Abstract

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Healthcare systems in high-income countries, despite many reforms, are under constant pressure to achieve significant improvement in the areas of cost control, quality and safety of care and population health (Maynard, 2013; Saltman and Cahn, 2013). Yet the reform models of the past – system restructuring and severe budget cuts – are no longer a viable option (Denis et al., 2011), and alternative routes are necessary (Institute of Medicine, 2012; McQueen et al., 2012; Nasmith et al., 2010; Starfield, 2011). One commonly accepted route is that institutional entrepreneurs are crucial in the redesign of contemporary health systems (Tuohy, 2012). Nonetheless, differences in the structure and available resources of national healthcare systems pose the question of what actors better play this role. In this session we aim to focus specifically on medical doctors as institutional entrepreneurs in the transformation of health systems. Initiatives that aim at involving medical doctors beyond the delivery of clinical services necessarily imply a combination of their professional expertise with other forms of knowledge, and the application of this expertise to more collective problems and issues (Denis & Van Gestel, 2015) including the sphere of health policies and large-scale reforms. While studies have shown benefits in the development of clinical leadership where clinical expertise is combined with other capacities such as managerial and policy knowledge; the materialisation and broad-scale diffusion of medical leadership for improvement within healthcare systems is not without challenges (Waring & Currie, 2009 Correia & Denis, 2016). Medical doctors may resist attempts by emerging medical leaders to reframe context of work and the relationships between health systems and their profession. Structural and economic mechanisms to better integrate medical doctors within organizations and systems have appeared insufficient to enable a new compromise and understanding of professional autonomy and health system’s imperatives (Burns, 2008). In sum, analyses of strategies and policies used by governments and organizations in various context to increase the support and contribution of medical doctors in health system adaptation and reforms are required.

Contributors to this session are invited to explore the theme of medical doctors in health systems transition and reforms. Papers can focus on the involvement of medical doctors in professional-managerial roles, in the design and management of changes and reforms and in the promotion of innovative forms of organizing. Attention is paid to tensions and contradictions that emerge from the co-existence of multiple institutional logics and to the pressures exert by social demands for increased accountability of the medical profession. Comparative analysis across health systems of various jurisdictions and between sub-national systems that operate under different regulatory arrangements are encouraged.  Our aim with this session is to get a better understanding of the politics of health system redesign through the analysis of the tensions that surround the roles and status of medical profession in the context of health system reforms and transformation. 

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Session organizer(s)

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Jean-Louis Denis (CA) – is a professor of health policy and management at the School of Public Health, Université de Montréal, Senior Scientist, Research Center of the CHUM (CRCHUM) and Canada Research Chair (tier I) on governance and transformation of health systems. His current research looks at health system transformation and reforms, medical compensation, professional leadership and clinical governance. Recent papers have been published in Journal of Health Politics, Policy and Law, Organization Science, Academy of Management Annals, Milbank Quarterly, Administration and Society, Implementation Science and Journal of Public Administration Research and Theory.

 

Tiago Correia (PT) – is professor and research fellow of sociology of health at ISCTE-Lisbon University Institute. His current research interests build on the interplay among health professions, organizations and reforms. On these topics he has published extensively (e.g. Journal of Public Health, BMC Health Services Research, Current Sociology) and been part of several R&D networks in Europe, Canada and Brazil.

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