På sporet af dømmekraften: Den Danske Kvalitetsmodel iagttaget som nye beslutningspræmisser for beslutninger i sundhedssektoren

Morten Brock & Jan Vernholm Groth

Student thesis: Master thesis


The purpose of the thesis is to discus the relationship between accreditation standards and judgement in clinical decision making. Accreditation is a technology which is increasingly becoming a central part of the regulation of the public sector in many countries around the world. The technology describes it as its purpose to ensure the quality of decisions through standards. The empirical case of the thesis is The Danish Health Care Quality Programme which introduces accreditation standards as new decision premises in Danish health care organizations. In the first part of the thesis it is analysed how clinical decisions connect to the standards in the program. This is done by using the German sociologist Niklas Luhmanns systems theory. In Luhmanns systems theory decisions are understood as self-produced communication in organizational systems where decisions connect to previous decisions (decision premises). Organizational systems consist of many different decision premises and every single decision is a selection between different decision premises. The analysis of The Danish Health Care Quality Programme shows how contingency and uncertainty are central characteristics of clinical decision making, why standards are not always considered as god decision premises by the clinical decisions. It also shows the importance of judgement in clinical decision making. Judgement is a concept much discussed by a philosophic tradition where good decisions are said to be based on good judgement. The second part of the thesis discusses how the philosophy of judgement describes the relationship between decisions and decision premises. The purpose is to let the concept of judgement tell a different story of clinical decision making than the story accreditation tells. At the same time the concept of judgement might fill out a gap in Luhmanns systems theory which understands decisions as self-produced communication in organizations and therefore finds it difficult to explain how some decision premises are being selected instead of others. The philosophy of judgement shows how the judgement selects between different decision premises and creates successful connections between decisions and decision premises.

EducationsMSocSc in Political Communication and Managment, (Graduate Programme) Final Thesis
Publication date2009
Number of pages82