Health Care Professionalism Without Doctors
Spatial Surroundings and Counter-Identification in Local Health Houses
The article uses the organization of health houses in Denmark as a case to study the relationship between spatial surroundings and professionalization. The question is whether these new local health houses comprise an alternative to the medical view on health or ––even in the absence of the hospital–– script the professionals to identify themselves as agents from the medical field? In this article, macro-structural theory is combined with micro-relational theory in order to identify how macro structures such as professionalization nest the way social interaction takes place in concrete spatial situations and surroundings. The argument put forward is that we need to identity this process at the level of the individual in order to qualify and anchor our understanding of professionalization as a macro phenomenon. The empirical basis is two dissimilar locations (health houses), selected from a larger qualitative data set of interviews with health professionals and citizens and observations of health houses, originally selected from a nationwide survey. The presented analysis zooms in on selected places and situations and relates analyses to the overall picture of differences and similarities identified in the larger sample. The analysis shows how entrances, receptions, information screens and coffee tables not only design houses, but also script styles of interaction between health professionals and citizens as well as they work as signs creating expectations about professional roles and how to reflect and act as a professional in a given physical and social setting. The main finding is that spatial surroundings facilitate processes of identification and counter-identification crucial to a new kind of health professionals such as the ones under study here.
Abbott, A. (1988). The System of Professions. An Essay on the Division of Expert Labor. Chicago: The University Chicago Press.
Aarestrup, A. K., Due, T., Drud, & Kamper-Jørgensen, F. (2007). De kommunale sundhedspolitikker i danmark - en kortlægning. Odense: Statens institut for folkesundhed og Syddansk Universitet.
Barter, C. and E. Renold. 2000. ‘I Wanna Tell You a Story’: Exploring the Application of Vignettes in Qualitative Research with Children and Young People. International Journal of Social Research Methodology 3(4):307–23.
Bello, J. K., Adkins, K., Stulberg, D. B., & Rao, G. (2013). Perceptions of a reproductive health self-assessment tool (RH-SAT) in an urban community health center. Patient Education and Counseling, 93(3), 655-663.
Bullough, B., & Bullough, V. (2008). A brief history of medical practice. In E. Freidson, & J. Lorber (Eds.), Medical professionals and the organization of knowledge (pp. 86-102). London: Aldine Transaction.
Charmaz, K. (2006). Constructing grounded theory. A practical guide through qualitative analysis (2nd ed.). London: SAGE Publications.
Clauss‐Ehlers, C. C. (2003). Promoting ecologic health resilience for minority youth: Enhancing health care access through the school health center. Psychology in the Schools, 40(3), 265-278.
Etzioni, A. (1969). The semi-professions and their organization: Teachers, nurses, social workers Free Press.
Foucault, M. (2000). Klinikkens fødsel [Naissance de la clinique]. København: Hans Reitzel.
Freidson, E., & Lorber, J. (Eds.). (2008). Medical professionals and the organization of knowledge. London: Aldine Transaction.
Goffman, E. (1963). Behavior in public places. notes on the social organization of gatherings. New York: The Free Press.
Goffman, E. (1990). The presentation of self in everyday life. Harmondsworth: Penguin.
Haines, A., Sanders, D., Lehmann, U., Rowe, A. K., Lawn, J. E., Jan, S.,Bhutta, Z. (2007). Achieving child survival goals: Potential contribution of community health workers. The Lancet, 369(9579), 2121-2131. doi:10.1016/S0140-6736(07)60325-0
Hall, Peter & Lamont, Michèle. (2013). Social resilience in the neoliberal era. Cambridge: Cambridge University Press.
Lännerström, L., Wallman, T., & Söderbäck, M. (2013). Nurses experiences of managing sick-listing issues in telephone advisory services at primary health care centres. Scandinavian Journal of Caring Sciences, 27(4), 857-863.
Lebrun, L. A., Baggett, T. P., Jenkins, D. M., Sripipatana, A., Sharma, R., Hayashi, A. S., Metzger, Q. (2013). Health status and health care experiences among homeless patients in federally supported health centers: Findings from the 2009 patient survey. Health Services Research, 48(3), 992-1017.
Miles, M. B., Huberman, A. M., & Saldaña, J. (2014). Qualitative data analysis : A methods sourcebook (3rd ed.). Thousand Oaks, CA: Sage.
Navarro, V. (1976). Medicine under capitalism. New York: Prodist.
Olayiwola, J. N., Irizarry, O. C., O Connell, K., & Milan, S. (2013). Living smart, living fit: A patient-centered program to improve perinatal outcomes in a community health center population. Journal of Primary Care & Community Health, 4(1), 31-35.
Parsons, T. (1975). The sick role and the role of the physician reconsidered. Health and Society, 53(3), 257-278.
Pedersen, B. M. & Rank Petersen, S. (Eds.). (2014). Det kommunale sundhedsvæsen (1. udgave ed.). København: Hans Reitzels Forlag.
Ralph, A. P., Fittock, M., Schultz, R., Thompson, D., Dowden, M., Clemens, T.; Bailie, R. S. (2013). Improvement in rheumatic fever and rheumatic heart disease management and prevention using a health centre-based continuous quality improvement approach. BMC Health Services Research, 13(1), 525-525.
Schreier, M. (2012). Qualitative Content Analysis in Practice. London: SAGE.
Scott, K., & Shanker, S. (2010). Tying their hands? institutional obstacles to the success of the ASHA community health worker programme in rural north india. AIDS Care 22(2), 1606-1612.
Ministry of Health. (2010). Sundhedsloven. LBK nr 913 af 13/07/2010. København: Ministry of Health.
Turner, B., S. (2007). Medical power and social knowledge (Second Edition ed.). London: SAGE Publications.
Weiss, R. S. (1994). Learning from strangers. New York: Free Press.