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Rethinking professional governance

Rethinking professional governance: International directions in healthcare

Ellen Kuhlmann
Mike Saks
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    Rethinking professional governance
    Book Description:

    This original and innovative book opens up new perspectives in health policy debate, examining the emerging international trends in the governance of health professions and the significance of national contexts for the changing health workforce. In bringing together research from a wide range of continental European countries as well as the United Kingdom, Canada and Australia, the contributors highlight different arenas of governance, as well as the various players involved in the policy process. They expand the public debate on professional governance - hitherto mainly limited to medical self-regulation - to encompass a broad span of health care providers, from nurses and midwives to alternative therapists and health support workers. The book provides new data and geopolitical perspectives in the debate over how to govern health care. It helps to better understand both the enabling conditions for, and the barriers to, making professionals more accountable to the interests of a changing public. This book will be a valuable resource for students at an undergraduate and postgraduate level, particularly for health programmes, sociology of professions and comparative health policy, but also for academics, researchers and managers working in health care.

    eISBN: 978-1-84742-340-5
    Subjects: Health Sciences

Table of Contents

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  1. INTRODUCTION Changing patterns of health professional governance
    (pp. 1-12)
    Ellen Kuhlmann and Mike Saks

    Across many countries professional governance is under the spotlight of health policy makers and subject to public debate. this book provides new data and geopolitical perspectives in the debate over how to govern healthcare. It sets out to highlight new international directions and the significance of national contexts for the changing health workforce based on complex sets of cultural and institutional regulatory patterns. one central goal of the new health policies that are emerging is accountability and control of professionals, which in turn calls for tighter regulation and new forms of professional development. However, the dominant models of health reform...

  2. Part One: New directions in the governance of healthcare

    • ONE Protecting patients: international trends in medical governance
      (pp. 15-28)
      Judith Allsop and Kathryn Jones

      The regulation of professional work in healthcare has become tighter as states aim to provide cost–effective, high–quality health services for citizens. This is particularly true in the case of medical professionals whose clinical decisions generate substantial healthcare spending. In consequence, a variety of institutions, rules and regulations have developed across countries that aim to control and shape the decision making of physicians. Although the aims are similar, the mechanisms differ as they are shaped by history and culture. The extent of professional self-government, the range of functions that come within the scope of self–governance and the institutional...

    • TWO Global markets and national pathways of medical re-regulation
      (pp. 29-44)
      Viola Burau and Karsten Vrangbæk

      The market enjoys global currency. In healthcare, the market has been central to reforms across many countries, as is evident from the prominence of managed competition. At the same time, experiences with markets in healthcare suggest that the reforms not only have included considerable re–regulation, but also that such re–regulation remains firmly embedded in country–specific contexts. The present chapter aims to open the black box of ‘global markets’ by identifying country–specific pathways of re–regulation in relation to markets in healthcare in a cross–country comparative perspective. The chapter does so by analysing sector–specific institutional...

    • THREE Governing beyond markets and managerialism: professions as mediators
      (pp. 45-60)
      Ellen Kuhlmann

      Across countries healthcare systems respond to new needs and demands with the introduction of marketisation and new public management regimes, including a number of performance indicators and benchmarks operating at a meso level of professional governance as well as improved user participation both in the policy process and clinical decision making. these strategies bring about greater control of providers and enhance transformations towards more demand–led services. There is still much controversy, however, especially over the benefits of professional self–regulation and the options of new governance to shift the balance of power away from the medical profession (davies,2006;Gabe et...

    • FIVE Professionalism meets entrepreneurialism and managerialism
      (pp. 77-92)
      Rosalie A. Boyce

      The shift in recent decades towards free–market economics, competition and ‘small government’ policies in Western liberal democracies has led to an ideological and political climate that has favoured a suite of reformist activity characterised in the literature as ‘new public management’ (Pollitt, 1990). New public management (NPM) is not simply a set of new management practices but a form of deep restructuring drawing together the principles of managerialism and marketisation into context–specific priorities for change in the public sector. Underpinning reform directions is the belief in the superiority of private sector management principles, organisational forms and market–based...

  3. Part Two: Drivers and barriers to integration:: health policies and professional development

    • SIX Collaborative care and professional boundaries: maternity care in Canada
      (pp. 95-110)
      Ivy Lynn Bourgeault and Elizabeth Darling

      There is a growing interest in collaborative models of healthcare — or what has alternatively been referred to as ‘interprofessionalism’ — as a means to address a range of concerns within healthcare systems, not the least of which are shortages of healthcare professionals (DH,2000;Institute of Medicine,2003;Health council of Canada, 2005) . Collaborative models of practice are viewed as an important tool for increasing the flexibility of the health labour force. In a recently released report on health human resources in Canada it is argued that ‘bringing together physicians and other health professionals to work in teams can be an important part of...

    • SEVEN Interprofessional relationships: doctors and nurses in Slovenia
      (pp. 111-126)
      Majda Pahor

      Collaboration of different professional groups is an important dimension of the quality and efficiency of healthcare services that directly impact on patient outcomes. However, the relationships between the two largest professional groups in healthcare — nurses and doctors — have been traditionally hierarchical. In its classical version, professionalism is characterised by strategies of social exclusion, closure and demarcation. In particular, medical ‘tribalism’ and the interprofessional relationships between doctors and nurses have always been an area of conflict, although these relationships are also subject to general trends of inclusion and participation. Changes in social context — such as democratisation, women’s emancipation and higher levels...

    • EIGHT Educating generalists: flexibility and identity in auxiliary nursing in Finland
      (pp. 127-140)
      Sirpa Wrede

      The discourse of professionalism, consisting of a set of normative values and identities, is currently spreading to new occupational and organisational contexts (Evetts,2003). It is a mechanism for the control of work and workers, mobilised by employers as a form of self–discipline for employees (Fournier,1999). The discourse of professionalism is employed in organisations as an ideology of occupational powers to divide work within and between occupations (Fournier, 2000). This chapter examines the dynamics of this discourse in the context of changes in the welfare state, taking both its disciplinary and enabling aspects into account. The constitution of a normative...

    • NINE Culture matters: integration of folk medicine into healthcare in Russia
      (pp. 141-154)
      Elena Iarskaia-Smirnova and Pavel Romanov

      The integration of complementary and alternative medicine (CAM) into orthodox healthcare systems and the professionalisation of these services are global phenomena. These developments place new challenges on both the governance of healthcare and the dominance of orthodox medicine (Saks, 2006). However, national governments and professional bodies respond in different ways to these new demands. Integration and professionalisation are driven by various forces and the success of new professional projects is uneven. This chapter explores the processes of integration of CAM into the official healthcare system in Russia. It places the demand for, and supply of, ‘folk medicine’ in the context...

    • TEN Policy dynamics: marginal groups in the healthcare division of labour in the UK
      (pp. 155-170)
      Mike Saks

      This chapter analyses from a regulatory viewpoint the policy dynamics of health support work and complementary and alternative medicine (CAM) in the UK, as examples of marginal groups in the healthcare division of labour. Typically, in the past, social scientific studies of professionalisation have focused on fully fledged professions, at the expense of occupational groups with a less developed professional structure — not least in the area of health. Theoretically, this applies to traditional trait and functionalist approaches more positively oriented towards professions as much as to the more critical recent neo–Weberian orthodoxy based on the interests of such privileged...

  4. Part Three: Workforce dynamics:: gender, migration and mobility

    • ELEVEN Free riders in a fluid system: gender traps in agency nursing in Norway
      (pp. 173-186)
      Rannveig Dahle and Gry Skogheim

      In the 1980s the Norwegian public sector was subject to substantive modernisation. As in most Western countries the principles of new public management (NPM) were introduced to overcome rigid bureaucratic and inefficient systems and improve flexibility. The new managerial regimes paved the way for different professional working patterns. Deregulation and a radical decentralisation of employment practices are part of the restructuring process. Politicians and managers, in line with researchers, perceived the health workforce to be in need of flexibility and called for more outsourcing of functions and increased use of temporary staff. As a consequence, the use of contract employees...

    • TWELVE From health to tourism: being mobile in the wellness sector in Hungary
      (pp. 187-200)
      Katalin Formadi

      With people’s growing desire to be healthy, fit and environmentally sensitive, wellness is becoming increasingly popular as a concept. This constitutes a motivation for a certain type of tourism:health and wellness tourism (HWT). In Hungary, spas represent an important element of this sector, which has been rapidly expanding to serve a (Western) European market. Professionally organised spas are based on trans–sectoral employment and — ideally — employees have experience in both the health and tourism sectors and have tourism and management competencies. No standardised occupational profile exists in the sector, however, and there is a lack of data on employees’ professional...

    • THIRTEEN Migration and occupational integration: foreign health professionals in Portugal
      (pp. 201-216)
      Joana Sousa Ribeiro

      Cross–border healthcare provision is being established as one of the policies of the European union (EU). the free movement of goods, services and people — both patients and healthcare professionals — reflects the establishment of a single European market. The migration of healthcare workers is increasingly relevant in the provision of healthcare (Buchan, 2006). Although the EU aims to promote mobility, a number of structural and cultural barriers persist that impede the integration of foreign health professionals.

      This chapter explores the obstacles to the mobility of healthcare professionals that exist in Portugal. the focus is on the existence of both formal...

    • FOURTEEN Professionals in transition: physicians’ careers, migration and gender in Lithuania
      (pp. 217-230)
      Elianne Riska and Aurelija Novelskaite

      During recent decades, migration has become one of the most significant social forces influencing the labour market, and ‘skilled migration is rapidly becoming one of the major components of migration streams in many parts of the world’ (Raghuram,2004, p 163;see also Guibernau and Rex, 1997). There are, however, few studies that focus on the migration of high–status professionals — for example, lawyers, scientists, physicians. The dearth of research on this group might be related to the assumed unproblematic character of this kind of migration. Migration of highly skilled professionals is welcomed and has been facilitated and encouraged by governments in...

  5. CONCLUSION Health policy and workforce dynamics: the future
    (pp. 231-244)
    Ellen Kuhlmann and Mike Saks

    This book has attempted to open up new perspectives in the topical health policy debate on professional governance that has become increasingly widely discussed in academic, policy and practice contexts. In this respect, we have argued for the need to link public policy and governance in healthcare to the study of professions. It has been our intention to add greater sophistication to, and provide more empirical evidence on, the complex ‘colonising’ debate on changing models of governance — currently biased towards both Anglo–American approaches and medical governance — instead of offering another ‘quick fix’ to a health policy debate overshadowed by...