cardiff school of nursing and midwifery studies ysgol astudiaethau nyrsio a bydwreigiaeth caerdydd...
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Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
Centre for Social Research in Health and Health Care, Sociology of Health
and Illness Foundation Seminar
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
Working Across Professional Boundaries
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
The Riches of Healthcare Work
• Technological rich
• Multiple organisational and agency interfaces
• Complex division of labour
• State intervention
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
Division of Labour
• System orientation
• Connections and inter-relations
• Work and workers
• How is work organised in a given historical/social context?
• What is the basis for the bundle of tasks aligned with particular occupations?
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
Work as a Social Activity
• Work has social meaning
• Individual and collective identity
• Distinctive occupational socialisation processes
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
Professional Dominance
• The medical profession is dominant and key point of reference for all other groups
• All other workers are paramedical professions
• Paramedical professions stand in an ambiguous relationship to medicine
(Freidson 1970)
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
Professionalisation
Traits of a Profession• skill based on exclusive body
of theoretical knowledge• an extensive period of
education• public service and altruism• a code of ethics• professional self-regulation• testing of competence of
members for admission to the professions
Uses and abuses of professionalisation
• Alerts us to the aspirations of occupational groups
But…
• assumes a linear path of development
• encourages a focus on individual professions, when the professions’ fates are interdependent
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
Proletarianisation
• The logic of capitalist development leads to all workers (including professions) being absorbed into the mass of workers
• Professions incorporated into factory-like production processes
• Progressive loss of autonomy and skills
(McKinlay)
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
Deprofessionalisation
• Changing professional-client relationships
• Loss of monopoly over health knowledge
• Loss of cultural authority
(Haug)
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
The System of Professions
1. System of professions 2. Larger social forces – social, political and
technological - generate new areas of work and destroy old ones
3. Differentiation within individual professions – generate and absorb system disturbances
(Abbott 1988)
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
Jurisdiction
• Each profession is bound to a task area by jurisdictional ties
• Professions are distinctive because of the role of abstract knowledge in creating ties of jurisdiction
• Abstraction = process through which tasks become constructed into professional problems
• Jurisdictional claims are made in Public, Legal and Workplace arena
(Abbott 1988)
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
Jurisdictional Settlements
• Full jurisdiction• Subordination of one profession to another• Retention of intellectual jurisdiction• Splitting of a jurisdiction into two interdependent
parts• One profession retains an advisory control over
certain aspects of the work• Division of labour not according to the content
of the work, but according to the nature of the client
(Abbott 1988)
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
Sources of System Disturbance
• Technological change
• Organisational developments
• Different social values
• State intervention
(Abbott 1988)
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
Intra-professional Differentiation
• Status• Client• Work organization• Career patterns
“Were there only one professional status, workplace, and client type in a given profession, any shift in these actualities would at once become publicly evident. But since there are many varieties of each, great changes can occur in their relative importance without forcing any great shift in the public image of professional life”.
(Abbott 1988)
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
Division of Labour as Social Interaction
…it seems accurate to see the division of labor as a process of social interaction in the course of which the participants are continuously engaged in attempting to define, establish, maintain and renew the tasks they perform and the relationship with others which their tasks pre-suppose.
(Freidson 1976: 311).
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
Negotiating Work/Role Boundaries
• Boundary blurring
• Boundary maintenance
• Moral division of labour (who I am)
• Technical division of labour (what I do)
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
Boundary Blurring
• Strain towards blurring of technical division of labour
• Negotiation, routine and custom which embed situation-specific jurisdictions
• Workplace assimilation
• Intra-organisational division of labour replaces an inter-professional one
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
Boundary Maintenance
• Boundary-work (Gieryn)
• Symbols
• Actions
• Texts
• Talk
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
Summary
• Division of Labour• Social meaning of
work• Professional
Dominance• Professionalisation• Deprofessionalisation• Proletarianisation
• System of Professions
• Boundary Blurring• Boundary
Maintenance• Technical/Moral
Division of Labour• Boundary Work
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
Food for thought….
• If our concern is with safe prescribing across professional boundaries, what kind of boundaries are we referring to?
• Is the issue that of working across professional boundaries or about the salience of boundary construction in the context of new ways of working?
• Where are the primary sites of boundary construction and what are the consequences for work organisation and patient safety?
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
More…..
• The loss of medicine’s monopoly over prescribing has created important shifts in the technical division of labour, but is this sufficient to change the moral division of labour in health care?
• Can we consider the implications of non-medical prescribing for professionalism in isolation from the multiple external social forces which are currently shaping healthcare work?
Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd
And finally…..
• What would the world of healthcare work look like if we turned away from professions for one moment and considered the occupational niches which are emerging?
• To what extent would we see an intra-organisational division of labour replacing an inter-professional one?
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