TY - JOUR
T1 - The uses and implications of standards in general practice consultations.
AU - Lippert, Maria Laura
AU - Reventlow, Susanne
AU - Kousgaard, Marius Brostrøm
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Quality standards play an increasingly important role in primary care through their
inscription in various technologies for improving professional practice. While ‘hard’
biomedical standards have been the most common and debated, current quality
development initiatives increasingly seek to include standards for the ‘softer’ aspects of
care. This article explores the consequences of both kinds of quality standards for chronic
care consultations. The article presents findings from an explorative qualitative field study
in Danish general practice where a standardized technology for quality development
has been introduced. Data from semi-structured interviews and observations among 17
general practitioners were analysed using an iterative analytical approach, which served
to identify important variations in the uses and impacts of the technology. The most
pronounced impact of the technology was observed among general practitioners who
strictly adhered to the procedural standards on the interactional aspects of care. Thus,
when allowed to function as an overall frame for consultations, those standards supported
adherence to general recommendations regarding which elements to be included in
chronic disease consultations. However, at the same time, adherence to those standards
was observed to narrow the focus of doctor–patient dialogues and to divert general
practitioners’ attention from patients’ personal concerns. Similar consequences of quality
standards have previously been framed as manifestations of an inherent conflict between
principles of patient-centredness and formal biomedical quality standards. However, this
study suggests that standards on the ‘softer’ aspects of care may just as well interfere
with a clinical approach relying on situated and attentive interactions with patients.
AB - Quality standards play an increasingly important role in primary care through their
inscription in various technologies for improving professional practice. While ‘hard’
biomedical standards have been the most common and debated, current quality
development initiatives increasingly seek to include standards for the ‘softer’ aspects of
care. This article explores the consequences of both kinds of quality standards for chronic
care consultations. The article presents findings from an explorative qualitative field study
in Danish general practice where a standardized technology for quality development
has been introduced. Data from semi-structured interviews and observations among 17
general practitioners were analysed using an iterative analytical approach, which served
to identify important variations in the uses and impacts of the technology. The most
pronounced impact of the technology was observed among general practitioners who
strictly adhered to the procedural standards on the interactional aspects of care. Thus,
when allowed to function as an overall frame for consultations, those standards supported
adherence to general recommendations regarding which elements to be included in
chronic disease consultations. However, at the same time, adherence to those standards
was observed to narrow the focus of doctor–patient dialogues and to divert general
practitioners’ attention from patients’ personal concerns. Similar consequences of quality
standards have previously been framed as manifestations of an inherent conflict between
principles of patient-centredness and formal biomedical quality standards. However, this
study suggests that standards on the ‘softer’ aspects of care may just as well interfere
with a clinical approach relying on situated and attentive interactions with patients.
U2 - 10.1177/1363459315590245
DO - 10.1177/1363459315590245
M3 - Journal article
C2 - 26112800
SN - 1363-4593
VL - 21
SP - 3
EP - 20
JO - Health
JF - Health
IS - 1
ER -