Week 1 Flashcards
Relational expertise:
The ability to attune one’s responses to the enhanced
interpretation with those being made by other professionals’
Adaptive expertise
Flexibility, ability to innovate, continuous learning,
creativity
Not ‘having’ authority
but earning by actions and by being context-sensitive
and receptive to others’ experience and interest; perform trust
Relational autonomy
where decision room isn’t fixed but shaped in a process
with other praticipants
Developments that are related to the reconfiguration of professionalism
o Changing medical curriculum: CanMEDS
o Multidisciplinary teams and centres
o Shared decision making
o Medical management
Professionals have 5 strategies to cope with the introduction of knowledge management:
- Compliance: full participation
- Co-optation: assimilate KM systems but assume local control
o They welcomed the introduction of additional procedures that could contribute to
service quality, but on the understanding that they were led by doctors rather than
managers.
o Ownership, control of the information that is passed on to managers. Filter the
information that is giving to the management. No changes to the content of the
proms and prems. - Adaptation: modify and apply KM systems, but maintain local control
o There will be changes to the content of the proms and prems. Implementation will be
led by the professionals and the managers sometimes won’t be able to access the
information systems.
o Little experience with management tools, more dependent on the management to
help them - Circumvent: reject management systems, given the superiority of existing systems
o New systems will be put aside because there is already a suitable tool to measure the
same things. They do not share the information from their own systems. - Resistant: refuse to participate in KM systems
Professionalism as a list of traits and behaviours:
lists of qualities, behaviours or roles,
checklist approach is popular, however it lacks explanatory power in terms
of how professional behaviours actually arise
Professionalism as a role played in society:
Professionals as a group are assumed to act in the
public interest and for this reason their behaviour is regulated and their actions scrutinised by
public and professional bodies. Unprofessional behaviour by any one individual reflects badly
on the profession as a whole and ultimately results in a loss of public faith and, possibly, in
the revoking or limiting of a profession’s self-regulating status by government.
Professionalism as a social construction:
professionals profess to know better than others the
nature of certain matters, and to know better than their clients what ails them or their affairs.
Professionalism as means and affect of social control:
link between power and control and
larger societal inequities
Increasing pressures
- Social cultural pressures
- Financial-economic pressures
- Technological pressures
- Public- and political turmoil
Trends
- From mono- to multidisciplinary practices
- From supply centered to client centered
- From intramural to extramural services
- From single organisations and practices to networks
Towards holistic and integrated service delivery (horizontal and vertical
integration)
Dimensions of professionalism
- Expertise
- Authority
- Autonomy
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
Authority
- Legitimate power
- Based on knowledge
- Based on legal, organisational, professional, personal status
- Unquestioned?
Professionalism as controlled content (autonomy)
- Task
- Function
- Occupation
- Profession
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
- 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 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
- Economical autonomy
- Clinical autonomy
- Focussed on the process
- Focussed on content (professional discretion)
Medical professionality:
The values, behaviours and relationships with the society that support
and justifies the trust people have in doctors
OR:
Forms the foundation of the social contract between the professional
group and the society
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?
Connective professionalism (Noordegraaf 2020)
- Expertise, authority and autonomy become relational and procedural
- Not fixed and closed, but contructed and reconstructed with others
- Co-design, share, earning trust
- Are they seen as effective, optimal and legitimate
Psychological development & 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)
Professional role-identities:
‘the way that professionals see themselves in
terms of who they are and what they do’ (Reay et al. 2017)
Why do professional identities & roles need to
change?
Workforce pressures: task shifting, skill mix: healthcare assistants,
medical associates, nurse practitioners
* Digital health and Big data: driving development of multi-disciplinary
collaborations, with clinicians working alongside computer scientists and
engineers. New roles in data science, data security, ethics, genomics, human
factors
* Moving from protective to connective professionalism
* Policy & Financial pressures: transform health and care systems from
being disease-focused, hospital-oriented, physician-centric, with little patient
involvement towards decentralized, people-centered health and care
* Crossing traditional boundaries: professional, organizational, sectoral
Institutions
are conventions subject to self-regulating controls that
create pressure to act according to the convention
Non conformity costs: economic (increases risk), cognitive (more
thought), social (reduces legitimacy)
Institutions
Three pillars of Institutions
Regulative, Normative, Cultural-cognitive
Types of professional identity threat
- Status loss
o (e.g., feelings of technical incompetence, erosion of professional
authority, loss of autonomy, doing mundane clinical tasks,
challenge to expert knowledge & skills, struggling to keep pace
with AI advancements) - Professional values conflict
o (e.g., accepting professional responsibility and accountability in
AI defined clinical duties, paternalism vs respecting patient
autonomy, explainability vs black boxing) - Social identity (beyond work) conflict
o (e.g., privatization and commoditization of care, unethical or
biased AI: fake data, privacy, bias, techno-centrism and
dehumanization of care )
Forms of identity work:
- Reframing (articulating what the new identity is)
- Authenticating (connecting new identity to profession’s true
& enduring values, to a true form of practice) - Cultural repositioning (incorporating wider social, political &
cultural ideals to justify new identity)
