This is an extensive summary of all the lectures with their notes, all literature and all workgroups including the things that were discussed during the workgroup. I got a 8.4 for this course. I hope this summary helps you as well.
Healthcare organizations under pressure
Healthcare organizations face
- Numerous challenges
- Numerous solutions
Organizational behavior helps to navigate by understanding human behavior.
> For example, will they accept AI?
What is organizational behavior?
“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.”
➢ Going a step further
“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.”
➢ So why and how people behave in an organization, and if this improves things within the
organization.
Hawthorne study
> Could be seen as one of the most famous OB studies.
Researchers and managers were conducting a study of lightning on productivity in manufacturing.
> They studied only this. But more is important. How the employers felt, how they wanted to change
things etc.
Different from HRM?
Human Resource Management:
The management of work and people towards desired ends.
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.
> HRM related to OB but not the same. HRM is more practical.
What is organizational behaviors?
- Explain and predict human behavior by replacing intuitive explanations with systematic study
> OB strives to base ideas on systematic studies, not intuition.
- Educated view an opinion based on scientific.
- Not straightforward
Common sense or OB?
- Hospitals should require parttime nurses to work one hour per week more to solve the labor
shortage (based on McKinsey study), we don’t have a problem than anymore.
> Is this a good solution?
- HRM impacts hospital performance in a way that it can reduce patient mortality.
> Is this true? Depends on how you argue it.
- Being a physician in 2023 requires taking on a role as medical leader
> Should all physicians be a medical leader?
,Professionals:
Increasing pressures
- Social cultural pressures: more complex patients, elderly
- Financial- economic pressures: 1 in 5 Dutch persons should work in healthcare
- Technological pressures
- Public- and political turmoil: organizations need to respond to this all the time
Makes healthcare difficult, we’re quite fragmented.
Trends
- From mono- to multidisciplinary practices, in teams, has an impact on the professional
- From supply centered to client centered, listening to patients and including them
- From intramural to extramural services, care at home
- From single organizations and practices to network, work together with all these
organizations.
Towards holistic and integrated service delivery (horizontal and vertical integration)
> Major impact on professionals, we focus on professionals today.
Who are professionals?
- Police officer?
- Lawyer? Judge?
- Pilot? Flight attendant?
- Physician? Nurse?
Dimensions of professionalism
1. Expertise
2. Authority
3. Autonomy
1. Unique expertise
- Professionalism is about applying general, scientific knowledge to specific cases
- Complex knowledge, scientific: we need people that can translate this general information to
specific cases.
- Both explicit and tacit knowledge: explicit is knowledge that you can put in protocols, you can
write it down. Tacit knowledge is knowledge that you obtain from experience.
Professionalism is a lot about tacit knowledge. Makes it difficult for outsiders to control
professionalism.
, - Functional knowledge and reflective skills: every client is different, you have to reflect what
fits.
- Beneficial for society: you are providing an important societal function, society needs you.
2. Authority
- Legitimate power / reason to decide for others what they need. You trust them.
- Based on knowledge. They have more knowledge than you.
- Based on legal, organizational, professional, personal status
- Unquestioned? Nowadays, more and more questioned. Maybe because we are more high
educated.
3. Professionalism as controlled content (autonomy)
Continuum:
- Task: how to divide tasks? Task is within organization, can be change over time.
- Function: combination of tasks, probably more stable over time within organization.
- Occupation: consist of certain type of tasks, these are stable over time and also stable over
different organizations. You hired because you have this occupation. Organizations have less
control over this.
- Profession: even has more say so. They not only decide what tasks they are doing but also:
who gets this education, what do we educate about this, who can access this profession,
what are quality criteria? They are very independent. Organization does not have influence
on the thinks the professional does.
Freidson: a profession is a special status in the division of labor that is supported by an official
and sometimes public belief that it is worthy of that status.
Organization cannot say that someone is not a professional anymore.
Professional autonomy;
- It could refer to the individual or the group
- According to Beauchamp and Childress: ‘virtually all theories of autonomy view two
conditions as essential for autonomy: liberty (independence from controlling influences) and
agency (capacity for intentional action, be able to work autonomously)
- So its 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.
Types of autonomy;
- Political autonomy: decide things on a more political level, healthcare policies are influenced
by doctors.
- Economical autonomy: professionals decide themselves what they earn, this is changing now.
- Clinical autonomy: core of professionalism. What we talked about earlier.
> Focused on the process
> Focused on content (professional discretion)
Different views on (classic) professionalism
How a profession is viewed depends on your perspective:
1. A list of traits and behaviors
2. As a role played in society (functionalism)
3. As a social construction
4. As means and affect of social control (critical studies)
, 1. Professionalism as a list of traits and behaviors
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-registratie)
Of a professional
- Specialized knowledge
- Altruistic: do something that is important for society
- Reflexivity: reflexive society
2. Professionalism as a role played in society (functionalism)
- Professions have certain traits and behaviors because of the function they have for the
society -> they are important for the society. They have relevant, impactful work.
We can’t control them, we as society, so we have to trust them.
We have a social agreement. We trust you, you get autonomy, but you have to control
yourself.
- 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.
> Ideas of control increased over time. Nowadays, control is also about evidence-based
medicine, you have to build guidelines and protocols.
If we ask professionalism to define protocols, they make their tacit knowledge explicit. This
means that other people can go control the professionals. So, this is a dilemma. Managers
can use the guidelines to control the professionals. So they keep these with themselves.
Consequence of this is that some care is not concentrated.
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.
> Forms the foundation for the social context. Upholding this contract, trust we have in society.
3. Professionalism as a social construction -> more a power perspective
- How is professionalism socially constructed and sustained?
The work on gaining and remaining that autonomy. They defend their domain by lobbying
with government for example.
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; within professionalism as a social construction
Differences in professional identities and core beliefs on:
- What constitutes evidence
- Safe practice
- Quality
- The use of standard pathways / guidelines
- Importance of teamwork: teams struggle because of these differences
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