Decision-making and accountability:differences of distribution

Goodwin, Dawn (2014) Decision-making and accountability:differences of distribution. Sociology of Health and Illness, 36 (1). pp. 44-59. ISSN 0141-9889

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Abstract

The cognitive and individual framing of clinical decision-making has been undermined in the social sciences by attempts to reframe decision-making as being distributed. In various ways, shifts in understanding in social science research and theorising have wrested clinical decision-making away from the exclusive domain of medical practice and shared it throughout the healthcare disciplines. The temporality of decision-making has been stretched from discrete moments of cognition to being incrementally built over many instances of time and place, and the contributors towards decision-making have been expanded to include non-humans such as policies, guidelines and technologies. However, frameworks of accountability fail to recognise this distributedness and instead emphasise independence of thought and autonomy of action. In this article I illustrate this disparity by contrasting my ethnographic accounts of clinical practice with the professional codes of practice produced by the General Medical Council and the Nursing and Midwifery Council. I argue that a ‘thicker’ concept of accountability is needed; one that can accommodate the diffuseness of decision-making and the dependencies incurred in collaborative work.

Item Type:
Journal Article
Journal or Publication Title:
Sociology of Health and Illness
Uncontrolled Keywords:
/dk/atira/pure/subjectarea/asjc/2700/2719
Subjects:
ID Code:
66929
Deposited By:
Deposited On:
01 Oct 2013 08:46
Refereed?:
Yes
Published?:
Published
Last Modified:
08 Jul 2020 03:49