Professional Jurisdiction Research Articles

The Evolution of Spiritual Assessment Tools in Healthcare

This article explores the history of spiritual assessment tools as a lens through which to consider the place of spirituality and religion in American healthcare. While precise definitions of spiritual assessment have evolved with the concept, the phrase generally refers to the process of evaluating someone’s spiritual needs and resources and addressing those needs in the context of clinical healthcare. We trace the diffusion of spiritual assessment tools from their origins in chaplaincy and pastoral counseling in the 1970s through nursing, medicine and social work in subsequent decades. While engaging with patients around religion and spirituality began as the professional jurisdiction of chaplains, spiritual assessment tools were designed – in part - to enable professionals in other fields to talk with patients about these topics. As such they are both a mechanism of diffusion – a set of questions healthcare professionals who advocate for greater attention to spirituality and religion teach their colleagues to ask – and a symbolic representation of how that diffusion is taking place and where there have been conflicts and bumps along the way.

I rapporti inter-professionali in sanità: dal vecchio al nuovo professionalismo

The sociological analysis of the professions may provide useful theories and concepts for the debate contained in this volume. The old model of professionalism, based on the notions of autonomy and professional jurisdiction and on building and defending inter-professional boundaries, is challenged by powerful factors of change. A study on multi-disciplinary teams engaged in the implementation of social- health integration provides some useful ideas for building a new model of professionalism.

Tracking habitus across a transnational professional field

The sociology of the professions has shied away from cross-national comparative work. Yet research in different professional jurisdictions emphasizes the transnational nature of professional fields. Further work is therefore needed that explores the extent to which transnational professional fields are characterized by unity or heterogeneity. To that end, this article presents the results of a qualitative interrogation of the habitus of partners in ‘Big 4’ professional service firms across, primarily, five countries (Bangladesh, Canada, France, Spain and the UK). Marked differences are observed between the partner habitus in Bangladesh and the other countries studied in terms of entrepreneurial and public service dispositions. In turn, these findings highlight the methodological relevance of habitus for both the sociology of the professions and comparative capitalism literatures: for the former, habitus aids in mapping the dynamics of transnational professional fields; for the latter, habitus can elucidate the informal norms and conventions of national business systems.

Le cas Bonnemaison

A physician is out of Court at the end of a criminal trial for murder. He is however condemned by the professional jurisdiction (excepted his appeal).

The Claim to the Tax Domain: Examining the Activities of Accountants in the Late Nineteenth and Early Twentieth Century

This paper examines the activities of UK accountants in the late nineteenth and early twentieth centuries. Its aim is to determine the nature of their work in relation to taxation, by looking chiefly at the contemporary evidence provided by The Accountant, the accountants’ professional journal. First published in 1874, this journal provides information on tax and other activities at a time when accountants were establishing their credentials as a new profession. The paper considers issues surrounding income tax in this period, as the complexities associated with it provide the wider context and backdrop for accountants’ activities. It then specifically considers why and how accountants met the increasing need for tax advice and claimed this work domain as part of their professional jurisdiction. The paper then goes on to consider the role of lawyers in taxation during the same period.

Brokerage Professions and Implementing Reform in an Age of Experts

In this comparative ethnographic case study of the implementation of a reform related to the Affordable Care Act in two community health centers, I find that professionals may not compete to claim new tasks (and thereby not implement reform) if these tasks require them to acquire information unrelated to their professional expertise, use work practices that conflict with their professional identity, or do impure or low-value tasks that threaten their professional interests. In such cases, reform may be implemented if lower-status workers fill in the gaps in the division of labor between the professions targeted by the reform, playing a brokerage role by protecting each profession’s information, meanings, and tasks in everyday work. When the new tasks represent professionally ill-defined problems, brokers can be more effective if they use buffering practices rather than connecting practices—managing information rather than transferring it, matching meanings rather than translating them, and maintaining interests rather than transforming them—to accomplish reform. By playing a buffering role in the interstices between existing professional jurisdictions, lower-status workers can carve out their own jurisdiction, becoming a brokerage profession between existing professions that need to collaborate with one another for reform to occur.

A Conflict of Analysis: Analytical Chemistry and Milk Adulteration in Victorian Britain

This article centres on a particularly intense debate within British analytical chemistry in the late nineteenth century, between local public analysts and the government chemists of the Inland Revenue Service. The two groups differed in both practical methodologies and in the interpretation of analytical findings. The most striking debates in this period were related to milk analysis, highlighted especially in Victorian courtrooms. It was in protracted court cases, such as the well known Manchester Milk Case in 1883, that analytical chemistry was performed between local public analysts and the government chemists, who were often both used as expert witnesses. Victorian courtrooms were thus important sites in the context of the uneven professionalisation of chemistry. I use this tension to highlight what Christopher Hamlin has called the defining feature of Victorian public health, namely conflicts of professional jurisdiction, which adds nuance to histories of the struggle of professionalisation and public credibility in analytical chemistry.

Reboundarying professional jurisdiction: educational work on discount sale

Education is a critical instrument for governments and communities managing economic and social development in global times. Reboundarying educational work reflects this dynamic where the national and local are networked in complex ways. In this frame, the focus in this article is on a policy debate on educational labour force and gendered work orders. The article examines how the politics of professional jurisdiction refabricates institutional, professional and unionist trajectories, and how these processes are then encountered in the everyday experiences of vocational education teachers.

Regulating through the "Logic of Appropriateness" and the "Rhetoric of the Expert": The Role of Consultants in the Case of Intangibles Reporting in Germany

The paper provides some insights into the rationales, processes and actors according to which Intangibles Reporting (IR) has reached a (soft) regulatory stage in the German business context since the mid 2000's. It draws on the "logic of appropriateness" (March and Olsen, 1992; 1997) combined with the "rhetoric of the expert" (Czarniawska, 1997) in order to examine the documents published in relation to IR. The analysis demonstrates how in Germany this (soft) regulation of reporting of these resources has been mainly realized by a group of management consultants. It is of a particular interest that in the Guidelines they have devised and promoted, the ad hoc organizational figure, the moderator, that has been identified as central for the proposed intangibles reporting does not belong to the accounting domain. This way, the work contributes and expands on previous debates in relation to the "professional jurisdiction" that has made claim throughout the arena of Intangibles by accountants (Napier and Power, 1992; Power, 2006), illustrating an example of an alternative site in which its professionalization and regulation can occur (Cooper and Robson, 2006). Specifically, it is suggested that the actors and the ways in which regulation is created and perpetuated have sometimes to be disentangled from the ones created within the accounting field.

Epistemic arbitrage: Transnational professional knowledge in action

This article discusses transnational professional knowledge in action and puts forward a conception of how professionals play off different forms of knowledge to provide policy solutions and, in doing so, generate markets for their services. The key concept is ‘epistemic arbitrage’—when professionals exploit opportunities between bodies of professional knowledge. Professionals mediate between knowledge pools for strategic advantage and, if successful, they can become the ‘arbiters’ on what knowledge and practices are most influential in their area of transnational governance. Organizations also have a demand for epistemic arbitrage, as it permits managers to have more influence over what knowledge is dominant and allows greater control of staff. The concept of epistemic arbitrage is situated in the relevant literature from International Relations, Organization Studies, and Sociology, and this interdisciplinary article brings them together to advance the new transnational sociology of professions. I suggest that transnationality matters for how professionals behave and one can draw a distinction between ‘thin’ transnational environments that are especially permissive of epistemic arbitrage and professional mobilization, and ‘thick’ domestic environments where professional jurisdictions can dampen epistemic arbitrage. The article outlines how transnational professionals can be understood as unique groups that have careers and operate in networks where there is a supply of, and demand for, epistemic arbitrage. It also establishes why ‘knowing well’ is crucial to those who have power in shaping how transnational issues are governed.

Admission time to hospital: a varying standard for a critical definition for admissions to an intensive care unit from the emergency department.

Time spent in the emergency department (ED) before admission to hospital is often considered an important key performance indicator (KPI). Throughout Australia and New Zealand, there is no standard definition of 'time of admission' for patients admitted through the ED. By using data submitted to the Australian and New Zealand Intensive Care Society Adult Patient Database, the aim was to determine the differing methods used to define hospital admission time and assess how these impact on the calculation of time spent in the ED before admission to an intensive care unit (ICU). Between March and December of 2010, 61 hospitals were contacted directly. Decision methods for determining time of admission to the ED were matched to 67,787 patient records. Univariate and multivariate analyses were conducted to assess the relationship between decision method and the reported time spent in the ED. Four mechanisms of recording time of admission were identified, with time of triage being the most common (28/61 hospitals). Reported median time spent in the ED varied from 2.5 (IQR 0.83-5.35) to 5.1 h (2.82-8.68), depending on the decision method. After adjusting for illness severity, hospital type and location, decision method remained a significant factor in determining measurement of ED length of stay. Different methods are used in Australia and New Zealand to define admission time to hospital. Professional bodies, hospitals and jurisdictions should ensure standardisation of definitions for appropriate interpretation of KPIs as well as for the interpretation of studies assessing the impact of admission time to ICU from the ED. WHAT IS KNOWN ABOUT THE TOPIC?: There are standards for the maximum time spent in the ED internationally, but these standards vary greatly across Australia. The definition of such a standard is critically important not only to patient care, but also in the assessment of hospital outcomes. Key performance indicators rely on quality data to improve decision-making. WHAT DOES THIS PAPER ADD?: This paper quantifies the variability of times measured and analyses why the variability exists. It also discusses the impact of this variability on assessment of outcomes and provides suggestions to improve standardisation. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS?: This paper provides a clearer view on standards regarding length of stay in the ICU, highlighting the importance of key performance indicators, as well as the quality of data that underlies them. This will lead to significant changes in the way we standardise and interpret data regarding length of stay.

Soviet Madness: Nervousness, Mild Schizophrenia, and the Professional Jurisdiction of Psychiatry in the USSR, 1918–1936

В 1931−36 гг. советские психиатры диагностировали многочисленные случаи “мягкой шизофрении”, т.е. шизофрении по типу невроза, которая предположительно являлась характерной именно для СССР. В 1936 году в ситуацию вмешался Народный комиссариат здравоохранения, распустив исследовательский институт, развивавший концепцию “мягкой шизофрении”. Комиссариат здравоохранения фундаментально переориентировал психиатрическую науку с изучения “пограничных заболеваний” и проблем психологической адаптации на исследования базовых психических заболеваний и их биологических причин. Настоящая статья прослеживает эволюцию проблематики “мягкой шизофрении” в контексте противостояния психиатрической экспертизы и государства в годы высокого сталинизма. Концепцией “мягкой шизофрении” активно интересовались психиатры из Института невропсихиатрической профилактики под руководством директора Льва Розенштейна. В 1920-х годах они пытались создать новую дисциплину – психогигиену, которую понимали как составляющую международного движения за психическую гигиену, основанного американским психиатром Адольфом Мейером ( Adolf Meyer ). Советские психогигиенисты мечтали о сети “невропсихиатрических пунктов”, разбросанных по всей стране. Эти учреждения должны были изучать природные и социальные условия на местах с целью улучшить душевное здоровье и предотвратить заболевания. Деятельность в этом направлении привела к конфликту Розенштейна и его коллег с партийными органами. Работая с понятием “мягкой шизофрении”, психиатры стремились выразить нормальность в психометрических и социальных индексах, а не в терминах политического и социального сознания. Партийные власти, напротив, настаивали на том, чтобы юрисдикция медицинской экспертизы относилась только к специфическим типам заболеваний, но не к условиям работы и жизни в целом. Постулирование “мягкой шизофрении” как биологического заболевания и было ответом Розенштейна и коллег на партийную позицию. Распустив руководимый им институт и разоблачив концепцию “мягкой шизофрении”, власти установили жесткие границы юрисдикции психиатров. В итоге советская психиатрия оказалась четко ориентированной на концепцию психиатрического заболевания как биологического феномена.

Generalist-Specialist Jurisdiction and Work Boundaries: An Ethnography of Hospitalist Integrators

Many professional service organizations are experiencing increasing levels of specialization. However, with increasing specialization, there arises a growing tension between organizational differentiation (specialization) and the need for integration (coordination). I study the creation of a new Generalist profession as a coordination mechanism specifically created to counter some of the consequences of specialization. In particular, I study Hospitalists, a group of Generalist physicians who act as coordinators of care across multiple Specialist units in the hospital setting. Using ethnographic methods, I observe Hospitalists at a children’s hospital during weekly meetings and inpatient/outpatient rounds with other Specialists. Through a grounded theory approach, my observations reveal three antecedents of work boundary assignment between Generalists and Specialists: functional, organizational, and structural. Further, I explain the processes Hospitalists consistently apply to negotiate work boundaries when determining whether to act as primary or consult physicians on different patient cases. These processes serve to either constrain or facilitate professional jurisdiction over work boundaries, and have major implications on successful practice outcomes. In a broader sense, this research contributes to our limited understanding of the challenges that arise when organizations seek to mitigate the differentiation and integration tension, namely through one type of integration strategy— the use of integrators.

‘There’s a lot of tasks that can be done by any’: Findings from an ethnographic study into work and organisation in UK community crisis resolution and home treatment services

Across the United Kingdom, large numbers of crisis resolution and home treatment services have been established with the aim of providing intensive, short-term care to people who would otherwise be admitted to mental health hospital. Despite their widespread appearance, little is known about how crisis resolution and home treatment services are organised or how crisis work is done. This article arises from a larger ethnographic study (in which 34 interviews were conducted with practitioners, managers and service users) designed to generate data in these and related areas. Underpinned by systems thinking and sociological theories of the division of labour, the article examines the workplace contributions of mental health professionals and support staff. In a fast-moving environment, the work which was done, how and by whom, reflected wider professional jurisdictions and a recognisable patterning by organisational forces. System characteristics including variable shift-by-shift team composition and requirements to undertake assessments of new referrals while simultaneously providing home treatment shaped the work of some, but not all, professionals. Implications of these findings for larger systems of work are considered.

Why I act differently: studying patterns of legitimation among CIOs through motive talk

PurposeIT governance has become the recognized norm system for chief information officers. The purpose of this paper is to understand how CIOs relate to these norms, by studying how they legitimate incompliance with the norms.Design/methodology/approachThe paper uses an interpretive, qualitative, structured interview study with 18 CIOs in large Swedish organizations regarded as having excellent IT governance practice, using motive talk as analytical lens to identify the informants’ relationship to norms.FindingsThe study identifies norm‐specific patterns for how CIOs legitimate incompliance with IT governance, finding that CIOs use a combination of excuse and justifications as strategies of legitimation. The study also finds that CIOs display a tendency of not contesting IT governance‐related norms unless these are in conflict with neighboring professional jurisdictions. This is regarded as an identification of the “margins” of IT governance.Research limitations/implicationsThe study illustrates how the theory of motive talk is a viable road ahead for future studies of IT professionals. The generalizability of the identified patterns of legitimation is limited by the selection of large organizations with solely male CIOs, as well as the selection of solely organizations that have succeeded in establishing external legitimacy concerning IT governance and the organizations being Swedish.Practical implicationsCIOs aspiring to increase their legitimacy should avoid direct conflicts with neighboring professions. In addition to this, they should also aspire to be clear in a separation of motive talk and actual practice, since full norm compliance may be detrimental to their factual operations.Originality/valueThe originality of this paper lies in the methodological approach of combining motive talk and speech acts to investigate CIO legitimation practices.

Research Paper - A thematic analytic exploration of how counselling psychologists in the UK experience and position themselves in relation to the NICE guidelines

BackgroundCollective professional identity is dynamic and responsive to the context within which it exists. Thus the current climate of a pervasive medical model as experienced through the imposition of National Institute for Health and Clinical Excellence (NICE) guidelines (2004) and associated Increased Access to Psychological Therapies is relevant to the profession of counselling psychology. Therefore, the possible professional position and the lived experience of its members, whilst existing in a professional arena that requires professionals to fulfil pre-determined criteria, is of interest to this paper.MethodologyA qualitative design explored the declared position and related experiences of counselling psychologists. Semi-structured interviews were conducted with nine qualified professionals and transcripts subjected to thematic analysis.FindingsThree key themes relevant to the declared position and associated individual experience were discerned in the data, namely: NICE experienced as relevant and affecting counselling psychology; counselling psychology declaring a pluralistic identity in relation to NICE guidelines; and client as focus.ConclusionParticipants described a desire to engage with the NICE guidelines, and pluralism seemed to offer them a valid voice with which to achieve this. Pluralism also functioned to offer greater professional jurisdiction and potential autonomy. Pluralism whilst positive in many ways did also produce professional anxiety for many as they struggled with finding their identity within it. Overall, the proclaimed identity appeared to show a dynamically responsive profession that may influence the psychological arena.

In the service of God and the parish: Professional ideologies and managerial control in the Church of Sweden

Professional ideologies are not only shared norms, beliefs, and values but also ‘operational philosophies’ – actual practices – that both constitute and regulate a professional community. Professional ideologies may both accommodate and even embrace certain managerial practices and counteract them if they are regarded as a threat to professional jurisdictions and other privileges. A study of ministers of the Church of Sweden, the established church in Sweden, demonstrates that new demands for managerial control, deriving from shrinking financial resources as the church loses members, are, on the one hand, recognized in terms of providing a joint perspective on the activities of the parish while, on the other, there is a significant skepticism toward more elaborate evaluation methods and performance metrics. For ministers, religious services must not be regarded as being like any other market-based activity, and the church, as a faith-based organization, needs to carefully position itself vis-à-vis industry and public administration. The study contributes to the professionalism literature, the accounting literature, and the study of faith-based organizations.

Border Patrol: Professional Jurisdictions in Sustainable Urban Environments

According to the United Nations, our world is becoming more populated, more urban, more connected, more globalized, and more complex. With this physical and social complexity comes a need for increased coordination in negotiating our urban futures. Environmental design and planning professionals have worked for decades according to traditional institutionalized role structures. Sustainability”in considering a wider variety of stakeholders”promises not only to include more members in the typical design and construction team (e.g., sustainability consultants, community representatives, technical specialists, etc.), but also to change the jurisdiction of tasks (e.g., project management, decision making, design leadership, etc.) taken on by actors in traditional roles (e.g., owner, architect, contractor, etc.). This paper examines how a wider social concern for environmental and social sustainability has affected the design and construction industry. Organizational and sociological theories suggest that professions are "bound to a set of tasks by ties of jurisdiction... [P]rofessions make up an interacting system... and a profession's success reflects as much the situations of its competitors and the system structure as it does the profession's own efforts” (Abbott 1988: 33). Abbott also suggests that "larger social forces” affect the structuring of professional boundaries. Treating sustainability as a "larger social force,” this paper examines current understandings of professional boundaries in the planning, design, and construction of our environments. It answers questions of how professionals renegotiate roles, responsibilities, and compensation when dealing with an uncertain change in traditional processes.The qualitative data stem from three university building projects. Each project was proposed ab initio without a mandate to achieve LEED Certification, but this complex criterion was subsequently added at different phases of design for each project. The in situ reconfiguration of existing responsibilities”and assignment of new responsibilities”shows how professionals integrate new practices and processes to achieve both environmentally and professionally sustainable futures.

Abortion Law and Professional Boundaries

The medical profession’s formative role in the development of abortion law has been acknowledged. A number of the studies to have considered the development of law in the nineteenth century have traced how the emerging profession’s campaigns against abortion advanced its social and economic goals. Analysis of abortion law as a focus for medicine’s professionalisation has not, however, extended into the twentieth century. Consideration of this period generally characterises medicine’s influence as a product of its professional power. Rather than evidence of a static professional status, this article argues that consideration of the first half of the twentieth century reveals how abortion remained the terrain on which the profession actively pursued its occupational ambitions. Further, it highlights how medical responses to abortion changed as the imperatives of professionalisation changed. Employing work that has highlighted the importance of boundaries for enduring social entities, this article recognises abortion as a boundary issue for the profession; that is, a key site where professional jurisdiction is asserted. A dynamic model of the processes of professionalisation, and an identification of the role of abortion in medicine’s professionalisation project, is essential in order to understand the contemporary social and legal reality of abortion.

Re‐Theorizing Change: Institutional Experimentation and the Struggle for Domination in the Field of Public Accounting

AbstractUsing change theory integrated with Bourdieusian sociology, we re‐theorize a major institutional shift in the field of public accounting. The case we examine involves the consolidation of commercial values in the auditing profession. In reinterpreting this shift, we highlight an institutional process structured around a conflict between commercial innovators and guardians of the professional tradition. Our analysis indicates a peculiar kind of institutional work, wherein economic capital is reinforced at the field level while the logic of commercialism is strengthened in accounting firms' structures and practitioners' mindset. From our studying of the field of accountancy, we develop the concept of institutional experimentation in order to offer a view of institutional work as a fragile and unpredictable process. Specifically, the latter is subject to trials and tests by actors involved in a series of more or less connected experiments in trying to extend their professional jurisdiction through institutional innovation, while seeking to consolidate the traditional foundations of their jurisdictional legitimacy through institutional reproduction. Our paper also challenges the notion of organizational archetypes. While a focus on the firms' formal organizational parameters may suggest archetypical stability, the picture is more complex when one takes into account processes of institutional experimentation and the duality of institutional change and stability.