Boundary work in task-shifting practices - a qualitative study of reablement teams

BACKGROUND

Health services worldwide have provided incentives for establishing teams to accommodate complex health care tasks, enhance patient outcomes and organizational efficiency, and compensate for shortages of health care professionals. Parallel to and partly due to the increased focus on teamwork, task shifting has become a health policy. Task shifting involves new tasks and responsibilities, which may result in social negotiations about occupational boundaries.

OBJECTIVE

The aim of this study was to explore how the division of tasks, responsibilities, and roles in reablement practices can appear as boundary work between physiotherapists (PTs) and home trainers (HTs).

METHODS

The study drew on data from fieldwork with seven Norwegian reablement teams, including observations and individual interviews with PTs and HTs. We conducted thematic analysis informed by a theoretical framework on professional boundaries.

RESULTS

We identified two different practices, which we labeled as: i) "The engine and the assistant" and ii) "The symbiotic team." We drew on these practices and theory of boundary making and boundary blurring to interpret the results.

CONCLUSION

The findings indicate that boundary-making processes may generate asymmetric power relations that may constrain autonomous work and job satisfaction in teams, whereas boundary-blurring processes may promote collaborative practices that enhance holistic approaches and mutual learning on reablement teams.

Pricing the Priceless Surgery: Professional Expertise and the Marketing of High-Risk Surgery in South Korea

Through ethnographic fieldwork in cosmetic surgery clinics in Seoul, South Korea in 2018, in this article I investigate how professional clinicians persuade consumers to purchase surgery during consultations. Enamored by the ascendancy of the Korean cultural industry, many non-Koreans are drawn to Korea for the storied, domestic brand of surgery believed to be inextricable from the aesthetic appeal of their idols. Clinical professionals capitalize on this Korean ascendancy by transforming the meanings of surgical success (as symbolic attainment of moral-existential satisfaction) and failure (as deficiency of its symbolic rewards) to trust in their moral authority and expertise.

Professional flows: Lateral moves of law firm partners in Hong Kong, 1994–2018

This article uses the case of law firms in Hong Kong to develop a processual approach for understanding lateral mobility in professional service firms. Based on the analysis of 1,461 lateral moves of law firm partners reported in 300 monthly issues of the official journal of the Law Society of Hong Kong during 1994–2018, as well as archival data and interviews conducted in Hong Kong, the article offers both a bird’s-eye view of the lateral mobility of partners across law firms of different jurisdictional origins and an in-depth investigation of how elite law firms in this market, namely the Magic Circle and Wall Street firms, are influenced by the dynamics of professional flows. Theoretically, the article reconceptualizes professional service firms as organizations connected by and transform through the flows of professionals between them, a dynamic process characterized by three key concepts: waves, cycles, and turning points. In addition to its theoretical contribution, the study has broader implications for understanding Hong Kong’s economic transformation since the 1990s, particularly after Hong Kong’s handover to China in 1997 and the global financial crisis in 2008.

How professional actions connect and protect

Below we provide responses to the ongoing debate sparked by Mirko Noordegraaf’s intervention in suggesting that we are moving toward forms of ‘connective professionalism’. Critics in this debate have objected to Noordegraaf in a number of ways. Some object to a conflation of ideal types and empirical description. Others assert that Noordegraaf suggests a staged process of moving from protective to connective types of professionalism does not ring true; that we can finds forms of connection and protection in contemporary professionalism and in professional action. Our companions in this issue (Alvehus, Avnoon, and Oliver) suggest that greater connectiveness also permits new forms of protection as part of professionalism. Our short essays contribute to the Noordegraaf debate by focusing less on professionalism and more on how forms of professional action lead to mechanisms of connection and protection.

Qualifying the green city: professional moral practices of trying urban rainwater forms

This article explores how the green, sustainable city is built in situations of uncertainty though professional practical engagements of testing and trying, and how these are formed by moral investments in professional work. Following recent studies investigating professional work and moral agency, the article engages with Terence Halliday’s famous distinction between science-based and normative professions. Contrary to this argument, the article argues that the practice of engineers, the clearest example of the so-called ‘science-based’ profession, is fraught with moral questions and practices. By drawing on French pragmatic sociology, the article conceptualizes the different ways engineers and others work in situations of uncertainty as different modes of trying. In these modes, professionals rely on different moral principles and ideas for evaluating and judging the professional solutions. As such, the article contributes to the sociology of professions by suggesting a new analytical frame for analyzing moral work as fundamental to professional practice in situations of uncertainty. Empirically, the article builds on fieldwork observations and interviews with professionals from an ongoing research project on Danish climate adaptation in cities and urban rainwater management.

In a flash of time: knowledge resources that enable professional cross-boundary work

In this paper, we highlight the networked context of the professions. In particular, we indicate that neo-classical professionals tend to work across organizational boundaries in project teams, often to meet the needs of clients and the wider society. However, little is known about the resources that professionals draw on to meet immediate, fast paced, client demands in project network organizations (PNOs). We pinpoint how knowledge resources, human, social and organizational capital enable professionals to produce outputs at a fast pace/tempo. Temporality emerged as an unexpected but key issue in our empirical research and we explore this further here. First, we put forward how professional work organization(s) has changed by focusing on the boundaries of organizations, and how this is often temporary and project-driven. Second, we use the specific lens of knowledge resources which are drawn upon to enable networked working and ask the question: which knowledge resources enable professionals to work at a fast pace within networks? Third, appreciative of the vast literature on temporary and networked organizations in professional work, our focus is beyond a single profession or organization, and hence, we build upon the prior research on PNOs. We do this by drawing on empirical data of a humanitarian aid project networked organization (HN) that upscales across its network at high speed, often within days, to generate funds for humanitarian disasters in order to save lives.

Forever a profession in the making? The intermediate status of project managers in Germany

Research typically finds that several new professions are barely institutionalized. Labels such as ‘semi-profession’, ‘emerging profession’, or ‘commercialized profession’ have been developed to capture this notion of professions in the making. Yet there is limited understanding of the factors contributing to such an intermediate status. Employing a relational perspective on professions, we study the case of project managers in Germany to shed light on the underlying reasons for this limited institutionalization. We show how project managers in Germany face a particular field of relations populated by various stakeholders, including neighboring occupations embedded in existing institutional structures, which helps explain their sustained status as a profession in the making. Our study contributes to the literature by revealing the reasons for this limited institutionalization, and by offering a positive mapping of professions in the making, as opposed to seeing them either as failed professionalization projects or merely as a stage in the process toward full professionalization.

Professional fission in medical routines: medical scribes and physicians in two US hospital departments

In this study we argue that professionalism imposed from above can result in a type of fission, leading to the ambiguous emergence of new occupations. Our case focuses on the US’ federally mandated use of electronic health records and the increased use of medical scribes. Data include observations of 571 patient encounters across 48 scribe shifts, and 12 interviews with medical scribes and physicians in the ophthalmology and digestive health departments of a community hospital. We found substantial differences in scribes’ roles based on the pre-existing routines within each department, and that scribes developed agency in the interface between the electronic health record and the physicians’ work. Our study contributes to work on occupations as negotiated orders by drawing attention to external influences, the importance of considering differences across professional task routines, and the personal interactions between professional and technical workers.

Who is in charge? Jurisdictional contests and organizational outcomes

We explored how professional jurisdiction contests influence organizational outcomes by examining how Certified Registered Nurse Anesthetist (CRNA) schools in the USA were impacted by a policy pursuing educational upskilling. While others have focused on boundary work at the field and work levels, we argue that contests between professions also influence important organizational outcomes. We detail how the profession’s accreditation decision requiring schools to provide Master’s degrees within a 17 year window took place in the context of physicians historically battling CRNAs. We provide an analytic narrative illustrating the history of this jurisdictional dispute, and empirically examine how CRNA schools with cultures differentially supportive of physicians’ field-level dominance responded to the requirement of educational upskilling. Our analysis indicates that the timing of a school adopting a graduate program was influenced by whether the organizational culture, represented by organizational ownership, supported physician dominance. We also highlight the importance of access to resources as another conduit for boundary work impacting organizational outcomes.