The micropolitics of clinical guidelines : an empirical study
By: McDONALD, Ruth
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Contributor(s): HARRISON, Stephen.
Material type: 
ArticlePublisher: UK : Policy Press, apr. 2004Policy & Politics 32, 2, p. 223-239Abstract: This article analyses data from a participant observation study of decision making in local National Health Service institutions, focusing on the construction of local clinical guidelines. We found that guideline construction departed significantly from the 'bureaucratic-scientific' model. Although clinical guidelines are often seen as constraining the practice of medicine, our study suggests that there is nothing intrinsically corrosive of professional autonomy about guidelines.It is not likely to be guidelines per se which diminish physician autonomy but rather the manner in which they are implemented. Participation in the guidelines process functioned primarily as a device by which actors hoped to pursue their existing opinions, either through imposing them on others, or by creating a framework of legitimation for themselves
This article analyses data from a participant observation study of decision making in local National Health Service institutions, focusing on the construction of local clinical guidelines. We found that guideline construction departed significantly from the 'bureaucratic-scientific' model. Although clinical guidelines are often seen as constraining the practice of medicine, our study suggests that there is nothing intrinsically corrosive of professional autonomy about guidelines.It is not likely to be guidelines per se which diminish physician autonomy but rather the manner in which they are implemented. Participation in the guidelines process functioned primarily as a device by which actors hoped to pursue their existing opinions, either through imposing them on others, or by creating a framework of legitimation for themselves
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