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'Pastoral practices’ for quality improvement in a Kenyan clinical network
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McGivern, Gerry, Nzinga, Jacinta and English, Mike (2017) 'Pastoral practices’ for quality improvement in a Kenyan clinical network. Social Science & Medicine, 195 . pp. 115-122. doi:10.1016/j.socscimed.2017.11.031 ISSN 0277-9536.
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Official URL: http://doi.org/10.1016/j.socscimed.2017.11.031
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.
Item Type: | Journal Article | ||||||||||||
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Subjects: | R Medicine > R Medicine (General) | ||||||||||||
Divisions: | Faculty of Social Sciences > Warwick Business School | ||||||||||||
Library of Congress Subject Headings (LCSH): | Medical care -- Kenya -- Quality control., Clinical competence -- Kenya., Pastoral care- Kenya., Health services administration -- Kenya., Public health -- Kenya., Social medicine -- Kenya. | ||||||||||||
Journal or Publication Title: | Social Science & Medicine | ||||||||||||
Publisher: | Elsevier | ||||||||||||
ISSN: | 0277-9536 | ||||||||||||
Official Date: | December 2017 | ||||||||||||
Dates: |
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Volume: | 195 | ||||||||||||
Page Range: | pp. 115-122 | ||||||||||||
DOI: | 10.1016/j.socscimed.2017.11.031 | ||||||||||||
Status: | Peer Reviewed | ||||||||||||
Publication Status: | Published | ||||||||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||||||||
Date of first compliant deposit: | 17 November 2017 | ||||||||||||
Date of first compliant Open Access: | 27 November 2017 | ||||||||||||
RIOXX Funder/Project Grant: |
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