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Power and integrated health care : shifting from governance to governmentality

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Abstract
Integrated care occurs within micro, meso and macro levels of governance structures, which are shaped by complex power dynamics. Yet theoretically-led notions of power, and scrutiny of its meanings and its functioning, are neglected in the literature on integrated care. We explore an alternative approach. Following a discussion on governance, two streams of theorising power are presented: mainstream and second-stream. Mainstream concepts are based on the notion of power-as-capacity, of one agent ­having the capacity to influence another—so the overall idea is ‘power over ’. Studies on integrated care ­typically employ mainstream ideas, which yield rather limited analyses. Second-stream concepts focus on ­strategies and relations of power—how it is channelled, negotiated and (re)produced. These notions align well with the contemporary shift away from the idea that power is centralised, towards more fluid ideas of power as dispersed and (re)negotiated throughout a range of societal structures, networks and actors. ­Accompanying this shift, the notion of governance is slowly being eclipsed by that of governmentality. We propose governmentality as a valuable perspective for analysing and understanding power in integrated care. Our contribution aims to address the need for more finely tuned theoretical frameworks that can be used to guide empirical work.
Keywords
South Africa, mental health services, governmentality

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MLA
Janse van Rensburg, André, et al. “Power and Integrated Health Care : Shifting from Governance to Governmentality.” INTERNATIONAL JOURNAL OF INTEGRATED CARE, vol. 16, no. 3, 2016, pp. 1–11, doi:10.5334/ijic.2480.
APA
Janse van Rensburg, A., Rau, A., Fourie, P., & Bracke, P. (2016). Power and integrated health care : shifting from governance to governmentality. INTERNATIONAL JOURNAL OF INTEGRATED CARE, 16(3), 1–11. https://doi.org/10.5334/ijic.2480
Chicago author-date
Janse van Rensburg, André, Austa Rau, Pieter Fourie, and Piet Bracke. 2016. “Power and Integrated Health Care : Shifting from Governance to Governmentality.” INTERNATIONAL JOURNAL OF INTEGRATED CARE 16 (3): 1–11. https://doi.org/10.5334/ijic.2480.
Chicago author-date (all authors)
Janse van Rensburg, André, Austa Rau, Pieter Fourie, and Piet Bracke. 2016. “Power and Integrated Health Care : Shifting from Governance to Governmentality.” INTERNATIONAL JOURNAL OF INTEGRATED CARE 16 (3): 1–11. doi:10.5334/ijic.2480.
Vancouver
1.
Janse van Rensburg A, Rau A, Fourie P, Bracke P. Power and integrated health care : shifting from governance to governmentality. INTERNATIONAL JOURNAL OF INTEGRATED CARE. 2016;16(3):1–11.
IEEE
[1]
A. Janse van Rensburg, A. Rau, P. Fourie, and P. Bracke, “Power and integrated health care : shifting from governance to governmentality,” INTERNATIONAL JOURNAL OF INTEGRATED CARE, vol. 16, no. 3, pp. 1–11, 2016.
@article{8075198,
  abstract     = {{Integrated care occurs within micro, meso and macro levels of governance structures, which are shaped by complex power dynamics. Yet theoretically-led notions of power, and scrutiny of its meanings and its functioning, are neglected in the literature on integrated care. We explore an alternative approach. Following a discussion on governance, two streams of theorising power are presented: mainstream and second-stream. Mainstream concepts are based on the notion of power-as-capacity, of one agent ­having the capacity to influence another—so the overall idea is ‘power over ’. Studies on integrated care ­typically employ mainstream ideas, which yield rather limited analyses. Second-stream concepts focus on ­strategies and relations of power—how it is channelled, negotiated and (re)produced. These notions align well with the contemporary shift away from the idea that power is centralised, towards more fluid ideas of power as dispersed and (re)negotiated throughout a range of societal structures, networks and actors. ­Accompanying this shift, the notion of governance is slowly being eclipsed by that of governmentality. We propose governmentality as a valuable perspective for analysing and understanding power in integrated care. Our contribution aims to address the need for more finely tuned theoretical frameworks that can be used to guide empirical work.}},
  author       = {{Janse van Rensburg, André and Rau, Austa and Fourie, Pieter and Bracke, Piet}},
  issn         = {{1568-4156}},
  journal      = {{INTERNATIONAL JOURNAL OF INTEGRATED CARE}},
  keywords     = {{South Africa,mental health services,governmentality}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{1--11}},
  title        = {{Power and integrated health care : shifting from governance to governmentality}},
  url          = {{http://doi.org/10.5334/ijic.2480}},
  volume       = {{16}},
  year         = {{2016}},
}

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