Abstract
Recent decades have seen the influence of the professions decline. Lately, commentators have suggested a revived role for a "new" professionalism in ensuring and enhancing high-quality health care in systems dominated by market and managerial logics. The form this new professionalism might take, however, remains obscure. This article uses data from an ethnographic study of three English health care improvement projects to analyze the place, potential, and limitations of professionalism as a means of engaging clinicians in efforts to improve service quality. We found that appeals to notions of professionalism had strong support among practitioners, but converting enthusiasm for the principle of professionalism into motivation to change practice was not straightforward. Some tactics used in pursuit of this deviated sharply from traditional models of collegial social control. In systems characterized by fissures between professional groups and powerful market and managerial influences, we suggest that professionalism must interact creatively but carefully with other logics.
Highlights
The Rise, Fall, and Resurrection of Professionalism?On both sides of the Atlantic, the professions, and medicine, enjoyed a privileged place in the organization of healthcare through the early and mid-twentieth century—the period often characterized as the ‘Golden Age’ of medicine (Starr 1982)
We focus but not exclusively on medical professionalism, and we begin by briefly scoping its history and current position in a complex and heterogeneous institutional field
We focus on the degree to which this approach appeared to succeed in gaining legitimacy among individual clinicians, the tactics used by leads to turn legitimacy into action, and the way this was received by professionals themselves
Summary
On both sides of the Atlantic, the professions, and medicine, enjoyed a privileged place in the organization of healthcare through the early and mid-twentieth century—the period often characterized as the ‘Golden Age’ of medicine (Starr 1982). In a notable turn from his earlier position, Freidson, once the hammer of the professions, puts forward a defense of an ideal-type professionalism (as distinct from ‘actual existing professionalism’) He envisages a professionalism that might act as a countervailing power against managerial and commercial forces, working to the benefit of healthcare quality and patients’ interests. Case-study selection, both of these three projects and of participating teams in local NHS organizations, was guided by theoretical and empirical literature, and aimed to include variation in characteristics considered likely to influence the success or otherwise of this approach to improvement These included clinical setting, the ‘quality gap’ to be tackled, host organization, professional leadership, and organizational context. NVivo 8 software was used to assist in coding the data, locating recurrent themes, and grouping themes together
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