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Tucker R, Moffatt F, Timmons S. Austerity on the frontline- a preliminary study of physiotherapists working in the National Health Service in the UK. Physiother Theory Pract 2020; 38:1037-1049. [PMID: 32866057 DOI: 10.1080/09593985.2020.1812139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Organizational reform has been commonplace in the response to global socio-economic changes. Rising managerialism, consumerism and marketization has accelerated reforms; providing challenges for the healthcare professions. The latest socio-economic challenge, austerity, and its professional implications have scarcely been researched. This study aims to explore the lived reality of austerity as experienced by physiotherapists working on the frontline of the National Health Service (NHS) in the UK. METHODS Ethical approval was granted by the University of Nottingham; the study was advertised via the Chartered Society of Physiotherapy online network. Two participants took part; semi-structured interviews were completed, audio recorded, and transcribed. Data was analyzed using thematic analysis. FINDINGS Three themes arose from the data: (1) Fulfilling professional responsibilities; (2) Changing organizational landscape; and (3) Professional reality of rationalizing and accommodating austerity. The clinical implications of austerity included increased length of hospital stay, insufficient community services, constrained resources, and understaffing. Participants demonstrated attempts to preserve their professional status and services through restratification throughout the intra-professional hierarchy, changing division of labor, and re-professionalization. CONCLUSIONS Despite claims that austerity is coming to an end, it remained a reality for these clinicians in the NHS. Physiotherapists in this study used similar methods to preserve practice when faced with exogenous constraints as seen in medicine, such as re-professionalization and restratification. However, this attempt to defend professionalism by a non-medical healthcare profession was met with both successes and losses and has implications for the wider healthcare profession ecology, identifying an area for future research.
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Affiliation(s)
- Rachael Tucker
- Centre for Health Innovation, Leadership and Learning, Nottingham University Business School, University of Nottingham, Nottingham, UK
| | - Fiona Moffatt
- School of Health Sciences, University of Nottingham, Nottingham City Hospital, Nottingham, UK
| | - Stephen Timmons
- Centre for Health Innovation, Leadership and Learning, Nottingham University Business School, University of Nottingham, Nottingham, UK
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Randell R, Greenhalgh J, Hindmarsh J, Honey S, Pearman A, Alvarado N, Dowding D. How do team experience and relationships shape new divisions of labour in robot-assisted surgery? A realist investigation. Health (London) 2019; 25:250-268. [PMID: 31522572 DOI: 10.1177/1363459319874115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Safe and successful surgery depends on effective teamwork between professional groups, each playing their part in a complex division of labour. This article reports the first empirical examination of how introduction of robot-assisted surgery changes the division of labour within surgical teams and impacts teamwork and patient safety. Data collection and analysis was informed by realist principles. Interviews were conducted with surgical teams across nine UK hospitals and, in a multi-site case study across four hospitals, data were collected using a range of methods, including ethnographic observation, video recording and semi-structured interviews. Our findings reveal that as the robot enables the surgeon to do more, the surgical assistant's role becomes less clearly defined. Robot-assisted surgery also introduces new tasks for the surgical assistant and scrub practitioner, in terms of communicating information to the surgeon. However, the use of robot-assisted surgery does not redistribute work in a uniform way; contextual factors of individual experience and team relationships shape changes to the division of labour. For instance, in some situations, scrub practitioners take on the role of supporting inexperienced surgical assistants. These changes in the division of labour do not persist when team members return to operations that are not robot-assisted. This study contributes to wider literature on divisions of labour in healthcare and how this is impacted by the introduction of new technologies. In particular, we emphasise the need to pay attention to often neglected micro-level contextual factors. This can highlight behaviours that can be promoted to benefit patient care.
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Gunn V, Muntaner C, Ng E, Villeneuve M, Gea‐Sanchez M, Chung H. The influence of welfare state factors on nursing professionalization and nursing human resources: A time‐series cross‐sectional analysis, 2000–2015. J Adv Nurs 2019; 75:2797-2810. [DOI: 10.1111/jan.14155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 05/30/2019] [Accepted: 07/03/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Virginia Gunn
- Lawrence S. Bloomberg Faculty of Nursing University of Toronto Toronto ON Canada
- Collaborative Doctoral Program in Global Health, Dalla Lana School of Public Health University of Toronto Toronto ON Canada
| | - Carles Muntaner
- Lawrence S. Bloomberg Faculty of Nursing University of Toronto Toronto ON Canada
- Dalla Lana School of Public Health University of Toronto Toronto ON Canada
| | - Edwin Ng
- School of Social Work Renison University College, University of Waterloo Waterloo ON Canada
| | | | - Montserrat Gea‐Sanchez
- GESEC Group, Faculty of Nursing and Physiotherapy University of Lleida Lleida Spain
- GRECS Group Biomedical Research Institute of Lleida Lleida Spain
| | - Haejoo Chung
- Department of Public Health Sciences, Graduate School Korea University Seoul South Korea
- School of Health Policy & Management College of Health Sciences, Korea University Seoul South Korea
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Altman IL, Mandy PJ, Gard PR. Changing status in health care: community and hospital pharmacists’ perceptions of pharmacy practice. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2018; 27:249-255. [DOI: 10.1111/ijpp.12505] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 11/20/2018] [Indexed: 12/22/2022]
Abstract
Abstract
Objectives
This study aimed to explore experienced community and hospital pharmacists’ perceptions of how their pharmacy practice and status in health care are affected by others’ views of them.
Methods
A qualitative collective case study was conducted. The primary data were 20 in-depth semistructured interviews of community and hospital pharmacists in England that were audio-recorded, transcribed and analysed thematically.
Key findings
Thematic analysis of the data identified four themes: (1) ambiguities about being professionals, (2) internal divisions, (3) medicines experts and (4) shopkeepers as healthcare providers.
Conclusions
Pharmacists want to be recognised as medicines experts in health care. They are aware that their status is assessed by the public based on their practice, which is dispensing of medicines, and that the public’s image of all pharmacists is that of ‘a typical community pharmacist’ working in a retail shop while having little experience of pharmacists in other healthcare settings. Pharmacists consider that the public does not view them as registered healthcare professionals. They mainly associate being registered professionals with being controlled from afar by their professional regulator, instead of utilising this as an enabling strategy to support their reprofessionalisation efforts. Pharmacists remain the hidden healthcare profession and need to act in practice as healthcare professionals, so the public is aware of their place and contributions in health care to maintain or enhance their status. Internal divisions between community and hospital pharmacists appear to be due to differences in practice, knowledge and aspirations having the potential to adversely affect the pharmacy profession’s status.
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Affiliation(s)
- Iben L Altman
- Sussex Community NHS Foundation Trust, Brighton General Hospital, Brighton, UK
| | | | - Paul R Gard
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
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Gunn V, Muntaner C, Villeneuve M, Chung H, Gea-Sanchez M. Nursing professionalization and welfare state policies: A critical review of structural factors influencing the development of nursing and the nursing workforce. Nurs Inq 2018; 26:e12263. [PMID: 30175496 DOI: 10.1111/nin.12263] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 08/02/2018] [Accepted: 08/04/2018] [Indexed: 11/30/2022]
Abstract
Nursing professionalization is both ongoing and global, being significant not only for the nursing workforce but also for patients and healthcare systems. For this reason, it is important to have an in-depth understanding of this process and the factors that could affect it. This literature review utilizes a welfare state approach to examine macrolevel structural determinants of nursing professionalization, addressing a previously identified gap in this literature, and synthesizes research on the relevance of studying nursing professionalization. The use of a welfare state framework facilitates the understanding that the wider social, economic, and political system exercises significant power over the distribution of resources in a society, providing a glimpse into the complex politics of health and health care. The findings shed light on structural factors outside of nursing, such as country-level education, health, labor market, and gender policies that could impact the process of professionalization and thus could be utilized to strengthen nursing through facilitating increased professionalization levels. Addressing gender inequalities and other structural determinants of nursing professionalization could contribute to achieving health equity and could benefit health systems through enhanced availability, skill-level, and sustainability of nursing human resources, improved and efficient access to care, improved patient outcomes, and cost savings.
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Affiliation(s)
- Virginia Gunn
- Lawrence S. Bloomberg Faculty of Nursing & Global Health Collaborative Specialization, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Carles Muntaner
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Michael Villeneuve
- Governance and Strategy, Canadian Nurses Association, Ottawa, Ontario, Canada
| | - Haejoo Chung
- School of Health Policy and Management, College of Health Sciences, Korea University, Seoul, South Korea
| | - Montserrat Gea-Sanchez
- GESEC Group, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,GRECS Group, Biomedical Research Institute of Lleida, Lleida, Spain
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Givati A, Markham C, Street K. The bargaining of professionalism in emergency care practice: NHS paramedics and higher education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2018; 23:353-369. [PMID: 29127541 PMCID: PMC5882635 DOI: 10.1007/s10459-017-9802-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 11/01/2017] [Indexed: 06/07/2023]
Abstract
Over the past 2 decades, as part of reforms to the National Health Service and with it organizational changes to ambulance work in the UK, paramedic education has undergone a process of academisation and a shift from in-house, apprenticeship weeks-long occupational training, to university-based undergraduate programs. While the professional regulation and standardization of Allied Health Professionals' education in high-income countries has captured scholarly attention, the study of paramedic practice is still in its infancy and there is a need to explore its evolvement in relation to the fluid societal-political circumstances affecting its provision and demand. Based on interviews with front-line paramedics, paramedic educators and paramedic science students in the South of England, this article examines how the reforms to paramedic education have impacted the professionalization of paramedics and their discourse of professionalism. Framed within to the 'new' sociology of professions, the case of British paramedics demonstrates the complex nature of the relationship between the university and professional practice. It appears that universities, the providers of paramedic education, are caught between two opposing discourses of professionalism: on the one hand, that of providing a platform for students' socialization and engagement with professionalism 'from within' practice which is based on students' common goals and mutual experiences, and, on the other hand, serving as a conduit for managerial/organizational strategies of professionalism which appear to undermine the role of university socialization.
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Affiliation(s)
- Assaf Givati
- School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK.
| | - Chris Markham
- School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK
| | - Ken Street
- School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK
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Myburgh C. A qualitative exploration of key informant perspectives regarding the nature and impact of contemporary legislation on professional development: a grounded theory study of chiropractic in Denmark. J Manipulative Physiol Ther 2014; 37:383-95. [PMID: 25092554 DOI: 10.1016/j.jmpt.2014.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 12/19/2013] [Accepted: 01/15/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to construct a substantive framework of the manner in which the Danish government interacts with the Danish chiropractic profession and influences professional practice. METHODS An exploratory, qualitative study was performed using a substantive grounded theory (GT) approach. Unstructured, face-to-face, individual interviews were conducted during the years 2012 and 2013 and thematically analyzed. Six people were interviewed for this study including a gatekeeper and witness to legislative history, a previous chiropractic political representative and witness to legislative history, a previous Department of Health negotiator and previous administrator of chiropractic affairs and witness to legislative history, a current administrator of chiropractic affairs, an active chiropractic political representative and witness to legislative history, and a chief negotiator for Danish Regional Health Care Services. RESULTS Open and axial coding yielded 2 themes centering on licensing chiropractors in Denmark and the resultant developmental issues encountered. Through further selective coding, the GT core construct, "chiropractic practice in the Danish heath care system" emerged. The GT highlights the tension between the strategic political importance of legislation and the restrictive nature of the overly specific act currently regulating chiropractic practice. Moreover, the GT also revealed the perceived negative effect that the National Board of Health may exert on clinical practice due to its conservative interpretation of the act. CONCLUSIONS The Danish government is perceived to act as a countervailing power related to chiropractic practice. The derived substantive GT suggests that the Danish government's dualistic action relative to the Danish chiropractic community may inhibit the spontaneous evolution of contemporary Danish chiropractic practice. Although historically narrow legislation may limit chiropractic practice, conservative interpretations by the Danish National Board of Health may also play an important role.
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Affiliation(s)
- Corrie Myburgh
- Associate Professor, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Project consultant, Nordic Institute for Chiropractic and Clinical Biomechanics, Odense, Denmark.
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Timmons S, Nairn S. The development of the specialism of emergency medicine: media and cultural influences. Health (London) 2014; 19:3-16. [PMID: 24821928 DOI: 10.1177/1363459314530737] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this article we analyse, via a critical review of the literature, the development of a relatively new medical specialism in the United Kingdom, that of emergency medicine. Despite the high media profile of emergency care, it is a low-status specialism within UK medicine. The creation of a specialist College in 2008 means that, symbolically, recognition as a full specialism has now been achieved. In this article, we will show, using a sociology of professions approach, how emergency medicine defined itself as a specialism, and sought to carve out a distinctive jurisdiction. While, in the context of the UK National Health Service, the state was clearly an important factor in the development of this profession, we wish to develop the analysis further than is usual in the sociology of professions. We will analyse the wider cultural context for the development of this specialism, which has benefited from its high profile in the media, through both fictional and documentary sources.
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Affiliation(s)
- Stephen Timmons
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Stuart Nairn
- School of Health Sciences, University of Nottingham, Royal Derby Hospital, Derby, UK
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Smith DM, Smith JM, Baxter GD, Spronken-Smith R. The drive for legitimation of massage therapy in new zealand. Int J Ther Massage Bodywork 2012; 5:21-9. [PMID: 23429758 PMCID: PMC3528188 DOI: 10.3822/ijtmb.v5i4.196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Donna M Smith
- Higher Education Development Centre, University of Otago, Dunedin, New Zealand ; New Zealand Massage Therapy Research Centre, Southern Institute of Technology, Invercargill, New Zealand
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