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Summary OB: lectures, workgroups and literature
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Summary OB: lectures, workgroups and literature
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Organisational behaviourWeek 1
Introduction Lecture
Health care organisations are under pressure:
● Numerous challenges
● Numerous solutions
● Organisational behaviour helps to navigate by understanding human behaviour
What is it?
● “Organizational Behavior (OB) is the study of individuals and their behavior within the
context of the organization in a workplace setting. It is an interdisciplinary field that
includes sociology, psychology, and management.”
o Different views are good, but there is not one truth.
● “A field of study that investigates the impact that individuals, groups, and structure have on
behavior within organizations, for the purpose of applying such knowledge toward
improving an organization’s effectiveness.”
o Different layers
Hawthorne study: most famous study about the effect of lightning on productivity of employers. If
you focus on productivity, it will improve but is it about much more, like organizational behavior.
Different from Human Resource Management?
● The management of work and people towards desired ends (Boxall et al., 2007)
● HRM involves management decisions related to policies and practices that together shape
the employment relationship and are aimed at achieving individual, organizational, and
societal goals (Boselie, 2010)
● More the how and practical side.. (Google, Buurtzorg, Apple are examples)
Organizational behavior:
• Explain and predict human behavior by replacing intuitive explanations with systematic study
(so not basing it on intuition but on scientific evidence)
• Educated view
• Not straightforward
Common sense or OB (based on science)?
• Hospitals should require parttime nurses to work one hour per week more to
solve the labor shortage (based on McKinsey study)
o You could debate that this is a great or terrible solutions
• HRM impacts hospital performance in a way that it can reduce patient mortality
• Being a physician in 2023 requires taking on a role as medical leader
We will focus on different layers (individuals, group, organization) and on the context.
Lecture Professionals
Increasing pressures:
• Social cultural pressures
• Financial-economic pressures
• Technological pressures
• Public- and political turmoil
,Trends:
• From mono- to multidisciplinary practices (working in teams, leads to discussions with others
and not only deciding by yourself)
• From supply centered to client centered
• From intramural to extramural services (to care at home)
• From single organizations and practices to networks (organizations working together)
Towards holistic and integrated care service delivery (horizontal and vertical integration)
Who are professionals?
• Police officer?
• Lawyer? Judge?
• Pilot? Flight attendant?
• Physician? Nurse?
Dimensions of professionalism:
I. Expertise
II. Authority
III. Autonomy
I.Unique expertise:
• Professionalism is about applying general, scientific knowledge to specific cases (see Abbott,
1988; Elliott, 1972; Freidson, 1994, 2001).
• Complex knowledge, scientific
• Both explicit and tacit knowledge
• Functional knowledge, reflective skills.
• Beneficial for society (we need you, you perform an important job for society)
II. Authority:
• Legitimate power
• Based on knowledge
• Based on legal, organisational, professional, personal status
• Often questioned
III. Professionalism as controlled content (autonomy)
• Task (tasks can differ per day, you often have no influence on the task you get)
• Function (combination of tasks, organizations decide about the tasks that form your
function, think about secretaries at different organizations)
• Occupation (consists of a certain type of tasks, is stable over time among all organizations)
• Profession (it is a special status)
Freidson: 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 (a group decides if a professional cannot be seen
as a prof anymore, f.e. when not having lived up to their duties/standards)
• According to Beauchamp and Childress (10), ‘virtually all theories of autonomy view two
conditions as essential for autonomy: 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 performance of their
job.
,*Professional: has liberty and agency, being self-reflective is very important. A privilege you have to
self-govern.
Types of autonomy:
• Political autonomy
• Economical autonomy (professional decided themselves what this autonomy meant; this is
changing as the salaries were very high)
• Clinical autonomy
o Focussed on the process
o Focussed on content (professional discretion)
Different views on (classic) professionalism
1. A list of traits and behaviors
2. As a role played in society (functionalism)
3. As a social construction
4. As means and effect of social control (critical studies)
1. Professionalism as a list of traits and behaviors
Of the profession
Organized professional group that:
• Defines standards of training
• Criteria of competence
• Quality criteria
• A code of ethic/conduct
• Has exclusive rights to perform certain tasks (BIG-registration decides which tasks can be
performed by a certain prof)
Of a professional
• Specialized knowledge
• Altruistic
• Reflexivity
2. Professionalism as a role played in society (functionalism)
• Professions have certain traits and behaviors because of the function they have for the
society (society cannot control them and have to trust them but we ask them to control
themselves and live up to expectations of the society).
• Professionals are expected to act in the public interest, have a unique role
• Because of this important function they have certain rights (self-regulation); social contract
based on trust.
• Trust versus control (EBM and build guidelines/protocols – tested knowledge becomes
explicit – so it can be tested if profs live up to their duties. Guidelines can be used by
managers to see if profs lived up to them, meaning managers can control them. That is not
something profs want)
According to the Dutch society of specialists:
Medical professionality:
● The values, behaviors 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. Professionalism as a social construction
, • How is professionalism socially constructed and sustained? (A struggle for power and gaining
autonomy. Think about lobbying, use research, language and education to defend their
position)
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.
Professional clashes (because of different beliefs)
🡪 Differences in professional identities and core beliefs on:
- What constitutes evidence
- Safe practice
- Quality
- The use of standard pathways
- Importance of teamwork (teams sometimes struggle)
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
• What kind of activities? What kind of roles do we perform?
*Professionals are not equal in their capacity to expand or defend their boundaries.
4. As means and effect 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 (profs decide what is a disease or what is not,
what is a treatment and what is not? Also think about alternative medicine like acupuncture,
for which you might need to pay yourself. This has consequences for people.)
• The question is in who’s interest?
How do professional identities develop?
Socialization: construction of the professional identity
“The construction of the medical identity is not a straightforward process of replacing one value
system by another, but rather an on-going and tension-ridden series of encounters during which lay
values and attitudes become labelled as “suspect”, “dysfunctional,” and ultimately “inferior,” while
newly encountered, medical “ways of seeing and feeling” become internalized as “desirable,”
“functional,” and “superior”. (Hafferty 2000)
Professions in danger?
• Professionalization: the loss of the unique traits of a profession; autonomy, monopoly,
authority
• Proletarization; loss of power and status
• Post-professionalism; loss of exclusiveness of knowledge and skills (the professionalization of
everyone)
But is it true, and if so; is it bad?
(De)professionalization?
• External regulation (government, managers)
• Bureaucracy (paperwork)
• Performance measurement (value-based healthcare; others can control profs)
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