Image and identity negotiation

Image and identity negotiation: professionalism across institutional settings
drs. R. Oomkens, i.c.w. prof. dr. T. Knijn, prof. dr. F. Miedema en prof. dr. Ido de Haan

The medical profession appears to be – like many other professions – transforming from an autonomous highly discretional and high status profession into a managed, controlled and monitored profession. Arguments for the transformation are cost reductions, fraud, declining professional ethics and an overall distrust in professional efficiency and effectiveness. However, the tendency to legitimize and account as medical professionals for its performance to external actors vary across institutional and national settings. Due to the different characteristics of national healthcare systems, and the different position the medical profession takes in the healthcare system in relation to other (non-professional) actors, transitions in healthcare take different shapes. Consequently, medical professions across European countries probably face dissimilar challenges. 

Not only are challenges to traditional professionalism expected to vary across institutional contexts, so is the way medical professions adapt to these possible transitions and negotiate their image and identity. This project aims to study in what way medical professions act as institutional ‘agents’ or institutional ‘entrepreneurs’  in legitimating particular modes of service delivery and work organization in various institutional settings. Professions potentially derive power from the institutionalized healthcare governance structures to mediate the transitions in healthcare. High levels of corporate autonomy (i.e. control of the profession over admission into it, work standards and quality criteria for professionals’ work) reproduce existing interactions between professions and other actors in the field and influence the way professional images and identities can be negotiated. As institutionalized governance structures seem to fuel the reproduction of existing policy paths, the reactions to experienced challenges may be path-dependent and may therefore vary between medical professions across European countries. We assume that the way professionals deal with the new demands that are inspired with new public management discourse varies according to two characteristics of the national healthcare systems; 1) the statist organization of the health care management, which distinguishes the UK and France from the Netherlands and 2) the corporative autonomy of the medical professions, which distinguishes France and the Netherlands from the UK.

So far, the process by which the medical profession in different countries negotiate – with themselves and with others – what identities they craft as new images of professionalism are assumed, has received little empirical attention. Through cross-country document analyses and interviews with representatives of professional medical associations and medical school in the Netherlands, France and the UK, the proposed project offers a systematic and comparative investigation of how professional associations across institutional settings revise and implement new images and identities of professionalism. The aim of the study is to understand what the optimal balance is between professional discretion, public confidence in the profession and effective and efficient management of the profession could look like given the various institutional settings.