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How and where clinicians exercise power: Interprofessional relations in health care


Nugus, P and Greenfield, D and Travaglia, J and Westbrook, J and Braithwaite, J, How and where clinicians exercise power: Interprofessional relations in health care, Social Science & Medicine, 71, (5) pp. 898-909. ISSN 0277-9536 (2010) [Refereed Article]

DOI: doi:10.1016/j.socscimed.2010.05.029


This study aims to contribute to the limited set of interactional studies of health occupational relations. A "negotiated order" perspective was applied to a multi-site setting to articulate the ways in which clinicians’ roles, accountabilities and contributions to patient care are shaped by the care setting and are influenced by the management of patient pathways. The study responds to the polarized debate between a critical perspective that calls for collaboration as the re-distribution of occupational power, and a functionalist view that argues for better coordination of health care teams. The study draws on data from 63 interviews, 68 focus groups and 209 h of observation across acute and non-acute health services within a state/territory in Australia. The paper reveals the exercise of both "competitive power" and "collaborative power" in the negotiated order of health services. Both forms of power are exercised in all settings. Relationships among clinicians in various occupations are mediated by the expectation that doctors assume responsibility for patient management and coordinating roles in health care teams, and the degree of acuity of particular health care settings. The combination of a negotiated order perspective and its unique application across a whole health system shows the continuation of a broad pattern of power by doctors over those in other roles. The paper also reveals novel criteria for evaluating the extent of power-sharing in interprofessional interaction in case conferences, and a unique quantification of such interaction.

Item Details

Item Type:Refereed Article
Keywords:collaboration, patient management, interprofessional learning, Australia, power, negotiated order, interprofessional practice
Research Division:Health Sciences
Research Group:Health services and systems
Research Field:Health services and systems not elsewhere classified
Objective Division:Health
Objective Group:Evaluation of health and support services
Objective Field:Evaluation of health and support services not elsewhere classified
UTAS Author:Greenfield, D (Professor David Greenfield)
ID Code:111210
Year Published:2010
Web of Science® Times Cited:182
Deposited By:TSBE
Deposited On:2016-09-07
Last Modified:2017-12-08

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