Healthcare Governance, Erasmus School of Health Policy & Management, Erasmus Universiteit Rotterdam, Rotterdam, Netherlands.
Sociol Health Illn. 2023 Sep;45(7):1560-1577. doi: 10.1111/1467-9566.13654. Epub 2023 May 11.
Task reallocation is increasingly foregrounded as a promising solution for capacity problems. Numerous studies show, however, that task reallocation between medical professionals is a highly contested issue and difficult to institutionalise. Conflicts are omnipresent and often arise from 'intraprofessional competition': Zero-sum games between professionals from different disciplinary backgrounds where one party's gains require another party's losses. In this article, we build on calls to enrich the sociology of professions with new concepts and theories. We analyse a case of task reallocation between medical professionals in a nursing home using concepts from empirical ethics and valuation studies. We argue that modes of good care offer a valuable framework for analysing the reorganisation of professional work because they provide an empirically grounded and fine-grained conceptual toolkit for understanding the dynamics among professionals and between professionals and managers. Enactment of different modes of good care inspires innovation in service provision but at the same time creates new tensions between those involved. We show how, in times of scarcity, a dynamic emerges between professionals attempting to stave off and reallocate work, thereby restricting their professional domains.
任务重新分配作为解决能力问题的一种有前途的解决方案，越来越受到关注。然而，大量研究表明，医疗专业人员之间的任务重新分配是一个极具争议性的问题，并且难以制度化。冲突无处不在，往往源于“专业内部竞争”：来自不同学科背景的专业人员之间的零和博弈，一方的收益需要另一方的损失。在本文中，我们呼吁用新概念和理论丰富专业社会学。我们使用来自经验伦理和评估研究的概念来分析养老院中医疗专业人员之间的任务重新分配案例。我们认为，良好护理模式为分析专业工作的重组提供了一个有价值的框架，因为它们为理解专业人员之间以及专业人员与管理人员之间的动态关系提供了一个基于经验和精细的概念工具包。不同良好护理模式的实施为服务提供带来了创新，但同时也在相关人员之间产生了新的紧张关系。我们展示了在资源短缺时期，专业人员试图阻止和重新分配工作时会出现怎样的动态，从而限制了他们的专业领域。
