The mutuality metaphor: understanding healthcare provision in NHS Scotland

Brian Howieson (Lead / Corresponding author)

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    2 Citations (Scopus)
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    – Better Health, Better Care Action Plan (Scottish Government, 2007) sets out how the Scottish Government intends to strengthen public ownership of the National Health Service in Scotland. The purpose of this paper is to advance extant knowledge by understanding how a state-led mutual health policy may be interpreted, and importantly, communicated.

    – The definitional problem of mutuality will be discussed and analysed in terms of how it is (or perhaps should be) communicated? will be offered.

    – It actually may be more instructive to think of, and communicate, mutuality as a metaphor to aid understanding of the openness and fluidity found in NHS Scotland.

    Research limitations/implications
    – The existence of paradox and ambiguity does not, however, negate the usefulness of the term “mutuality”. Quite the opposite in fact: it is precisely by examining healthcare and its delivery through the lens of mutuality (rather than rejecting its complexity as a failure) that this amorphousness can be better appreciated.

    Practical implications
    – There is a need for more public, professional, and academic debate to explore and clarify its implementation, and how it is to be led. This must be provided whilst recognising the daily imperatives that NHS leaders must face. This would suggest, therefore, that a dual development path may help.

    – Although Better Health, Better Care Action Plan was published in 2007, some eight years on there is still confusion and misunderstanding as to what mutuality in healthcare is, not only in policy and theory, but also in practice. It is hoped that this analysis will help address, in part, some of this confusion and misunderstanding.
    Original languageEnglish
    Pages (from-to)666-671
    Number of pages6
    JournalJournal of Health Organization and Management
    Issue number4
    Publication statusPublished - 2016


    • Definition
    • Communication
    • NHS Scotland
    • Mutuality


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