Guidelines, professionals and the production of objectivity: standardisation and the professionalism of insurance medicine

Berg, Marc; Horstman, Klasien; Plass, Saskia; Heusden, Michelle Van

doi:10.1111/1467-9566.00230

Cited by 88 publications

(82 citation statements)

References 34 publications

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“…The question is often therefore not whether an individual is eligible to sickness benefit, but how the certificate could be formulated to secure that benefits will be granted. As reported elsewhere, physicians actual work has not changed, but what they write in their reports have [20].…”

Section: Overcoming the Dividementioning

confidence: 75%

The Work Ability Divide: Holistic and Reductionistic Approaches in Swedish Interdisciplinary Rehabilitation Teams

et al. 2009

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Section: Overcoming the Dividementioning

confidence: 75%

The Work Ability Divide: Holistic and Reductionistic Approaches in Swedish Interdisciplinary Rehabilitation Teams

et al. 2009

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“…At the same time the powers and rights of patients and the public have been strengthened through several organizational and legal reforms that encourage doctors to share decisions with patients. Previous studies recognized that the gatekeeping role of GPs seems to be weak compared with the role of being a patient advocate (Ford, 1998;Berg et al, 2000;Hussey et al, 2004) and many GPs want to relinquish their gatekeeping role (Hussey et al, 2004).…”

Section: Discussionmentioning

confidence: 99%

Does variation in general practitioner (GP) practice matter for the length of sick leave? A multilevel analysis based on Norwegian GP-patient data

Aakvik

Holmås²,

Islam

2010

Social Science & Medicine

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In Norway, as in many countries, the national insurance system is under economic stress from demographic change impacting on the pensions versus contributions balance, and an increasing number of disability and sickness benefit claimants. The general practitioner (GP) is responsible for assessing work capacity and issuing certificates for sick leave based on an evaluation of the patient. Although many studies have analyzed certified sickness absence and predictive factors, no studies assess its variation between patients, GPs or geographical areas within a multilevel framework. Using a rich Norwegian matched patient-GP data set and employing a multilevel random intercept model, the study attempts to disentangle patient, GP and municipality-level variation in the certified sickness absence length for Norwegian workers in 2003. We find that most observed patient and GP characteristics are significantly associated with the length of sick leave (LSL) and medical diagnosis is an important observed factor explaining certified sickness durations. However, 98% of the unexplained variation in the LSL is attributed to patient factors rather than influenced by variation in GP practice or differences in municipality-level characteristics. Our findings indicate that GPs practice variation does not matter much for the patients' LSL. Our results are compatible with a high degree of patient involvement in current general practice. Based on this understanding one may infer that GPs play an advocate role for their patients in Norway, where the patients' own wishes are important when decisions are made.

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“…Formal standards, however, are quickly seen as the ultimate bureaucratic instrument, prescribing what to do when and in what ways (Berg, Horstman, Plass, & van Heusden, 2000). This is considered an assault on professional powers, for at least two reasons.…”

Section: Resisting Standardsmentioning

confidence: 99%

Connective Routines: How Medical Professionals Work with Safety Checklists

Kuiper¹

2018

P&P

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New standards like checklists are introduced to establish so-called "connective professionalism," but it is difficult to work with checklists in daily circumstances. Professionals might comply with standards, but they might also neglect or resist them. By linking the sociology of professions to routine theory, we develop a relational perspective on working with standards, which is sensitive to the actual usage of standards, not so much "by" but "in-between" professionals. We analysed whether and how checklists are part of daily professional routines. Our ethnographic data show that medical professionals pragmatically cope with checklists. They "tick boxes," but also use standards to improve case treatment, depending on the nature of cases, time pressure, and team composition. Connections between professionals not so much result from standards, but are a prerequisite for using standards. Professionals themselves rather than checklists establish collaboration, but checklists might be important devices for using "connective potential." Keywords: Professional work, surgery, standards, implementation, routines, copingThe past few decades, many scholars have emphasized that routines are crucial for how organizations accomplish their tasks (Cyert & March, 1963; Nelson & Winter, 1982). Routines are "recognizable, repetitive patterns of interdependent action carried out by multiple actors" that structure work and are a basic necessity to carry out complex work in organizations (Feldman, Pentland, D'Adderio, & Lazaric, 2016, p. 505;Feldman & Pentland, 2003;Novak et al., 2012). Routines were mostly associated with stability and inertia (Cyert & March, 1963; Nelson & Winter, 1982) but a more recent perspective in the literature explicitly focuses on routines as a source for coping with complexity and change (e.g., Becker et al., 2005, Feldman & Pentland, 2003Feldman et al., 2016;Parmigiani & Howard-Grenville, 2011).Building on this, studies paid explicit attention to how organizational routines are changed triggered by exogenous events (Nigam, Huising, & Golden, 2016). Fundamental transitions in the context of work, such as new governmental regulations, knowledge and technologies, client demands and budgetary restraint (for an overview see Noordegraaf, 2015;2016) explicitly affect work in professional service domains and urge professionals to adapt their ways of working.More specifically, the complex interplay of service pressures has made professional service delivery more multifaceted, and this calls for multi-professional action (Noordegraaf, 2011;2016 healthcare require cooperation between various professionals. They might come from different (sub)disciplines. Professionals need to find ways to organize collaboration and create new routines that are connective (Noordegraaf, 2016;Noordegraaf, Schneider, van Rensen, & Boselie, 2016;Noordegraaf, van der Steen, & van Twist 2014). Put differently, the "recognizable, repetitive patterns of interdependent action carried out by multiple actors" need to be reconfigu...

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Guidelines, professionals and the production of objectivity: standardisation and the professionalism of insurance medicine

Cited by 88 publications

References 34 publications

The Work Ability Divide: Holistic and Reductionistic Approaches in Swedish Interdisciplinary Rehabilitation Teams

The Work Ability Divide: Holistic and Reductionistic Approaches in Swedish Interdisciplinary Rehabilitation Teams

Does variation in general practitioner (GP) practice matter for the length of sick leave? A multilevel analysis based on Norwegian GP-patient data

Connective Routines: How Medical Professionals Work with Safety Checklists

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