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Subject of Innovation
20
Subject of innovation Wouter Mensink Leiden University Institute of Health Policy & Management November 30, 2010
description
Lecture held at the
Transcript of Subject of Innovation
Subject of innovation
Wouter MensinkLeiden University
Institute of Health Policy & ManagementNovember 30, 2010
Outline
Subjectivation in Foucault’s work:
1. Modes of inquiry
2. Dividing practices / relations
3. Self-constitution
Subjectivation around healthcare innovation:
1. Measuring healthcare innovation
2. Electronic Health Record policy and relations in healthcare
3. Interaction with new technologies
Measuring healthcare innovation I
Two traditions of innovation studies• Mainstream economics: innovation as input to
increase productivity• Evolutionary economics: innovation as output
of a production process, commercialisation of new products
Measuring healthcare innovation II
Three reports• RVZ (2001). Technologische Innovatie in de
Zorgsector. 01/05. Zoetermeer: Raad voor de Volksgezondheid en Zorg.
• Scheepbouwer, A. (2006). Zorg voor innovatie! Sneller Beter - Innovatie en ICT in de curatieve zorg. The Hague: KPN.
• Ministerie van VWS (2008). Innovatie in preventie en zorg. MEVA/AEV-2830484. 's Gravenhage.
Measuring healthcare innovation III
Three measures of productivity • Diagnosis Treatment Combinations (DBC)• “Function-oriented description”• Quality-Adjusted Life Years (QALY)
Measuring healthcare innovation IV
Healthcare innovation, productivity and the recipient of care
• “Principal subject”• “Production subject”
02“Principal subject”, “Production subject”
Electronic Health Record policy and relations in healthcare I
Reciprocity in neoliberalism• Abandoning social contract theory• “Subject of interest” replaces “Subject of
right”• Reciprocity between individuals, populations
and government by “spontaneous synthesis”• Government manufactures freedom: strategic
programming of “entrepreneurs of the self”
02“Principal subject”, “Production subject”
Electronic Health Record policy and relations in healthcare II
Reciprocity in Electronic Health Record Policy• The “principal subject” as partial solution for
collective problems EHR prohibits medical mistakes (“production subject”)
• Individual data for collective measurements, collective data for norms for individuals
“Subject of reciprocity”?
02“Principal subject”, “Production subject”
03“Principal subject”, “Production subject”, “Subject of reciprocity”
Electronic Health Record policy and relations in healthcare III
Resistance? • Optional opt-out• No information about
collective goals in the information package
03“Principal subject”, “Production subject”, “Subject of reciprocity”
Electronic Health Record policy and relations in healthcare IV
“Immoderate” expectations• Secondary use possible?• Prohibiting medical mistakes possible?• Etc.
“Subject of immoderate expectations”?
03“Principal subject”, “Production subject”, “Subject of reciprocity”
04“Principal subject”, “Production subject”, “Subject of reciprocity”, “Subject of immoderate expectations”
Electronic Health Record policy and relations in healthcare V
Standardisation
04 “Principal subject”, “Production subject”, “Subject of reciprocity”, “Subject of immoderate expectations”
Healthcare sector
Patient
Communication(US)
I: Virtual recordII: Chain-integration
recordInformation
(EU)IV: Public
health recordIII: Personal health
record
Healthcare sector
Patient
CommunicationI: Virtual record
II: Chain-integration record
InformationIV: Public
health recordIII: Personal health
record
Scenario I: The Virtual Record
04 “Principal subject”, “Production subject”, “Subject of reciprocity”, “Subject of immoderate expectations”
Healthcare sector
Patient
CommunicationI: Virtual record
II: Chain-integration record
InformationIV: Public
health recordIII: Personal health
record
Scenario II: Chain-Integration Record
04 “Principal subject”, “Production subject”, “Subject of reciprocity”, “Subject of immoderate expectations”05 “Principal subject”, “Production subject”, “Subject of reciprocity”, “Subject of immoderate expectations”, “Expert subject”
“Expert subject”?
Healthcare sector
Patient
CommunicationI: Virtual record
II: Chain-integration record
InformationIV: Public
health recordIII: Personal health
record
Scenario III: Personal Health Record
05 “Principal subject”, “Production subject”, “Subject of reciprocity”, “Subject of immoderate expectations”06 “Principal subject”, “Production subject”, “Subject of reciprocity”, “Subject of immoderate expectations”, “Expert subject”,“Self-managed subject”
“Self-managed subject”?
Healthcare sector
Patient
CommunicationI: Virtual record
II: Chain-integration record
InformationIV: Public
health recordIII: Personal health
record
Scenario IV: Public health record
06 “Principal subject”, “Production subject”, “Subject of reciprocity”, “Subject of immoderate expectations”, “Expert subject”,“Self-managed subject”
06 “Principal subject”, “Production subject”, “Subject of reciprocity”, “Subject of immoderate expectations”, “Expert subject”,“Self-managed subject”
Healthcare sector
Patient
Communication I: Virtual recordII: Chain-integration
record
InformationIV: Public health
recordIII: Personal health
record
Electronic Health Record policy and relations in healthcare VI
Self-constitution in interaction with new technology I
Foucault on self-constitution• Ascetic practices: writing, reading, speaking,
listening• Institutionalisation and culture of self-
constitution• Community, mentoring and institutionalised
practices• Example of Zen
06 “Principal subject”, “Production subject”, “Subject of reciprocity”, “Subject of immoderate expectations”, “Expert subject”,“Self-managed subject”
Self-constitution in interaction with new technology I
Self-constitution at the Weight Watchers• Forms of institutionalisation: Weight diaries,
group meetings, dieting mentors• Framework of dominant discourses:– Societal pressure to be slim and fit– Feminist pressure to not subjugate to societal
expectations
06 “Principal subject”, “Production subject”, “Subject of reciprocity”, “Subject of immoderate expectations”, “Expert subject”,“Self-managed subject”
Self-constitution in interaction with new technology I
Technology-mediated self-constitutions• Diary keeping in Electronic Health Record “Self-constituted subject”?• Online chat rooms:– Critical reading and writing in online community,
resist medicine & geographical boundaries– Invaded by medical specialists, abuse of online
visibility
“Subject of compromised self-constitution”?
06 “Principal subject”, “Production subject”, “Subject of reciprocity”, “Subject of immoderate expectations”, “Expert subject”,“Self-managed subject”07 “Principal subject”, “Production subject”, “Subject of reciprocity”, “Subject of immoderate expectations”, “Expert subject”,“Self-managed subject”, “self-constituted subject”08 “Principal subject”, “Production subject”, “Subject of reciprocity”, “Subject of immoderate expectations”, “Expert subject”,“Self-managed subject”, “Self-constituted subject”, “Subject of compromised self-constitution”
“Subject of compromised self-constitution”
“Principal subject”
“Production subject”
“Subject of reciprocity”
“Subject of immoderate expectations”
“Expert subject”
“Self-managed subject”
“Self-constituted subject”
Thank you
Questions? [email protected]
