Agents of social change in the institutional field of medicine

Abstract

The pragmatic goal of this article is to study agent activity aimed at changes in the medical institutional field, under conditions of high social instability. The implementation of the empirical part of аrticle required an adequate methodological and conceptual approach, on the basis of which it could be designed and implemented. As a general methodological platform, the author chose the paradigm of complexity, which builds its methodological proposals on the assumption that large complex nonlinear systems change according to laws that are fundamentally different from those by which simple linear system formations function. Society refers precisely to such complex system objects, and therefore the appeal to such a methodological basis is adequate and fruitful. The work offers the author’s view on the processes of social changes, which are conceptualized as the process of changing the social order. The latter, in turn, is considered as a set of all the practices of social interactions that are currently present in society. The key point in this concept is the statement about the presence of two fundamentally different mechanisms of social change — organizational and self-organizational. It is emphasized that high social instability increases the weight of the self-organizing component of changes, which can fade into the background in relatively stable periods. Applying this theoretical framework to the processes in the institutional field of medicine, we get a model of relevant changes, where both organizational (formal rules of the game, laws, government regulations) and self-organization (informal, spontaneously formed rules of everyday interactions in this institutional field) are equally important. Both of these mechanisms have their conductors-agents, through whom they are implemented. The issue of consistency and balance between these different rules of the game is key for institutional management. At the empirical level, the work examines in detail the agentic actions of U. Suprun in the process of her attempts to reform domestic medicine during 2016-2019 (organizational mechanisms), as well as the agentic activity of volunteers from the "Svoi" Foundation, which is headed by Lesia Lytvynova (self-organizational mechanisms). All the features of these two processes of change, their fundamental difference and the complexities that arise in the process of their coordination are shown. The need to build managerial strategies that take these circumstances into account is emphasized.