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Journal of Foot and Ankle Research
Published in: Journal of Foot and Ankle Research 1/2015

Open Access 01-12-2015 | Research

Contested professional role boundaries in health care: a systematic review of the literature

Authors: Olivia King, Susan A Nancarrow, Alan M Borthwick, Sandra Grace

Published in: Journal of Foot and Ankle Research | Issue 1/2015

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Abstract

Background

Across the Western world, demographic changes have led to healthcare policy trends in the direction of role flexibility, challenging established role boundaries and professional hierarchies. Population ageing is known to be associated with a rise in prevalence of chronic illnesses which, coupled with a reducing workforce, now places much greater demands on healthcare provision. Role flexibility within the health professions has been identified as one of the key innovative practice developments which may mitigate the effects of these demographic changes and help to ensure a sustainable health provision into the future. However, it is clear that policy drives to encourage and enable greater role flexibility among the health professions may also lead to professional resistance and inter-professional role boundary disputes. In the foot and ankle arena, this has been evident in areas such as podiatric surgery, podiatrist prescribing and extended practice in diabetes care, but it is far from unique to podiatry.

Methods

A systematic review of the literature identifying examples of disputed role boundaries in health professions was undertaken, utilising the STARLITE framework and adopting a focus on the specific characteristics and outcomes of boundary disputes. Synthesis of the data was undertaken via template analysis, employing a thematic organisation and structure.

Results

The review highlights the range of role boundary disputes across the health professions, and a commonality of events preceding each dispute. It was notable that relatively few disputes were resolved through recourse to legal or regulatory mandates.

Conclusions

Whilst there are a number of different strategies underpinning boundary disputes, some common characteristics can be identified and related to existing theory. Importantly, horizontal substitution invokes more overt role boundary disputes than other forms, with less resolution, and with clear implications for professions working within the foot and ankle arena.
Literature
1.
Duckett S. Interventions to facilitate health workforce restructure. Aust N Z J Publli Heal. 2005;2:14.CrossRef
2.
Foot D, Gomez R. Population ageing and sectoral growth: the case of the UK 2006–2026. Oxf J Bus Econ. 2006;5:85–94.
3.
4.
Bach S, Kessler I, Heron P. Nursing a grievance? The role of healthcare assistants in a modernized national health service. Gend Work Organ. 2012;19:205–24.CrossRef
5.
Townson M. Developing a sustainable podiatry workforce for the UK towards 2030. London: Society of Chiropodists & Podiatrists; 2014.
6.
7.
McPherson K, Kersten P, George S, Lattimer V, Breton A, Bridgets E, et al. A systematic review of evidence about extended roles for allied health professionals. J Health Serv Res Policy. 2006;11:240–7.CrossRefPubMed
8.
Nancarrow S, Borthwick A. Dynamic professional boundaries in the healthcare workforce. Sociol Health Illn. 2005;27:897–919.CrossRefPubMed
9.
Masterson A. Cross-boundary working: a macro-political analysis of the impact on professional roles. J Clin Nurs. 2002;11:331–9.CrossRefPubMed
10.
Borthwick A. Challenging Medicine: the case of podiatric surgery. Work Employ Soc. 2000;14:369–83.CrossRef
11.
Borthwick A. Occupational imperialism at work: the case of podiatric surgery. Br J Podiatr. 2001;4:70–9.
12.
Isaac A, Gwilym S, Reilly I, Kilmartin T, Ribbans W. Interprofessional relationships between orthopaedic and podiatric surgeons in the UK. Ann R Coll Surg Engl. 2008;90:663–70.CrossRefPubMedPubMedCentral
13.
O’Kane C, Kilmartin T. Orthopaedic and podiatric surgery: Will you get the same operation? Pod Now. 2007;10:24–6.
14.
Currie G, Finn R, Martin G. Professional competition and modernizing the clinical workforce in the NHS. Work Employ Soc. 2009;23:267–84.CrossRef
15.
Larkin G. Occupational monopoly and modern medicine. London: Tavistock; 1983.
16.
Larkin G. Medical dominance in britain: image and historical reality. Millbank Q. 1988;66:117–32.CrossRef
17.
Parkin F. Marxism and class theory: a bourgeois critique. London: Tavistock; 1979.
18.
Saks M. Removing the blinkers? A critique of recent contributions to the sociology of professions. Sociol Rev. 1983;31:1–21.CrossRef
19.
Nancarrow S, Moran A, AM B, Buchan J, Dixon D, Enderby P, et al. The impact of workforce flexibility on the costs and outcomes of older peoples’ services: a policy and literature review. Sheffield: University of Sheffield School of Health and Related Research; 2006.
20.
Sanders T, Harrison S. Professional legitimacy claims in the multidisciplinary workplace: the case of heart failure care. Sociol Health Illn. 2008;30:289–308.CrossRefPubMed
21.
Martin G. Interprofessional Boundaries. In: Cockerham W, Dingwall R, Quah S, editors. The Wiley Blackwell Encyclopedia of Health, Illness, Behaviour and Society. London: John Wiley and Sons; 2014.
22.
Freidson E. Profession of medicine - a study of the sociology of applied knowledge. London: University of Chicago Press; 1988.
23.
Larkin G. Professional autonomy and the ophthalmic optician. Sociol Health Illn. 1981;3:15–30.CrossRef
24.
Willis E. Medical Dominance: The Division of Labour in Australian Healthcare (2nd Ed). London: George Allen and Unwin; 1989.
25.
Timmons S, Tanner J. A disputed occupational boundary: operating theatre nurses and operating department practitioners. Sociol Health Illn. 2004;26:645–66.CrossRefPubMed
26.
27.
Brooks J, King N. Qualitative psychology in the real world: the utility of template analysis. In: British Psychological Society Annual Conference. London: BPS; 2012.
28.
29.
Martin G, Currie G, Finn R. Reconfiguring or reproducing intraprofessional boundaries? Specialist expertise, generalist knowledgeand the ‘modenization’ of the medical workforce. Soc Sci Med. 2009;68:1191–8.CrossRefPubMed
30.
McIntyre M, Francis K, Chapman Y. The struggle for contested boundaries in the move to collaborative care teams in Australian maternity care. Midwifery. 2012;28:298–305.CrossRefPubMed
31.
Norris P. How ‘we’ are different from ‘them’: occupational boundary maintenance in the treament of musculo-skeletal problems. Sociol Health Illn. 2001;23:24–43.CrossRef
32.
Salhani D, Coulter I. The politics of interprofessional working and the struggle for professional autonomy in nursing. Soc Sci Med. 2009;68:1221–8.CrossRefPubMed
33.
34.
Moran A, Nancarrow S, Enderby P. Are we using support workers effectively? The relationship between patient and team characteristics and support worker utilisation in older people’s community based rehabilitation services in England. Health Soc Care Community. 2012;20:537–49.CrossRefPubMed
35.
Moran A, Nancarrow S, Wiseman L, Maher K, Boyce RA, Borthwick A, et al. Assisting role redesign: a qualitative evaluation of the implementation of a podiatry assistant role to a community health setting utilising a traineeship approach. J Foot Ankle Res. 2012;5:30.CrossRefPubMedPubMedCentral
36.
37.
Metadata
Title
Contested professional role boundaries in health care: a systematic review of the literature
Authors
Olivia King
Susan A Nancarrow
Alan M Borthwick
Sandra Grace
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Journal of Foot and Ankle Research / Issue 1/2015
Electronic ISSN: 1757-1146
DOI
https://doi.org/10.1186/s13047-015-0061-1

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