Administrative neoprofessions in health care: The case of organizational development professionals

Healthcare is highly institutionalized with taken-for-granted norms, values, and beliefs on how to do things and who should do them (Reay et al., 2017). In addition, healthcare professionals have strong adherence to “their” professional logics (Gadolin, 2018). Together, this creates circumstances where different identities become “locked” to each other (Andersson and Gadolin, 2020). Consequently, healthcare organizations have an inherent resistance towards new logics and neoprofessions, but they are also the organizations that may gain the most from the existence of such roles. However, to understand the way in which different logics interrelate in healthcare, it is essential to fully consider the complex context of healthcare, with all different and potentially competing institutional logics in play, including both “traditional” expertise (e.g. physicians, nurses) and neoprofessional claims of expertise (e.g. ODPs and management professionals).
Noordegraaf (2011: 1350) criticizes theorizing on professional service organizations for its inability to bridge different perspectives: “They focus on rank and file professionals, such as medical doctors or teachers, and ignore managers and organizational contexts; or they focus on managers, markets and organizational change, and pay less attention to work floors. ... The complexities of organizing professional services and the intricacies of linkages between societal, organizational and professional fields are easily missed.” By highlighting the everyday work of neoprofessionals, this research project aims to increase the understanding of how institutional logics are enacted in everyday work in health care
organizations. This is the fundamental operative level where more overarching efforts at changing management and control in healthcare organizations eventually will have to materialize.
Specifically, we ask:
1. How do ODPs receive, reinterpret, reconcile, and potentially reject different conflicting institutional logics?
2. How are these efforts received, reinterpreted, and potentially rejected by other professionals such as physicians, nurses, digitalization experts (and so on)?
3. What are the effects of such enactments on professional work and professional autonomy?
4. How do neoprofessionals affect relationships between different logics and power relationships between different professions, new and old?
We thereby contribute to (1) the theoretical understanding of the actors’ role in institutional processes, (2) an increased understanding of how institutional changes in health care organizing become manifest in everyday work, and (3) understanding power shifts between professions, with a particular emphasis on ODPs. The study design draws on insights from multi-site ethnographies and from phenomenology, combining shadowing and interviewing and thereby creating thick descriptions of activities, intentions, and actors’ interpretations.

I sjukvården får verksamhetsutveckling en allt större roll och i detta blandas styrformer och verksamhetslogiker. Utfallet av detta är oklart, inte minst gällande vilka som kommer att dominera. Denna ansökan baseras på en ambition att på ett mer djupgående och empiriskt detaljerat plan förstå hur olika yrkesgruppers verksamhetslogiker relateras till varandra. Empiriskt studeras verksamhetsutvecklare inom hälso- och sjukvården, som i vardagen ska förändra olika verksamhetslogiker. Syftet med projektet är att öka förståelsen för hur institutionella logiker uttrycks i vardagspraktiken i sjukvårdsorganisationer för att på så sätt bidra till ökad reflexivitet i vårdutvecklingsarbete.