Marianna Fotaki

What benefits will choice bring to patients? Literature review and assessment of implications:

Objectives To assess the demand for, and likely impact of, increasing patient choice in health care. The study examined whether patients would like to exercise choice of hospital, primary care provider and treatment, and investigated the likely impact of policies designed to increase choice on equity of access, and on the efficiency and quality of service delivery. Method Theory-based literature review including an analysis of the intended and unintended impact of choice-related policies in health care in the UK, European Union and USA. Selected papers focused not only on offering choice to individual patients but also evidence of the impact of choice by patients’ agents such as GPs, and on the impact of introducing choice in education and social services. Results Choosing between hospitals or primary care providers is not currently a high priority for the public, except where local services are poor, e.g. they have long waiting times and where individual patients’ circumstances do not limit their ability to travel. When patients become ill, they are increasingly likely to wish to rely on a trusted health practitioner to choose their treatment. Better educated populations make greater use of information and are more likely to exercise choice in health care. The increase in inequality which this could produce might be reduced by specific provision of information and help, enabling less advantaged populations to make choices about health care. There was little evidence in the literature that providing greater choice will in itself improve efficiency or quality of care. Conclusion Although patients may themselves make limited use of choices, the existence of choice may, in theory, stimulate providers to improve quality of care. Patients do, however, want to be more involved in individual decisions about their own treatment, and generally participate much less in these decisions than they would wish.

No Woman is Like a Man (in Academia): The Masculine Symbolic Order and the Unwanted Female Body:

Women continue to be under-represented in senior positions in universities and their relative absence from the top jobs in management and business schools remains a cause for concern. The aim of this study is to extend understanding of this situation by drawing on the feminist psychoanalytical post-structuralist theories of Luce Irigaray and Julia Kristeva. The theoretical frame proposed engages with debates over language, discourse and the body and allows development of a theory of the disembodied symbolic order explaining women’s continued marginalization and devaluation in academe. This is achieved through analysis of empirical findings of the experiences of women faculty in nine management and business schools in England. The study demonstrates how male norms and woman’s absence from symbolic representations disables their participation in equivalent terms in the institutions studied, and how women often both collude with and resist their own marginalization in academia.

Choice is yours: A psychodynamic exploration of health policymaking and its consequences for the English National Health Service

Patient choice is at the forefront of the debate about the future of healthcare provision in many industrialized countries. It is argued that understanding the complexities and the multiple consequences involved in implementing individual patient choice in public health systems calls for an analytic framework extending beyond economic determinism and positivist social science paradigms. This study applies psychoanalytic concepts to illuminate policy dynamics and limitations, using the example of patient choice in the English NHS. It separates declared from unexpressed policy goals theorizing on the role of imaginary institutions and their defensive and less obvious functions in society, and reflects on the implications of policies that are formulated at a distance from operational reality on healthcare organizations. By focusing on the deeper primitive anxieties that are evoked and enacted in patient–doctor interactions, this article examines opportunities and limitations involved in developing individual patient choice.

The sublime object of desire (for knowledge) : sexuality at work in business and management schools in England

This paper explores why and how sexuality intertwines with gender in the organizational context of academic institutions. Drawing on insights from the work of psychoanalyst post-structuralist feminists Luce Irigaray, H�l�ne Cixous and Julia Kristeva, we explore the institutionalized abjection of the real and imagined (womans) body as the root cause of her relative exclusion from knowledge (creation) and her subordinate position in it. The project is analytical as well as political: it both unravels and opposes the ways gender is superimposed on sexuality and how we as academics might collude, legitimize and perpetuate and gendered sexualized (and therefore exclusionary) ways of organizing in/of society. The findings of an empirical study of a sample of women academics in management and business schools in England are discussed in the light of the proposed theory.

Why do public policies fail so often? Exploring health policy-making as an imaginary and symbolic construction

Although it is widely accepted that public policies are difficult to implement, most analyses of policy failures are conceived of as predominantly rational processes. This article questions that assumption by introducing ideas of a desiring subject and socio-symbolic order drawn from Lacanian psychoanalytic theory to suggest that public policies are also a product of social fantasy, and to draw attention to the implications of this unrecognized function of policy-making. It also employs the idea of defensive splitting borrowed from Kleinian object relations theory to explain the difficulty of translating policy into public organizations, which have to perform often conflicting societal tasks. The example of patient choice in the UK National Health Service (the NHS) is used to illustrate theoretical arguments and to propose an alternative understanding of public policy-making by way of bridging fantasy with reality.

The sublime desire for knowledge (in academe). Sexuality at work in business and management schools in England

This paper explores why and how sexuality intertwines with gender in the organizational context of academic institutions. Drawing on insights from the work of psychoanalyst post-structuralist feminists Luce Irigaray, H�l�ne Cixous and Julia Kristeva, we explore the institutionalized abjection of the real and imagined (womans) body as the root cause of her relative exclusion from knowledge (creation) and her subordinate position in it. The project is analytical as well as political: it both unravels and opposes the ways gender is superimposed on sexuality and how we as academics might collude, legitimize and perpetuate and gendered sexualized (and therefore exclusionary) ways of organizing in/of society. The findings of an empirical study of a sample of women academics in management and business schools in England are discussed in the light of the proposed theory.

What Can Psychoanalysis Offer Organization Studies Today? Taking Stock of Current Developments and Thinking about Future Directions:

The introductory paper to the Special Issue discusses psychoanalytic contributions to the study of contemporary organizations. The aim is to draw attention to psychoanalysis as a critical theory with wide explanatory power and a potential for thinking about organizational practice in new ways. It does so firstly, by reviewing the impact it had so far on illuminating group dynamics, leadership dysfunctions and the sanctioned socially institutional defences. Secondly, it contests the limited impact of psychoanalysis on mainstream organization and management theory as an unfortunate outcome since it represents arguably the most advanced and compelling conception of human subjectivity that any theoretical approach has to offer. By way of example, seven papers comprising this Special Issue are introduced. Lastly the paper outlines future developments in the psychoanalytic studies of organizations that might be about: (i) greater conceptual inclusivity and crossing the boundaries between the humanities and science; (ii) the study of affect and emotion in organizations (iii) an integration of psychoanalytical insights with social theory via psychosocial approaches and ‘systems psychoanalysis’ and (iv) linking psychoanalysis to discourses of power and the politics of life.

Is the ‘F’-word still dirty? A past, present and future of/for feminist and gender studies in Organization

This article looks back at 20 years of feminist/gender theory in Organization. In these years a very rich variety of articles has drawn on feminist and gender perspectives. This suggests that Organization is a welcome site for exploring feminist and gender theories and their contribution to critical analysis of organizations. However, the more theoretically sophisticated work that is to be found in feminist and gender studies has not yet been explored in much depth. There is unfilled potential here. The article looks forward to the next decade by discussing a small selection from the treasure house of feminist theorists and concerns that could offer rich insights for management and organization theory. There are many others; this discussion introduces theorists who will be new to some readers, and might provoke more general interest in feminist thought.

Writing materiality into management and organization studies through and with Luce Irigaray

There is increasing recognition in management and organization studies of the importance of materiality as an aspect of discourse, while the neglect of materiality in post-structuralist management and organization theory is currently the subject of much discussion. This article argues that this turn to materiality may further embed gender discrimination. We draw on Luce Irigaray’s work to highlight the dangers inherent in masculine discourses of materiality. We discuss Irigaray’s identification of how language and discourse elevate the masculine over the feminine so as to offer insights into ways of changing organizational language and discourses so that more beneficial, ethically-founded identities, relationships and practices can emerge. We thus stress a political intent that aims to liberate women and men from phallogocentrism. We finally take forward Irigaray’s ideas to develop a feminist écriture of/for organization studies that points towards ways of writing from the body. The article thus not only discusses how inequalities may be embedded within the material turn, but it also provides a strategy that enriches the possibilities of overcoming them from within.

Maintaining the illusion of a free health care in post-socialism: A Lacanian analysis of transition from planned to market economy

Purpose – This paper aims to employ the concept of subjectivity taken from Lacanian psychoanalysis and Slavoj Žižeks idea of the law, enabled via its “inherent transgression”, to critique the premises of neolibertarian theory about the markets superior ways of organizing society.Design/methodology/approach – An alternative conceptual framework is being developed and applied to the analysis of the transition from a planned to a market economy in former socialist countries using the example of informal payments in the health system in Russia. The proposed schema builds on the idea of the subject eternally divided between the imaginary conceptions of the self/the other, and the socio‐symbolic order, which is offered to theorize on the role of phantasy in this transformation.Findings – The applied (psycho)‐analytic schema reveals why the totalizing discourse of the market is no less tyrannical and no less totalitarian in its intent than the socialist ideology it opposes. The central argument is how dominant...