The growing “McDonaldisation” of healthcare in the UK is leaving many doctors with “an underlying sense of powerlessness”, new research has warned.
Those with limited experience and influence feel they have little choice but to accept more commercialisation and bureaucracy, according to an academic study.
By contrast, marketisation is also giving rise to a “corporate elite” of doctors whose elevated positions are rooted in “financial investment and ideological alignment”.
The findings highlight the threat of “segmentation and inequality”, claims
Professor Justin Waring, of Nottingham University Business School, who led the research.
He said: “Bureaucratic and market logics are transforming all kinds of expert work, resulting in ever more rationalised and standardised practices and identities.
“In the field of healthcare this process of ‘McDonaldisation’ is leading to a more explicit emphasis on commercial viability and profit – what we might call ‘McMedicine’.
“Our study shows how doctors’ reactions to the new way of doing things vary and how those reactions reflect individuals’ standing in terms of the power they wield.
Sense of powerlessness
“We detected an underlying sense of powerlessness among inexperienced doctors who lack the influence and esteem of their more senior peers.
“They accept greater bureaucratisation and commercialisation largely because they see few alternatives to marketisation at a time of economic uncertainty.
“Meanwhile, a growing ‘corporate elite’ of doctors who hold medical-management positions are enthusiastic in advocating ‘new’ ways of working to increase operational productivity and, in turn, to advance their own financial positions and careers.
“However, one crucial question that’s inevitably raised by the elevated status and motivations of such an elite is precisely whose interests they really serve.”
The three-year study, carried over by academics from the School’s Centre for Health Innovation, Leadership and Learning (CHILL), focused on frontline staff.
"Hyper-rationalisation"
Researchers observed them in a variety of settings, from wards to rest areas to team meetings, and interviewed scores of employees, including medics and managers.
As an illustration of the “hyper-rationalisation” of procedures, executives often referred to doctors as “technicians” whose work needed better organising to prevent waste.
One manager remarked: “Medicine always has this human aspect to it, but in general, of course, it’s a production process – the same as every product and process.”
A few senior clinicians actively resisted greater bureaucracy, but employees of lesser standing accepted marketisation as possibly the only option for their careers.
One said when interviewed: “The whole NHS is changing, and there are going to be more units like this. I guess I should feel quite lucky to have this experience.”
Another told researchers: “I don’t know what will happen in the long term. I would like to go the US... This can only really help with that.”
By contrast, others spoke of “100% commitment” and “outperforming the NHS on its own terms” – but many of these held management or leadership positions.
One clinical director told researchers: “It works in John Lewis. I’m interested in how to take forward the partnership model. It promotes innovation and competition.”
Professor Waring said: “There’s no doubt that a mixed economy offers private companies a chance to transform the organisation and delivery of public healthcare.
“But it seems the corporatisation of healthcare values certain professional resources more than others in relation to their contribution to accumulating capital.
“As a result, the future is likely to involve more extreme forms of McDonaldisation for some employees and quite different opportunities for others.”
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