe how patient-centered actions are performed. They 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 creates an alignment between them to try to send patients elsewhere. New public management (NPM) reforms may consequently lead to the institutionalization of unintended healthcare 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.

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2012. Vol. 25, no 4, 260-271 p.
Keyword [en]
Patient-centred care, New public management, Risk tradeoffs, Risk substitution, Risk transformation, Patient care, Patients, Psychiatry, Risk management
National Category
Economics and Business
Research subject
Humanities and Social sciences
Identifiers
URN: urn:nbn:se:his:diva-6440DOI: 10.1108/09513551211244098Scopus ID: 2-s2.0-84861319086OAI: oai:DiVA.org:his-6440DiVA: diva2:558941
Available from: 2012-10-05 Created: 2012-10-04 Last updated: 2015-12-29Bibliographically approved

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CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf