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Professional projects and institutional change in healthcare: The case of American dentistry

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  • Kitchener, Martin
  • Mertz, Elizabeth

Abstract

This paper combines resources from the organization studies and sociology literatures to advance understanding of institutional change processes in healthcare that emerge from the professionalization projects of occupations. Conceptually, we introduce a model that combines the ‘archetype’ approach to analyzing structural change with a framework for analyzing the agency of emergent professions. We then employ the model to frame a historical case analysis (1972–2009) of the highly contested process by which the occupation of dental hygiene in the US fought to introduce a new organizational form, the alternative practice hygiene (APH) archetype. This archetype challenges the traditional model (the dentist’s office archetype) that is supported by the dominant dentistry profession. Our analysis contributes two main sets of empirical findings. First, we present a systematic comparison of the APH and Dentist’s Office archetypes in terms of their belief systems, formal structures, agents, and policy implications (e.g., access to services). Second, we provide an account of the agency of dental hygienists’ attempts to secure the APH model as part of their professionalization project.

Suggested Citation

  • 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.
    • Handle: RePEc:eee:socmed:v:74:y:2012:i:3:p:372-380
    DOI: 10.1016/j.socscimed.2010.10.005
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    References listed on IDEAS

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    1. Adams, Tracey L., 2004. "Inter-professional conflict and professionalization: dentistry and dental hygiene in Ontario," Social Science & Medicine, Elsevier, vol. 58(11), pages 2243-2252, June.
    2. Salhani, Daniel & Coulter, Ian, 2009. "The politics of interprofessional working and the struggle for professional autonomy in nursing," Social Science & Medicine, Elsevier, vol. 68(7), pages 1221-1228, April.
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    Cited by:

    1. Ong, Bie Nio & Morden, Andrew & Brooks, Lauren & Porcheret, Mark & Edwards, John J. & Sanders, Tom & Jinks, Clare & Dziedzic, Krysia, 2014. "Changing policy and practice: Making sense of national guidelines for osteoarthritis," Social Science & Medicine, Elsevier, vol. 106(C), pages 101-109.
    2. 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.
    3. Currie, Graeme & Dingwall, Robert & Kitchener, Martin & Waring, Justin, 2012. "Let’s dance: Organization studies, medical sociology and health policy," Social Science & Medicine, Elsevier, vol. 74(3), pages 273-280.

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