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Discursively framing physicians as leaders: Institutional work to reconfigure medical professionalism

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  • Berghout, Mathilde A.
  • Oldenhof, Lieke
  • Fabbricotti, Isabelle N.
  • Hilders, Carina G.J.M.

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.

Suggested Citation

  • Berghout, Mathilde A. & Oldenhof, Lieke & Fabbricotti, Isabelle N. & Hilders, Carina G.J.M., 2018. "Discursively framing physicians as leaders: Institutional work to reconfigure medical professionalism," Social Science & Medicine, Elsevier, vol. 212(C), pages 68-75.
    • Handle: RePEc:eee:socmed:v:212:y:2018:i:c:p:68-75
    DOI: 10.1016/j.socscimed.2018.07.013
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    References listed on IDEAS

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    1. Lockett, Andy & Currie, Graeme & Waring, Justin & Finn, Rachael & Martin, Graham, 2012. "The role of institutional entrepreneurs in reforming healthcare," Social Science & Medicine, Elsevier, vol. 74(3), pages 356-363.
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    3. Kitchener, Martin & Mertz, Elizabeth, 2012. "Professional projects and institutional change in healthcare: The case of American dentistry," Social Science & Medicine, Elsevier, vol. 74(3), pages 372-380.
    4. M. Noordegraaf & M. M. E. Schneider & E. L. J. Van Rensen & J. P. P. E. F. Boselie, 2016. "Cultural Complementarity: Reshaping professional and organizational logics in developing frontline medical leadership," Public Management Review, Taylor & Francis Journals, vol. 18(8), pages 1111-1137, September.
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    1. Reindersma, Thomas & Fabbricotti, Isabelle & Ahaus, Kees & Bangma, Chris & Sülz, Sandra, 2024. "Inciting maintenance: Tiered institutional work during value-based payment reform in oncology," Social Science & Medicine, Elsevier, vol. 347(C).
    2. Yuliya Snihur & Llewellyn D. W. Thomas & Raghu Garud & Nelson Phillips, 2022. "Entrepreneurial Framing: A Literature Review and Future Research Directions," Entrepreneurship Theory and Practice, , vol. 46(3), pages 578-606, May.
    3. Celeste Campos-Castillo & Noelle Chesley & Onur Asan, 2022. "Professionals as Change Agents or Instruments of Reproduction? Medical Residents’ Reasoning for Not Sharing the Electronic Health Record Screen with Patients," Future Internet, MDPI, vol. 14(12), pages 1-14, December.
    4. Merlijn C P van de Riet & Mathilde A Berghout & Martina Buljac-Samardžić & Job van Exel & Carina G J M Hilders, 2019. "What makes an ideal hospital-based medical leader? Three views of healthcare professionals and managers: A case study," PLOS ONE, Public Library of Science, vol. 14(6), pages 1-18, June.

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