Who is Qualitfied to Run Health Care?

Author(s):

Anne Laiho(presenting / submitting)Tarita Riikonen(presenting)

Conference:

ECER 2015

Network:

32. Organizational Education

Format:

Paper

Session Information

32 SES 03 A, Transition of Organizations (Universities and Other Organizations of Higher Education (Part 2)

Paper Session continues from 32 SES 02

Time:

2015-09-08

17:15-18:45

Room:

3004. [Main]

Chair:

Petr Novotný

Contribution

The role of doctors and nurses in health care administration and management has received much focus and attention in the reform of public sector management in Anglo-Saxon countries as well as in Finland. The changes introduced in reforms have involved conflicts of jurisdiction both within and between medical and nurse profession. At the same time, work in these occupational groups has been subjected to increasing demands of accountability and efficiency realized in the name of New Public Management (NPM). The principal manifestation of NPM is managerialism, which stands in a strained relationship with the ideology of professionalism.

The fight for the jurisdiction in the administration and management of the health care is connected with the management education of occupational groups. With the trend towards managerialisation, management competences and skills as well as management education and training have emerged as a new challenge for doctors and nurses. Professional organizations can also utilise management education to promote their members' career and improve the status and appreciation of the group (Evetts 2011; Noordegraaf 2011).

There is a clear hierarchy and division of labour between the medical and nurse profession based on the differences of their knowledge base. However, compared to other professional groups physicians and nurses operate together in the working life and there are many similarities in their tasks and professional challenges. (Kirkpatrick & al. 2011; Smeby & Vågan 2008.) The occupational group is always a part of the wider field of professions which is as a subject of a constant definition and negotiation (Abbott 1988; Andrews & Wærness 2011; Fournier 1999). So it’s justified to examine professional groups side by side.

The knowledge base and education of the occupational group have a central role in professionalism and building professional power. As Noordegraad (2011, 470; also see Smeby & Vågan 2008) states education is a resource which produce content (e.g. knowledge, skills, norms, rituals, subjectivities) and an actor in professionalization processes (e.g. selection, credentials, operation of closure regimes, symbols). The professional organizations indeed try to affect education in the field.

Professionalism can be approached as an occupational value, ideology or as a discourse of occupational change (Evetts 2011; Freidson 2001 ). Professionalism as an occupational value emphasizes a shared, identity which is based on competences produced by education and training. Professional relations are seen as collegial and cooperative. Furthermore, the confidence describes the relation of the practitioner to the customer and employer. (Evetts 2011, 409, 2013, 8.) This interpretation can be considered idealistic. In turn the critical interpretation sees professionalism as an ideology which directs occupational groups to reach for market closure and monopoly from control of the work. Professionalism will promote the practitioners own interests as status, power and salary as well as the monopoly of occupational jurisdiction. In this case the operation of professions will be examined from a conflict theoretical point of view which leans on the thoughts of Max Weber. (Evetts 2011, 410; 2013, 8–9; Macdonald 1999, 27.)

Professionalism as a discourse of occupational change and control combines the previous interpretations. It returns professionalism as a value but it is ideological and used as a means of employee control, as an instrument of managerial control in organisations. Professionalism has a role in attempts to rationalise, reorganize and control the professionals. (Evetts 2011, 410; 2013, 9; Fournier 1999.)

Method

In this presentation we explore doctors’ and nurses’ professional interests – voiced by trade unions – in health care administration and management as well as in education and training that provides the relevant qualifications. The critical interpretation of professionalism raises the self-interest as the central characteristic of the profession. We use concept professional interest in this significance. Furthermore, we look at how the two occupational groups perceive health care management, and examine the discourses they apply in their argumentation. The research material consists of declarations issued by the Finnish Medical Association (FMA) and the Union of Health and Social Care Professionals (Tehy), and editorials and Chairman’s Column articles published in the Finnish Medical Journal and in the Tehy journal in 2002–2012. Furthermore, the material includes policy documents related to medical and nursing education (OPM 2004; Puolijoki & Tuulonen 2007; STM 2011) as well as relevant publications and studies (Suomen Lääkäriliitto 2013; Suonsivu 2004; Tehy 2009; 2010) from the professional organisations. The questions related to the administration and management of health care were often repeated in the material. In this presentation we utilise those parts of material concerning management, knowledge base of management and management education. The texts written by the management of the professional organisation reflect the policy of association – and so professional interests also. Our research material represents for a public arena (Abbott 1988) and tells about occupational groups’ views on administration and management of the health care and management education. The Declarations as well as editorials often focus on state organs and especially their preparatory work. We analyzed documents by theory-driven content analysis informed by profession-theoretic concepts. In the reading of documents we utilised also rhetorical discourse analysis. The statements of the documents were connected to their social and temporal context.

Expected Outcomes

Tehy’s interest is to achieve a position of equality in management of nursing care and to achieve wider recognition for the role of management skills and competences in health care organisations. Management involves drawing a line of demarcation vis-à-vis the medical profession and social welfare professionals. Tehy has advocated the inclusion of nursing care management and management training in the Health Care Act. Although education programmes for nursing administration and management are well institutionalised all the way to the doctoral degree, it seems that this is not enough to guarantee nurses the necessary jurisdiction in the management of nursing care. The FMA’s interest is to safeguard the position of doctors, above all, vis-àvis professional managers. Doctors do not want to separate the roles of clinician and manager, nor the roles of strategic manager and financial manager. The medical profession’s position of dominance over the nursing profession, on the other hand, is clear and obvious, as the FMA makes no mention of the issue in its statements. The medical profession has a specific interest in establishing a separate, “state-run” management training programme. The FMA has also set up its own training programme to ensure its members have the necessary skills and opportunities to compete for their position in health care administration. Both interest organisations employ a managerialist discourse and vocabularies. Management is associated with everything: the implementation of new technologies, the management of change, the patient’s best interests, the availability of labour, wellbeing in the workplace. At the same time, the interest organisations are keen to criticise managerialism. For instance, the occupational groups emphasise the importance of specific managerial expertise in the field of health care. In their advocacy of professionalism, trade unions have to resort to contradictory discourses. These discourses clearly reflect the conflicting pressures from external and internal demands.

References

Abbot, Andrew: System of Professions. An Essay on the Division of Expert Labor. Chicago: University Of Chicago Press, 1988. Andrews, Therese M. & Wærness, Kari: Deprofessionalization of a female occuption: Challenges for the sociology of profession. Current Sociology 59 (2011): 1, 42–58. Evetts, Julia: A new professionalism? Challenges and opportunities. Current Sociology 59 (2011): 4, 406–422. Evetts, Julia: Professionalism: Value and ideology. Current Sociology 61 (2013): 5–6, 778–796. Fournier, Valerie: The appeal to ‘professionalism’ as a disciplinary mechanism. Social Review 47 (1999): 2, 280–307. Fournier, Valerie: The appeal to ‘professionalism’ as a disciplinary mechanism. Social Review 47 (1999): 2, 280–307. Freidson, Eliot: Professionalism reborn: theory, prophecy and policy. Cambridge: Polity Press, 1994. Freidson, Eliot: Professionalism: the third logic. London: Polity Press, 2001. Kirkpatrick, Ian, Dent, Mike & Jespersen Peter: The contested terrain of hospital management: Professional projects and healthcare reforms in Denmark. Current Sociology 59 (2011): 4, 489–506. Kurunmäki, Liisa: A hybrid profession – the acquisition of management accounting expertise by medical profession. Accounting, Organizations and Society 29 (2004): 3–4, 327–347. Macdonald, Keith M.: The Sociology of the Professions. London, Thousand Oaks, New Delhi: Sage Publications, 1999. Noordegraaf, Mirko: Remaking professionals? How associations and professional education connect professionalism and organizations. Current Sociology 59 (2011): 4, 465–488. OPM, 2004. Sosiaali- ja terveysalan johtamiskoulutustyöryhmän muistio. Opetusministeriön työryhmämuistioita ja selvityksiä 2004:30. Puolijoki, Hannu & Tuulonen, Anja: Erikoislääkäri ja erikoishammaslääkärikoulutuksen arviointi. 79 (2014):6 Sosiaali- ja terveysministeriön selvityksiä 2007:47. Helsinki, 2007. Smeby, Jens-Christian & Vågan André: Recontextualising professional knowledge – newly qualified nurses and physicians. Journal of Education and Work 21 (2008): 2, 159–173. STM: Erikoislääkäri- ja erikoishammaslääkärikoulutuksen uudistamistarpeet. Sosiaali- ja terveysministeriön selvityksiä 2011:17. Helsinki, 2011. Suomen Lääkäriliitto: Lääkäriliiton koulutuspoliittinen ohjelma. Helsinki, 2013. http://www.laakariliitto.fi/site/assets/files/5073/koulutuspol_ohjelma2013. (29.4.2014) Suonsivu, Kaija: Puun ja kuoren välissä. Hoitotyön johtajan tehtävät ja asema. Tehyn julkaisusarja A: tutkimuksia 1/2004. Tehy tilastoina, 2013: http://www.tehy.fi/@Bin/25201537/Tehy_tilastoina_2013.pdf (10.3.2014) Tehy: Johtaminen avainasemassa muutoksessa. Tehyn näkemyksiä sosiaali- ja terveysalan johtamisesta. Tehyn julkaisusarja F: 2/2009. Helsinki, 2009. http://www.tehy.fi/@Bin/45463/Johtaminen+avainasemassa.pdf (20.1.2014) Tehy: Tehyn koulutuspoliittiset teesit 2009–2013. Tehyn julkaisusarja F: 1/2010. Helsinki, 2010. http://www.tehy.fi/@Bin/45482/Koulutuspoliittiset+teesit.pdf (10.1.2014)

Author Information

Anne Laiho (presenting / submitting)

University of Turku

Department of Education

Piispanristi

Tarita Riikonen (presenting)

University of Turku, Finland

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