Professional autonomy and surveillance: the case of public reporting of cardiac surgery

Mark Exworthy, Jonathan Gabe, Ian Rees Jones, Glenn Smith

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Professional autonomy has come under greater scrutiny due to managerialism, consumerism, information and communication technologies (ICT), and the changing composition of professions themselves. This scrutiny is often portrayed as a tension between professional and managerial logics. Recently, medical autonomy has increasingly been shaped in terms of transparency, where publication of clinical performance (via ICT) might be a more pervasive form of surveillance. Such transparency may have the potential for a more explicit managerial logic but is contested by clinicians. This paper applies notions of surveillance to public reporting of cardiac surgery, involving the online publication of mortality rates of named surgeons. It draws on qualitative data from a case-study of cardiac surgeons in one hospital, incorporating interviews with health care managers and national policy-makers in England. We examine how managerial logics are mediated by professional autonomy, generating patterns of enrolment, resistance and reactivity to public reporting. The managerial `gaze’ of public reporting is becoming widespread but the surgical specialty is accommodating it, leading to a re-assertion of knowledge, based on professional definitions. The paper assesses whether this form of surveillance is challenging to or being assimilated by the medical profession, thereby recasting the profession itself.
Original languageEnglish
Pages (from-to)1-16
Number of pages16
JournalSociology of Health and Illness
Early online date15 Mar 2019
Publication statusE-pub ahead of print - 15 Mar 2019


  • public reporting
  • surveillance
  • autonomy
  • surgeons
  • Medical profession

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