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Colleges, literature and working group week 5
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Colleges, literature and working group week 5
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Week 5Lecture Professionals
Professionalism: concepts and theories
What is a profession, can be organized by: task, function, occupation, profession.
- A profession is a special status in the division of labour that is supported by an official and
sometimes public belief that it is worthy of that status.
Professional autonomy:
It could refer to the individual or the group
2 conditions are essential: liberty (independence from controlling influences) and agency
(capacity for intentional action)
So it is about the privilege and ability of self-governance
The quality and state of being independent and self-directing, especially in decision-making,
enabling professionals to exercise judgement as they see fit during the job-performance.
Types of autonomy: Political autonomy; Economical autonomy; Clinical autonomy: focused on the
process; focused on content (professional discretion)
Different views on professionalism:
1. A list of traits and behaviors
Of the profession: organize professional group that: defines standards of training, criteria of
competence, quality criteria, a code of ethic, has exclusive right to perform certain tasks
Of a professional: specialized knowledge, altruistic, reflexivity
2. As a role played in society (functionalism)
Professions have certain traits and behaviours because of the function they have for the society.
Professionals are expected to act in the public interest, have an unique role. Because of this important
function they have certain rights (self-regulation); social contract based on trust. Trust versus control.
Medical professionality: the values, behaviours and relationships with the society that support and
justifies the trust people have in doctors.
Medical professionality: forms the foundation of the social contract between the professional group and
the society.
3. As a social construction
How is professionalism socially constructed and sustained? For example a political perspective:
professionals secure a monopoly by carving out a domain, using specific tactics. Professions compete
with each other for jurisdictional control.
Differences in professional identities and core beliefs on: what constitutes evidence, safe practice,
quality, the use of standard pathways, importance of teamwork
Boundary work: the range of activities by which professionals seek to lay claim to particular fields of
knowledge and to assert their jurisdiction over particular tasks in the face of competition from other
professional groups. Inter but also intra-professional.
4. As means and affect of social control (critical studies)
The link between power and control and large societal inequities. The process of professionalization as a
means of controlling 'knowledge production’. Professionals have the power to define and control what
is true for example in what constitutes health, sickness and treatment. The question is: in who's
interest?
, Organized professionalism
Professions in danger:
Deprofessionalisation: the loss of the unique traits of a profession; autonomy, monopoly,
authority
Proletarisation: loss of power and status
Post-professionalism: loss of exclusiveness of knowledge and skills
(De)professionalization: external regulation (government, managers), bureaucracy (paperwork),
performance measurement, empowerment (voice & choice) of clients, multi-disciplinary team work,
professional control (protocols)
Lecture Professionals (guest speaker)
Celebrated cases are windows or distorting mirrors that allow us an opportunity to interpret ourselves
2 types of discourse:
System error: blame free environment, root cause analysis, procedures/guidelines. Shifting
legitimate knowledge as it reclassifies clinical expertise as just one of the kinds of knowledge
needed to organize good care.
Location of responsibility
System and the professional approach.
Nurses are supposed to have a holistic view (attend to all aspects of patients’ needs). Increasing
complexity: upgrade nurse education (university level), different levels of nursing qualification,
healthcare assistants (task reallocation).
Literature
Waring, Currie (2009). Managing expert knowledge: organizing challenges and managerial futures for
the UK medical profession. 755-778.
Organization of professional work: considering the reordering of professional work through processes of
‘re-stratification’ (= role of professional elites in managing change) and ‘bureaucratization’
(= rationalization of work through procedural guidelines.
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