The Intrusion of the Discourse of Economics Into the Clinical Space II: From Excellence to Outcomes

Abstract

Objective: There has been a recent dissemination of the term ‘excellence’ in psychiatric services without a full appreciation of the origins of its contemporary usage. In recent years, we have also been witness to an increasing emphasis on the language and notions of goals and outcomes in clinical practice, particularly in the public sector. This paper examines the origin and prevalence of the term excellence in both commercial and clinical services and the corresponding preoccupation with strategies and outcomes. Conclusions: It is argued that the contemporary talk of ‘excellence’ has been directly imported from the commercial sector. A closer examination of the ascendency of the use of this term has not been borne out by the results of the companies purported to be ‘excellent’. In a similar vein, the political and corporate talk of strategies and outcomes has been transferred onto the clinical field. Such a movement has occurred primarily through political and financial motivations. A model of outcome-driven treatment is examined as an end result of such a preoccupation with outcomes.