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Discursively framing physicians as leaders: Institutional work to reconfigure medical professionalism.
Soc Sci Med. 2018 09; 212:68-75.SS

Abstract

Physicians are well-known for safeguarding medical professionalism by performing institutional work in their daily practices. However, this study shows how opinion-making physicians in strategic arenas (i.e. national professional bodies, conferences and high-impact journals) advocate to reform medical professionalism by discursively framing physicians as leaders. The aim of this article is to critically investigate the use of leadership discourse by these opinion-making physicians. By performing a discursive analysis of key documents produced in these strategic arenas and additional observations of national conferences, this article investigates how leadership discourse is used and to what purpose. The following key uses of medical leadership discourses were identified: (1) regaining the lead in medical professionalism, (2) disrupting 'old' professional values, and (3) constructing the 'modern' physician. The analysis reveals that physicians as 'leaders' are expected to become team-players that work across disciplinary and organizational boundaries to improve the quality and affordability of care. In comparison to management that is negatively associated with NPM reform, leadership discourse is linked to positive institutional change, such as decentralization and integration of care. Yet, it is unclear to what extent leadership discourses are actually incorporated on the work floor and to what effect. Future studies could therefore investigate the uptake of leadership discourses by rank and file physicians to investigate whether leadership discourses are used in restricting or empowering ways.

Authors+Show Affiliations

Erasmus School of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, Rotterdam, 3000 DR, The Netherlands. Electronic address: berghout@eshpm.eur.nl.Erasmus School of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, Rotterdam, 3000 DR, The Netherlands. Electronic address: oldenhof@eshpm.eur.nl.Erasmus School of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, Rotterdam, 3000 DR, The Netherlands. Electronic address: fabbricotti@eshpm.eur.nl.Erasmus School of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, Rotterdam, 3000 DR, The Netherlands. Electronic address: hilders@eshpm.eur.nl.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30014983

Citation

Berghout, Mathilde A., et al. "Discursively Framing Physicians as Leaders: Institutional Work to Reconfigure Medical Professionalism." Social Science & Medicine (1982), vol. 212, 2018, pp. 68-75.
Berghout MA, Oldenhof L, Fabbricotti IN, et al. Discursively framing physicians as leaders: Institutional work to reconfigure medical professionalism. Soc Sci Med. 2018;212:68-75.
Berghout, M. A., Oldenhof, L., Fabbricotti, I. N., & Hilders, C. G. J. M. (2018). Discursively framing physicians as leaders: Institutional work to reconfigure medical professionalism. Social Science & Medicine (1982), 212, 68-75. https://doi.org/10.1016/j.socscimed.2018.07.013
Berghout MA, et al. Discursively Framing Physicians as Leaders: Institutional Work to Reconfigure Medical Professionalism. Soc Sci Med. 2018;212:68-75. PubMed PMID: 30014983.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Discursively framing physicians as leaders: Institutional work to reconfigure medical professionalism. AU - Berghout,Mathilde A, AU - Oldenhof,Lieke, AU - Fabbricotti,Isabelle N, AU - Hilders,Carina G J M, Y1 - 2018/07/07/ PY - 2017/11/29/received PY - 2018/07/03/revised PY - 2018/07/06/accepted PY - 2018/7/18/pubmed PY - 2019/3/20/medline PY - 2018/7/18/entrez KW - Discourse KW - Institutional work KW - Medical leadership KW - Medical professionalism KW - Netherlands KW - Physicians SP - 68 EP - 75 JF - Social science & medicine (1982) JO - Soc Sci Med VL - 212 N2 - Physicians are well-known for safeguarding medical professionalism by performing institutional work in their daily practices. However, this study shows how opinion-making physicians in strategic arenas (i.e. national professional bodies, conferences and high-impact journals) advocate to reform medical professionalism by discursively framing physicians as leaders. The aim of this article is to critically investigate the use of leadership discourse by these opinion-making physicians. By performing a discursive analysis of key documents produced in these strategic arenas and additional observations of national conferences, this article investigates how leadership discourse is used and to what purpose. The following key uses of medical leadership discourses were identified: (1) regaining the lead in medical professionalism, (2) disrupting 'old' professional values, and (3) constructing the 'modern' physician. The analysis reveals that physicians as 'leaders' are expected to become team-players that work across disciplinary and organizational boundaries to improve the quality and affordability of care. In comparison to management that is negatively associated with NPM reform, leadership discourse is linked to positive institutional change, such as decentralization and integration of care. Yet, it is unclear to what extent leadership discourses are actually incorporated on the work floor and to what effect. Future studies could therefore investigate the uptake of leadership discourses by rank and file physicians to investigate whether leadership discourses are used in restricting or empowering ways. SN - 1873-5347 UR - https://www.unboundmedicine.com/medline/citation/30014983/Discursively_framing_physicians_as_leaders:_Institutional_work_to_reconfigure_medical_professionalism_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0277-9536(18)30369-1 DB - PRIME DP - Unbound Medicine ER -
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