The clinical governance of the soul: ‘deep management’ and the self-regulating subject in integrated community mental health teams

• Published in: Social science & medicine (1982) Vol. 56; no. 1; pp. 67 - 81
• Main Authors: Brown, Brian, Crawford, Paul
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 2003; Elsevier; Pergamon Press Inc
• Series: Social Science & Medicine
• Subjects: Administrative Personnel; Biological and medical sciences; Clinical Competence; Clinical effectivenes; Clinical governance; Clinical governance Self-regulation Mental health Community care UK; Community; Community care; Community Mental Health; Community mental health services; Community Mental Health Services - organization & administration; Decision Making, Organizational; England; Governance; Health; Health participants; Health Professions; Health Services Research; Humans; Interviews as Topic; Management; Medical personnel; Medical sciences; Medicine; Mental health; Occupational Therapy; Organizational Structure; Patient Care Team - organization & administration; Process Assessment (Health Care); Professional Autonomy; Psychiatry; Psychology, Clinical; Public health. Hygiene; Public health. Hygiene-occupational medicine; Qualitative Research; Rural Health Services - organization & administration; Self regulation; Selfregulation; Social sciences; Social Work, Psychiatric; Task Performance and Analysis; Teams; Teamwork; United Kingdom; Workforce; United Kingdom > UK; Community care; Clinical governance; UK; Mental health; Self-regulation; Human; Health staff; Cooperation; Team work; Community health; Professional activity; Public health
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/S0277-9536(02)00008-4

Health professionals have often been described as if they were in conflict with the new managerialist spirit in health care. However, because of their distributed and mobile sites of intervention, the work of community teams presents particular problems for traditional notions of management. In this UK study we identify how mental health team members are regulated by means of a subtle ‘deep management’. Team members point to a lack of management direction from senior colleagues, even though some of them participate in the management process themselves. However, the lack of overt management leads them to prioritise clients and foreground professional identities in performing their duties and much additional administrative work besides. This also meant that the organisational structure—the team—was defined in subjective terms. Participants had become self-regulating ‘deep managed’ subjects under a largely hands-off management regime.