Resisting bureau - medicalisation: The integration of 'Spaces of Compassion' with the Biomedical Healthcare Environment

同情心在提高患者满意度、帮助患者康复以及让患者对自己的健康产生责任感方面提供了实质性的好处（Van der Cingel, 2011）。然而，在不断加速向更高的“效率”、“工具化约主义”和“技术官僚冷漠”的转变中，证明同情心的重要性是当代医疗保健服务提供中的一个关键挑战（Dutta等人，2019；Hensmans和van Bommel， 2020）。拟议的项目借鉴了“抵抗的地理”文献，以评估富有同情心的空间与医院服务的地方整合，作为对医疗保健服务日益合理化和新自由主义化的以社区为中心的回应。两位消费文化、市场和健康研究方面的资深专家将与英格兰西北部的NHS牧师团队合作，指导一名博士生的研究，内容涉及同情空间所占据的政治和意识形态维度，以及临床环境中多重（有时是相互竞争的）身份、价值观和实践的持续纠缠。不断增加的预算压力、人口老龄化和全国范围内更高水平的疾病已经将英国的公共医疗保健转向了“局医疗化”，Nathan和Webber（2010: 15）将其定义为“[生物]医学模式和组织必要性的有力结合”。局医疗化以财政纪律和健康净值为中心；一个主要以市场为中心的特派团，通过在各种情况下进行经验性衡量和管理评估，执行大规模、高效和普遍的卫生服务，实现业务目标。然而，将护理与目标等同起来，评估护理提供者的表现，衡量和概括护理形式的动力，从本质上讲，既不适合量化，也不适合泛化，破坏和限制了临床环境中同情的机会。

Compassion offers substantial benefits in terms of improving patient satisfaction, aiding patients' recovery, and engendering a sense of responsibility in patients for their own health (Van der Cingel, 2011). Nevertheless, justifying the importance of compassion amidst ever-accelerating shifts towards greater 'efficiency', 'instrumental reductionism', and 'technocratic apathy' represents a key challenge in contemporary healthcare service provision (Dutta et al., 2019; Hensmans and van Bommel, 2020).The proposed project draws upon 'geographies of resistance' literature to assess the local integration of compassionate spaces with hospital services as a community-centric response to increasing rationalisation and neoliberalisation of healthcare provision. In partnership with an NHS Chaplaincy team in the North-West of England, two senior experts in consumer culture, markets, & health studies will supervise a doctoral student's research on the political and ideological dimensions that compassionate spaces occupy and the ongoing entanglements of multiple, and sometimes competing, identities, values, and practices within clinical environments.Increasing budgetary pressures, an ageing population, and greater levels of illness nationally has shifted public healthcare in the UK towards "bureau-medicalisation", what Nathan and Webber (2010: 15) define as, "a potent combination of the [bio]medical model and organisational imperative". Bureau-medicalisation centres on fiscal discipline and net health value; a largely market-centric mission to meet operational targets through executing mass, efficient and generalisable health services informed by empirical measurement and managerial assessment across contexts. Yet the impetus to equate care with targets, to assess the performance of care providers, and to measure and generalise forms of care which, by their nature, are neither amenable to quantification nor generalisability, undermines and limits the opportunities for compassion in clinical settings.