東華大學圖書館 |

Language: English

Help

回圖書館首頁

手機版館藏查詢

Back

Switch To: Labeled | MARC Mode | ISBD

Transformation of professional contr...

Nigam, Amit.

Linked to FindBook

Google Book

Amazon

博客來

Transformation of professional control: Changes in medical work in the shift to managed care.

Record Type:	Language materials, printed : Monograph/item
Title/Author:	Transformation of professional control: Changes in medical work in the shift to managed care./
Author:	Nigam, Amit.
Description:	247 p.
Notes:	Adviser: William Ocasio.
Contained By:	Dissertation Abstracts International67-08A.
Subject:	Business Administration, Management. -
Online resource:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=3230117
ISBN:	9780542820908

Transformation of professional control: Changes in medical work in the shift to managed care.
Nigam, Amit.

Transformation of professional control: Changes in medical work in the shift to managed care. - 247 p.

Adviser: William Ocasio.

Thesis (Ph.D.)--Northwestern University, 2006.

Professions play a central role in coordinating expert work. Despite their importance, little research examines how professions coordinate expert work, or how their role changes over time. This dissertation draws on multi-method analysis to examine the changing role of the medical profession in the shift to managed care. I examine the changing role of the medical profession and consequent changes in patient care practice in three studies. Study 1 uses content analysis to show that the medical profession redefined its control over work in response to the shift to managed care. It deemphasizes individual training, skill and discretion and instead emphasizes rules and measures that define appropriate work practice. Central to this change is the growing discussion and production of clinical guidelines. In response to institutional pressure focused on health care costs, the medical profession grafts new approaches towards medical work with more traditional approaches into new, hybrid forms of professional control. In the second and third studies, I examine the impacts of these new professional controls on patient care practice. The second study extends my initial focus on professions to examine the alternate roles of professions and hierarchies in shaping expert work. In the context of the shift to managed care, I show that the proliferation of clinical practice guidelines responds to growing field-level concerns with cost by reducing the use of resource intensive medical procedures. In so doing, new forms of professional self-control substitute for more direct organizational controls by HMOs. The third study shows that both redefined professional controls and HMOs impact standardization. Both professional and organizational controls can standardize patient care by reinforcing established care practices. In addition, by introducing new patient care practices, they temporarily increase variation for some clinical conditions. This variation decreases as newly introduced practices become better established. My dissertation extends existing research by highlighting the critical role of professions in organizing expert work, explaining their changing role in periods of institutional change, and predicting the impacts of new professional and organizational controls on expert-work.

ISBN: 9780542820908Subjects--Topical Terms:

626628
Business Administration, Management.

Transformation of professional control: Changes in medical work in the shift to managed care.
LDR:03227nam 2200289 a 45 001 971005
005 20110921
008 110921s2006 eng d
020 $a 9780542820908
035 $a (UMI)AAI3230117
035 $a AAI3230117
040 $a UMI $c UMI
100 1 $a Nigam, Amit. $3 1295041
245 1 0 $a Transformation of professional control: Changes in medical work in the shift to managed care.
300 $a 247 p.
500 $a Adviser: William Ocasio.
500 $a Source: Dissertation Abstracts International, Volume: 67-08, Section: A, page: 3065.
502 $a Thesis (Ph.D.)--Northwestern University, 2006.
520 $a Professions play a central role in coordinating expert work. Despite their importance, little research examines how professions coordinate expert work, or how their role changes over time. This dissertation draws on multi-method analysis to examine the changing role of the medical profession in the shift to managed care. I examine the changing role of the medical profession and consequent changes in patient care practice in three studies. Study 1 uses content analysis to show that the medical profession redefined its control over work in response to the shift to managed care. It deemphasizes individual training, skill and discretion and instead emphasizes rules and measures that define appropriate work practice. Central to this change is the growing discussion and production of clinical guidelines. In response to institutional pressure focused on health care costs, the medical profession grafts new approaches towards medical work with more traditional approaches into new, hybrid forms of professional control. In the second and third studies, I examine the impacts of these new professional controls on patient care practice. The second study extends my initial focus on professions to examine the alternate roles of professions and hierarchies in shaping expert work. In the context of the shift to managed care, I show that the proliferation of clinical practice guidelines responds to growing field-level concerns with cost by reducing the use of resource intensive medical procedures. In so doing, new forms of professional self-control substitute for more direct organizational controls by HMOs. The third study shows that both redefined professional controls and HMOs impact standardization. Both professional and organizational controls can standardize patient care by reinforcing established care practices. In addition, by introducing new patient care practices, they temporarily increase variation for some clinical conditions. This variation decreases as newly introduced practices become better established. My dissertation extends existing research by highlighting the critical role of professions in organizing expert work, explaining their changing role in periods of institutional change, and predicting the impacts of new professional and organizational controls on expert-work.
590 $a School code: 0163.
650 4 $a Business Administration, Management. $3 626628
650 4 $a Health Sciences, Health Care Management. $3 1017922
650 4 $a Sociology, Organizational. $3 1018023
690 $a 0454
690 $a 0703
690 $a 0769
710 2 0 $a Northwestern University. $3 1018161
773 0 $t Dissertation Abstracts International $g 67-08A.
790 $a 0163
790 1 0 $a Ocasio, William, $e advisor
791 $a Ph.D.
792 $a 2006
856 4 0 $u http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=3230117