The Mutation of Professionalism as a Contested Diffusion Process: Clinical Guidelines as Carriers of Institutional Change in Medicine

Abstract

The Anglo‐American institution of the profession is mutating: we propose to analyse this mutation as a contested diffusion process that spreads new organizing practices among professionals. We offer an integrated account of the roles played in this diffusion/mutation process by facilitating and impeding factors at three levels: individual professionals (their autonomy, expertise, values, identities, and ties), professional organizations (their strategies, structures, cultures, skills, and systems), and the broader institutional field (professional associations, accountability demands, and competition). At the occupational and organizational level, we show how the distinctive and evolving features of professionalism moderate the mechanisms found in prior research on diffusion in other, non‐professional settings; and at the field level, we show how field‐level forces moderate the impact of professionalism on these diffusion dynamics. Changes at each of these levels interact with changes at the others, with influences flowing both downward and upward. We ground and illustrate this theoretical synthesis with evidence from the case of clinical guidelines as carriers of institutional change in the medical profession.

Nurses’, physicians’ and radiographers’ perceptions of the safety of a nurse prescribing of ionising radiation initiative: A cross-sectional survey

“…'Deprofessionalisation' (loss of autonomy, monopoly over knowledge, and public respect) (Haug, 1973) and 'proletarianisation' (regulation by state control akin to other workers) (Oppenheimer, 1973) are among the most prominent of these theorisations to mediate sociological analyses of professions (see Elston and Gabe 2013). A more recently emerging concept to explain the replacement of physicians' traditional decision-making autonomy with procedural rules is 'professional mutation' (Adler and Kwon 2013).…”

“Devils May Sit Here:” The Role of Enchantment in Institutional Maintenance

“…Adler & Kwon, 2013;Muzio, Brock & Suddaby, 2013;Bevort & Suddaby, 2016). Following on from the work of Scott (2008) and more recent contributions by Muzio, Brock & Suddaby, (2013), Adler & Kwon, (2013), Kipping & Kirkpatrick, (2013) we emphasized the value of studying professions as institutions, and connected the patterns of professionalization with the broader processes of institutionalization. So how does our analysis of institutional maintenance help us explain maintenance of professions?…”

“…Adler & Kwon, 2013;Muzio, Brock & Suddaby, 2013). These approaches draw on the work of Scott (2008: 219) who saw professions as 'preeminent institutional agents of our time'.…”

“…Muzio, Brock & Suddaby (2013) emphasized the value of studying professions as institutions, and connected the patterns of professionalization with the broader processes of institutionalization. Viewed from this perspective, professions are not only the key mechanisms for institutional change, but also the primary targets of the processes of institutionalization (Greenwood, Suddaby & Hinings, 2002;Reay & Hinings, 2009;Suddaby & Viale, 2011;Adler & Kwon, 2013;Kipping & Kirkpatrick, 2013). We refer to advocates as an institution and, because all Scottish advocates belong to the Faculty of Advocates, we treat the Faculty as the organizational aspect of the institution following a long-standing recognition of both normative and structural elements of institutions (Scott, 1987;Gutierrez, Howard-Grenville & Scully, 2010).…”

Field or Fields? Building the Scaffolding for Cumulation of Research on Institutional Fields

“…Professional exchange fields usually contain professional organizations that, as gatekeepers, police membership and practice boundaries in the profession, socialize members and educate them regarding the set of practices to which they must adhere, creating strong identities. Thus they are strong structuring and constraining forces in the fields in which they exist (Adler & Kwon, 2013;Suddaby & Muzio, 2015). As a result, professional exchange fields have a high degree of homogeneity in practices and meanings, though there are established status hierarchies and niches of practice focus.…”