Case 2
Pre-knowledge
Organization
An organization is a social arrangement which pursues collective goals, which controls its own
performance/behaviour, and which has a boundary separating it from its environment.
Mission, vision and strategy are the strategic issues. The four pillars need to be aligned if you want to
have a stable outcomes in the behaviour organization (joint optimization = social and technical
system need to be balanced). E.g. if you implement a new information system, it is important that
the other three pillars are not staying behind. Otherwise the middle will be unstable and this will
have a negative effect on the behaviour of the organization. The behaviour of the organization, such
as level of effectiveness, efficiency, greenness, is the connection with the ecosystem.
1. What is:
a. Professionalism
theory of professionalism: method and substance – Freidson
The intention of this paper has been to sketch the framework of a theory that specifies both the
topics and the theoretical issues which I believe must be confronted by any systematic analysis of
professions. Furthermore, it has tried to show how those topics are related to one another and why
analysis must deal with issues in both the sociology of work and the sociology of knowledge. The
topics themselves and the issues they address should be familiar, for the literature has analysed
them all, although seldom all together and often in different ways.
Professionalism: the occupational control of work (which is logically and empirically distinct from
consumer control and managerial control). What for a specific profession determines what should be
performed. The profession controls the work that is done, not the organization. Being part of a
profession influences your behaviour.
Profession = occupation; generic activity of how an profession works.
It is about legitimacy; becoming officially recognized; it does not have to be ‘real’ but it also
about the practice, what others think. A group is influenced by institutions (rules how people
, act), the professionals work in an organization behaviour organizations/how professional
acts.
Type of professional organization: bureaucracy.
Core characteristics:
1. Main resource of a profession
Knowledge
Skill
2. Commitment to service
3. Intra- or inter professional boundary work.
Summary
Professional boundaries make inter-professional communication, collaboration and teamwork more
challenging and can jeopardise the provision of safe, high quality patient care. This in-depth interview
study conducted in three UK acute hospital organisations in 2003-2004 explored how professional
boundaries affected efforts to improve routine practice by acute pain services (small specialist teams
set up to drive improvements in postoperative pain management through education, training,
standard setting and audit).
Professional boundaries are a set of guidelines, expectations and rules which set the ethical
and technical standards in the social care environment. They set limits for safe, acceptable and
effective behaviour by workers.
- The study found that many anaesthetists and to a lesser extent nursing staff saw
postoperative pain management as a new and unjustified addition to their professional role.
- Professional identities and strong fears about the risks of treatments meant that health
professionals resisted attempts by the acute pain services to standardise practice and to
change medical and nursing roles in relation to postoperative pain management.
- Efforts by the acute pain services to improve practice were further hindered by inter-
professional boundaries (between the medical and nursing professions) and by intra-
professional boundaries (within the medical and nursing professions).
The inter-professional boundaries led to the acute pain services devoting a substantial
part of their time to performing a ‘go-between’ function between nurses and doctors.
The intra-professional boundaries hindered collaborative working among doctors and
limited the influence that the acute pain service nurses could have on improving the
practice of other nurses. Further work is needed to address the underlying fears that can
lead to resistance around role changes and to develop effective strategies to minimise
the impact of professional boundaries on patient care.
Inter refers to between, whereas Intra refers to within.
- Inter-professional boundaries = communication collaboration etc between
different profession
- Intra = communication, collaboration quality etc in one profession.
Jurisdictional claims
- Ability of a profession to lay claim depends on power and status
- Professional boundaries demarcate professions/disciplines from each other
- Contests for professional territory e.g. medical-nursing boundary; observing, defending
and expanding boundaries
, Based on differences in identities and core beliefs.
Occupational control, or professionalism distinguished
1) constants, professionalism ideal typically and the first thing that officially recognizes until
professional schooling. Fixed elements you should have; required skills, knowledge.
professional organization how a profession should act or behave.
internal variables.
2) institutional variables, that represent the interacting contingencies of the process of
professionalization. Ideology, variation skills.
Constants: define professionalism; a process of becoming a professional
Variables: the interacting contingencies of the process of professionalism. Onvoorziene factoren
die invloed hebben op professionalism.
Different variables:
First 4 are institutional constants
5-7 are institutional variables
1. Type of officially recognized work = professional work is defined as specialized work that
cannot be performed mechanically because the contingencies of tasks vary so greatly from
one another that the worker must exercise to adapt his knowledge and skill to each
circumstance in order to work successfully.
- theoretically based discretionary specialization
- of high social standing
- Specialized work
2. Occupational determination of its division of labour = lot of specialization in the medicine world.
- negotiating jurisdictional boundaries
- distinct from determined by
1) market
2) hierarchy (organization)
3. Occupational control of its labour market = i.e. how is the market controlled, e.g. not everyone
can enter the school to become a doctor, you need to be competent enough to be accepted as a
member.
- labor market shelter (social closure)
- only those certified by the profession can perform the labor
- occupation supervised and evaluates work
4. Professional schooling = often a long study, professionals need to keep educating
themselves, e.g. at an University.
- associated with a university teaches abstract and theoretical knowledge
- separate from the labor market tension between science and practice; some member of
the profession hold cognitive authority