Corporate rationalisers', professional monopolists', and patients' interests and values compared.
| Corporate rationalisers | Professional monopolists | Patients |
| Rational, that is, planned and efficient use of resources1 | Resources according to professionally-defined need4 | According to need as defined by doctor and patient(i) |
| For populations of patients1 | For individual patients1,4 | For both populations and individuals(ii) |
| Economic efficiency the goal4 | Quality the goal4 | Quality the goal but quality includes some efficiencies(iii) |
| Aim to reduce professionals' discretion as much as possible, to maximise efficiency and predictability4 | Professionalism intrinsically at odds with managerialism4 | Not known, but doctors more trusted than managers(iv) |
| Control of clinicians' patterns of working4 | Free to work as think best, control own work4 | Probably managerial control over patterns of working but not over clinical decisions(v) |
| Abolition of clinical autonomy4 | Preservation of clinical autonomy4 | Preservation of clinical autonomy(vi) |
| Replacement of highly qualified professionals by cheaper ones4 | Resist or doubtful about such replacements | Problematic(vii) |
| A small number of highly qualified professionals to become consultants to other staff4 | Highly qualified professionals in direct relationships with patients4 | Highly qualified professionals as consultants to patients(viii) |
| Guidelines and protocols compulsory19 | Guidelines and protocols discretionary — essence of professionalism is knowledge and judgement4 | Guidelines and protocols to be offered to patient, then shared decision making(ix) |
| Promote information and choice for patients1 | Slow to offer information and choice1 | Value full information, choice of treatment(x) |
| Support innovation1 | Clinicians often resistant to change1,12 | Support innovation in response to patients' views and requests(xi) |
| Regulation heavy, managers and lay people in majority | Regulation light, professionals predominate | Regulation heavy,(xii) should include lay people |
| Belief in money as motivator23 | Belief in altruism as motivator23 | Probably both, like most people(xiii) should include lay people |
The Roman numerals refer to paragraphs in the rationale in Box 1.