Professionalism Redundant, Reshaped, or Reinvigorated? Realizing the “Third Logic” in Contemporary Health Care

Abstract

improve service quality. We found that appeals to notions of professionalism had strong support 10 among practitioners, but converting enthusiasm for the principle of professionalism into 11 motivation to change practice was not straightforward. Some tactics used in pursuit of this

How do Elite Doctors Respond to Tensions in Hybrid Healthcare Organizations?

“…Finally, certain strands of the deprofessionalization of medicine thesis emphasize how the profession is losing: (a) its traditional status in society, (b) influence over other healthcare professional groups and (c) the respect of patients (Filc, 2006;McDonald et al, 2012). This last point maps onto Kyratsis et al's (2016) social identity conflict and the identity work that 'willing hybrid' doctors have undertaken to 'reprofessionalize' medicine, often by embracing the logic, discourse and practices of medical leaders (Bishop & Waring, 2016;Kirkpatrick et al, 2016;McGivern et al, 2013;Martin, Armstrong, Aveling et al, 2015;Waring & Bishop, 2013).…”

“…In some contexts, these tensions create conditions that help organizations become more effective (Goodrick & Reay, 2011;Reay & Hinings, 2009;Waring & Bishop, 2013); in others, they result in deep-seated conflicts and sub-optimal functioning (Kirkpatrick, Jespersen, Dent & Neogy, 2009;McGivern, Currie, Ferlie, Fitzgerald & Waring, 2013). It is widely acknowledged that medical professional groups play a key role in dealing with tensions inside organizations (Ackroyd, 2016;Dent, Bourgeault, Denis et al, 2016;Goodrick & Reay, 2011;Martin, Armstrong, Aveling et al, 2015). Thus we take as our point of departure Freidson's (1970) work, one of the best known researchers on professionalism, who originally saw doctors as a self-serving elite concerned mainly to resist changes to their autonomy and long-held privileges.…”

“…First, it sheds new light on process of hybridization and the future of the professions in public services organizations (Light, 2000;2010;Martin, Armstrong, Aveling et al, 2015). In most studies of hybridity and professionals, typically only two logics have been discussed -professional and a business related logic (Reay & Hinings, 2009).…”

The New Public Management and Public Management Studies

“…Martin et al (2015) explored the fate of attempts to restimulate professional logics in service improvement projects in the English NHS to secure genuine professional engagement with change. These projects ran into the problem that the professional logic was not the only or even the dominant logic in the current health care field: a managerial logic retained considerable power over the allocation of resources.…”

“…clinicians; lawyers; academics) and their relationship with NPM reforms remains of great interest. Will the old logic of professionalism eventually be remobilized against empowered managerialism (Friedson, 2001;Martin et al, 2015), especially if levels of social and political trust in the 'hard' ethos of NPM erodes?…”