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专业角色认同:跨组织边界的医学协作核心

Professional Role Identity: At the Heart of Medical Collaboration Across Organisational Boundaries.

作者信息

Touati Nassera, Rodríguez Charo, Paquette Marie-Andrée, Maillet Lara, Denis Jean-Louis

机构信息

École Nationale d'Administration Publique (ENAP), Québec, CA.

Department of Family Medicine, Faculty of Medicine, McGill University, Quebec, CA.

出版信息

Int J Integr Care. 2019 Apr 2;19(2):1. doi: 10.5334/ijic.4184.

Abstract

PURPOSE

The purpose of this paper was to help answer two persistent calls in the literature: the first asks to strengthen the understanding of medical collaboration across levels of healthcare delivery; the second one requests paying more attention to the individual experience of different forms of professional work. Accordingly, the study was guided by the following research question: How do family physicians and specialists working at different levels of healthcare delivery enact their professional identity when interacting in their situated clinical contexts?

METHODOLOGY

This was a multiple interpretive case study in which, based on Giddens' ideas, professional identity was viewed as a dynamic structural element of social life recursively related to professionals' collaborative actions through sensemaking processes. The study involved 57 participants. Face-to-face individual semi-structured interviews and organizational documents were the main sources of data. Deductive-inductive thematic analysis was adopted as strategy for data analysis.

FINDINGS

Three prevailing physicians' identity roles were elicited: medical expert, care coordinator, and team member. These professional identities, not mutually exclusive, were instantiated in three specific modalities of collaboration: quasi-inexistent, restrained, and extended. The entanglement of a particular identity role and a specific collaborative practice became meaningful through a complex net of organizational and institutional features, and patients' nosological profiles.

摘要

目的

本文旨在回应文献中两个长期存在的呼吁:第一个呼吁是加强对医疗服务各层面医疗协作的理解;第二个呼吁是更多关注不同形式专业工作的个人体验。因此,本研究受以下研究问题的指引:在不同医疗服务层面工作的家庭医生和专科医生在其所处临床环境中互动时,如何展现其职业身份?

方法

这是一项多重解释性案例研究,基于吉登斯的观点,职业身份被视为社会生活的动态结构要素,通过意义建构过程与专业人员的协作行动递归相关。该研究涉及57名参与者。面对面的个人半结构化访谈和组织文件是主要数据来源。采用演绎 - 归纳主题分析作为数据分析策略。

结果

引出了三种主要的医生身份角色:医学专家、护理协调员和团队成员。这些职业身份并非相互排斥,而是在三种特定的协作模式中得以体现:准不存在模式、受限模式和扩展模式。特定身份角色与特定协作实践的交织,通过组织和制度特征以及患者病种概况的复杂网络变得具有意义。

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