Alliance Manchester Business School, Institute for Health Policy and Organisation, Manchester, UK.
Sheffield Methods Institute, University of Sheffield, Sheffield, UK.
Sociol Health Illn. 2021 Jan;43(1):149-166. doi: 10.1111/1467-9566.13210. Epub 2020 Oct 28.
Internationally, there has been substantial growth in temporary working, including in the medical profession where temporary doctors are known as locums. There is little research into the implications of temporary work in health care. In this paper, we draw upon theories concerning the sociology of the medical profession to examine the implications of locum working for the medical profession, healthcare organisations and patient safety. We focus particularly on the role of organisations in professional governance and the positioning of locums as peripheral to or outside the organisation, and the influence of intergroup relationships (in this case between permanent and locum doctors) on professional identity. Qualitative semi-structured interviews were conducted between 2015 and 2017 in England with 79 participants including locum doctors, locum agency staff, and representatives of healthcare organisations who use locums. An abductive approach to analysis combined inductive coding with deductive, theory-driven interpretation. Our findings suggest that locums were perceived to be inferior to permanently employed doctors in terms of quality, competency and safety and were often stigmatised, marginalised and excluded. The treatment of locums may have negative implications for collegiality, professional identity, group relations, team functioning and the way organisations deploy and treat locums may have important consequences for patient safety.
在国际上，临时工作的数量有了实质性的增长，包括在医学领域，临时医生被称为“临时工”。关于临时工作对医疗保健的影响的研究很少。在本文中，我们借鉴了有关医学职业社会学的理论，考察了临时工工作对医学职业、医疗保健组织和患者安全的影响。我们特别关注组织在专业治理中的作用，以及临时工在组织中的边缘化或外部地位，以及群体间关系（在这种情况下是永久医生和临时工医生之间的关系）对职业认同的影响。2015 年至 2017 年，我们在英格兰对 79 名参与者进行了半结构化的定性访谈，参与者包括临时工医生、临时工机构工作人员以及使用临时工的医疗保健组织的代表。分析采用了归纳编码与演绎、理论驱动解释相结合的回溯方法。我们的研究结果表明，临时工在质量、能力和安全性方面被认为不如长期受雇的医生，而且往往受到污名化、边缘化和排斥。对临时工的待遇可能对同事关系、职业认同、群体关系、团队功能产生负面影响，而组织部署和对待临时工的方式可能对患者安全产生重要影响。
