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Beyond professional boundaries: relationships and resources in health services' modernisation in England and Wales
Author(s) -
Huby Guro,
Harris Fiona M,
Powell Alison E.,
Kielman Tara,
Sheikh Aziz,
Williams Sian,
Pinnock Hilary
Publication year - 2014
Publication title -
sociology of health and illness
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.146
H-Index - 97
eISSN - 1467-9566
pISSN - 0141-9889
DOI - 10.1111/1467-9566.12067
Subject(s) - contest , boundary work , professional boundaries , negotiation , public relations , remuneration , social capital , service (business) , sociology , work (physics) , political science , economic growth , business , social science , law , economics , marketing , mechanical engineering , engineering
This article draws on theories of social capital to understand ways in which the negotiation of professional boundaries among healthcare professionals relates to health services change. We compared reconfiguration of respiratory services in four primary care organisations ( PCO s) in England and Wales. Service development was observed over 18 months during a period of market‐based reforms. Serial interviews with key clinicians and managers from hospital trusts and PCO s followed progress as they collaborated around, negotiated and contested developments. We found that professionals work to protect and expand their claims to work territory. Remuneration and influence was a catalyst for development and was also necessary to establish professional boundaries that underpinned novel service arrangements. Conflict and contest was less of a threat to change than a lack of engagement in boundary work because this engagement produced relationships based on forming shifting professional allegiances across and along boundaries, and these relationships mediated the social capital needed to accomplish change. However, this process also (re)produced inequalities among professions and prevented some groups from participation in service change.