Organization and Subjectivity in the US Medical Profession: Physician Responses to Structural Changes within Advanced Capitalism

Domagalski, Theresa A.

doi:10.1057/9780230592827_6

Cited by 9 publications

(10 citation statements)

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“…New Labour's approach was, therefore, a paradoxical one – it involved developing subordinate medical occupations into Allied Health Professions while demanding simultaneous adherence to strict performance and auditing measures (Clegg, , p. 10). In other words, it combined the logic of professionalism with that of managerialism (or de‐professionalization: see Domagalski, ; Haug, , ; Light, ). Although the New Labour government paid more attention to augmenting professional discretion in the AHPs, it was wary of losing control of the delivery of public services.…”

Section: Context: the Changing Status Of Uk Ambulance Workmentioning

confidence: 99%

Still Blue‐Collar after all these Years? An Ethnography of the Professionalization of Emergency Ambulance Work

McCann

Granter

Hyde

et al. 2013

J Management Studies

105

163

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This paper explores the professionalization project of paramedics, based on an ethnographic study of UK National Health Service (NHS) ambulance personnel. Drawing on concepts derived from institutional theory and the sociology of professions, we argue that the project is enacted at two levels, namely a formal, structural and senior level reflecting changing legitimation demands made on NHS practitioners and pursued through institutional entrepreneurship, and an informal, agentic, ‘street level’ enacted by the practitioners themselves via ‘institutional work’. Focusing on this latter, front‐line level, our ethnographic data demonstrate that the overall impact of the senior level professionalization project on the working lives of paramedics has been somewhat muted, mostly because it has had limited power over the organizations that employ paramedics. Given the slow progress of the senior level professionalization project, paramedics at street level continue to enact subtle forms of institutional work which serve to maintain ‘blue‐collar professionalism’ – a form originally identified in Donald Metz's ethnography of ambulance work. Our analysis draws attention to the complex and contested nature of professionalization projects, in that their enactment at senior and street levels can be somewhat misaligned and possibly contradictory.

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Section: Context: the Changing Status Of Uk Ambulance Workmentioning

confidence: 99%

Still Blue‐Collar after all these Years? An Ethnography of the Professionalization of Emergency Ambulance Work

McCann

Granter

Hyde

et al. 2013

J Management Studies

105

163

View full text Add to dashboard Cite

show abstract

“…Not least among these challenges is the fact that, despite its origins as a collegiate profession, medicine has shifted to become an organizational profession, with many medics now paid employees “in substantial parts of the Western world including especially UK and USA” (Muzio, Ackroyd, & Chanlat, , p. 7). Thus, organizational professionals are increasingly subject to hierarchical and managerial accountability (Adler & Kwon, ; Domagalski, ). Leicht and Fennell (, p. 11) suggest that this is “making professional work look more like conventional white‐collar work … controlled by managers.” Nonetheless, the specialist knowledge inherent in professional practice, combined with its status and the tradition of professional autonomy, continue to make it difficult for managers to gain legitimacy (Abbott, ; Freidson, 1970/2007).…”

Section: From Strategy To Practice: Roles and Responsibilities Under mentioning

confidence: 99%

From Bipartite to Tripartite Devolved HRM in Professional Service Contexts: Evidence from Hospitals in Three Countries

McDermott

Fitzgerald

Gestel

et al. 2015

Human Resource Management

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This article explores the devolution of HRM in a hospital context. Based on secondary data and 128 interviews conducted in nine hospitals across three European countries (Ireland, the Netherlands, and the United Kingdom), we examine roles and responsibility for HRM under devolution and coordination between those delivering it. Findings challenge bipartite conceptions of devolution, identifying a tripartite model with (1) HR practitioners, (2) line managers, and (3) senior professionals (managers and specialists) implementing HRM. Involving senior professionals in HRM reflects long‐standing concern regarding managerial legitimacy in overseeing professional work. In the tripartite relationship, each party has scope to contribute to people management: HR practitioners to formulate a strategic framework, HR practices, and provide advisory services; line managers to implement HR practices and interface between HR and frontline professionals; and senior professionals to act as line managers’ advocates and provide expert knowledge and credibility to inform people‐related decision making. However, lack of role clarity and tensions in coordination relate to the differing goals of, and distance between, the HR function, line managers, and senior professionals. Our theoretical reframing of devolution notes potential for tripartite relational involvement to enhance HR performance in professional service contexts, the contingencies affecting this, and potential implications for the HR architecture. © 2015 Wiley Periodicals, Inc.

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“…As we saw, these involved attempts by professional associations, acting collectively in the wider public arena, to lobby policy-makers and articulate new 'institutional logics' to support (or legitimate) their claims. Associated with this have also been changes in professional education and training to incorporate management ideas (although, as yet this has not led to the creation of new medical management specialization, as in the US [Domagalski, 2007;Fitzgerald and Ferlie, 2006]). …”

Section: Discussionmentioning

confidence: 99%

“…Also possible is that these struggles will be fought out in the broader public arena as different clinical groups engage in what one of us (Kragh Jespersen, 2006) has previously termed 'professional management projects'. Here, the emphasis is on attempts by professions -acting collectively -to control the jurisdiction of management through tactics of lobbying or more subtle changes to professional training and education (Domagalski, 2007; also see article by Noordergraaf, this issue). However, to date, while the idea that clinical professions may seek to colonize management has been mooted in the literature (Kuhlmann, 2008), there have been few attempts to examine this process directly.…”

Section: Enter Managementmentioning

confidence: 99%

The contested terrain of hospital management: Professional projects and healthcare reforms in Denmark

2011

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Although much has been written on the changing management of professional services organizations, only limited attention has been given to the way in which management itself might represent a contested terrain. Drawing on concepts from the sociology of professions, this article develops this idea in relation to the Danish hospital sector. The analysis of secondary sources reveals how, from the mid-1980s, both the nursing and medical professions in Denmark actively sought to lay claim to the jurisdiction of hospital management. The result of this struggle was to further reinforce the dominant position of doctors in the clinical division of labour although the position of nurses has also been enhanced. Such findings point to the need to give more attention to the way broader changes in hospital governance are mediated by interprofessional struggles and rivalries. Such struggles, in turn, have implications not only for the division of labour and status order between professions but also for the way management work itself is enacted.

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Organization and Subjectivity in the US Medical Profession: Physician Responses to Structural Changes within Advanced Capitalism

Cited by 9 publications

References 0 publications

Still Blue‐Collar after all these Years? An Ethnography of the Professionalization of Emergency Ambulance Work

Still Blue‐Collar after all these Years? An Ethnography of the Professionalization of Emergency Ambulance Work

From Bipartite to Tripartite Devolved HRM in Professional Service Contexts: Evidence from Hospitals in Three Countries

The contested terrain of hospital management: Professional projects and healthcare reforms in Denmark

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