QUESTION
Literature Review: Change and Professional Autonomy.
SOLUTION
Autonomy is a vital characteristic for achieving professional status and it can exist on individual as well as group level (Molony, 1992). Autonomy is a complex and multidimensional phenomenon and it has been defined in dictionary as the right of personal freedom, self-government and the freedom of will. Various authors have classified professional autonomy as forms of attitudinal attribute which forms the foundation for the definitions cited in many disciplines. This structural autonomy relates to the freedom of the worker depending on the requirements of the job (White, 2002). These attitudinal and structural dimensions are encompassed by professional autonomy which is the freedom of self-governance and organization of the activities of the profession granted by law and society (Chitty, 1993). Due to the increasing involvement of government agencies, absolute professional autonomy has become unrealistic (Dempster, 1994). The developing leaning towards interdependence and shared control in health care has become an important part of professional nurse autonomy. Autonomy has been defined as a dynamic process which demonstrates changing amount of self-governance, interdependent sentiments and behaviors which are related with empowerment, readiness, valuations and actualization of autonomous performance. For achieving positive patient outcomes in the present day complex healthcare system, professionals have to be engaged in collective enterprise. Autonomy is manifested in the form of communication of mutual trust and respect which has to be intra as well as inter-professional. This interdependence challenges and stimulates the individual opinions and guides and encourages initiative. This it also demands individual accountability and responsibility.
Autonomous decision-making is not involved with the performance of routine tasks but is related with intellectual flexibility and self-direction which are required to compromise and negotiate. Self responsibility is the precursor to responsibility and responsible decision-making needs the individuals to examine their own values and also to support ethical conduct (Chally, 1993). The consequences of professional autonomy include empowerment, accountability and a commitment to the profession. It is widely believed that rule accountability needs to a feeling of personal efficacy and empowerment (Chitty, 1993). There are several studies which have regarded the changes taking place in the independence of emerging health professions and reviewed these changes in light of medical dominance. They are however different views regarding the significance of these changes and also regarding the manner in which these changes relate to the medical dominance. Some studies state that rising independence of upcoming health occupations pose a serious challenge to the medical dominance, some other studies proposed that they had not been a significant decline in economic and rising independence of developing health occupations is consistent with the medical dominance (Coote, 2003). These studies claim that greater independence is not a result of any decline in medical dominance but does not offer any alternative explanation for these changes.
Professional autonomy: professional autonomy and medical dominance are somehow related concepts. The meaning of autonomy can be realized in the context of social relationship and increase in autonomy always involves the decrease of the dominance of corresponding group or individuals. For example several health professions which are managed by doctors in the past have got the right of self management. This increase in autonomy provided by the right of self management corresponds with a decrease in the dominance of these professions by doctors. Here it would be important to add a qualification – some professions which were being previously managed by administrators and many were managed by doctors and administrators. Therefore it is an empirical question that if the increase in professional autonomy of an occupation corresponds with any decrease in the dominance by other group or a medical dominance.
Professional Autonomy at National Level: most professional associations at the national level issue a code of practice which contains the agreed standards of work and ethics. This code puts restrictions on the questions that can be asked by an employing organization from the members of these professional associations. This way the professionals are protected against the instructions and demands which may contravene the code of practice, standards and ethics with the support provided by colleagues and professional associations (Miller et al, 2004).
The term professional autonomy is generally used to describe it at an individual level. Some occupations argue that any kind of management even when done by a person from the same occupation could not be compatible with the work done by the professionals engaged in that occupation. They argue that the presence of the manager can harm the process of the development of the personalized and confidential relation between the practitioner and the patient. It is held that by being administratively accountable to a manager, who has the power to appraise their work and override their decisions these professionals are detracted from their primary responsibilities and such a position is also harmful for the therapeutic relationship that exists with individual patient. This type of professional autonomy is called reckless autonomy because in this case they enjoy a freedom from interference by managers, which extends to other areas of the work of these professionals. For example there is no manager to instruct a medical consultant about his schedule of work or how much research or teaching should the medical consultant engage in. Another form of professional autonomy generally accompanies the practice autonomy as it is considered necessary for the development of a therapeutic relationship with the patients. This is the freedom granted to a medical practitioner to refuse in any patient. This freedom corresponds with the right of the patience to select their practitioner (Sturmberg, 2004).
In most of the developing health occupations, there are established managerial hierarchies but it is also felt that these managers should not be held accountable for clinical decisions made by medical practitioners. It is generally felt that there is a stage in the areas of all professionals where they should assume complete responsibility for clinical decisions made by them. The managers should have the authority over the clinical work and their managerial authority is appropriate only in the fields of teaching and administration (Hernes, 2001). Another form of professional autonomy is derived at the individual level from the responsibility that lies with the professional as he is ultimately in charge of a particular case. This type of autonomy is right of medical practitioners as he is ultimately responsible coordination of other professionals involved in that case. This freedom provides them a right to assess the case and to prescribe treatment and even the right to terminate further action in some cases. The doctors are mainly provided with this professional autonomy under the NHS.
This categorization of professional autonomy can help in the identification of related characteristics of medical dominance. Professional autonomy includes empowerment, accountability and a commitment towards the profession. Accountability is generally confused with responsibility, but being accountable means disclosure to the client, the employing agency, to profession and to self. A feeling of personal efficacy and empowerment is generated by true accountability. Empower individuals feel positive about their job and this was the feeling influences the whole work environment. The feeling of empowerment strengthens the commitment of the professionals (Coote, 2003).
Most of the research in the field of professional autonomy and change is descriptive in nature which examines the relationship between this concept and they were related characteristics. Some of the main characteristics of professional autonomy in health-care are (i) affiliate relationship with clients, (ii) responsible and discretionary decision-making, (iii) pro active advocacy for clients and (iv) collegial interdependence with other team members. The main effect of autonomy is accountability. The association between professional autonomy and work autonomy reflects in increased satisfaction among the professionals and the development of a commitment towards their profession. These professionals learn the skills, values and attitudes that are associated with their professional role during the process of their formal education. Therefore it is important that students use their faculty members as autonomous role models (Lewis and Marjoribanks, 2003). The education programs for these professionals have been often accused of advancing an attitude of conformity and rigidity which curtails the ability of the students to learn professional autonomy. Therefore it is important that the curriculum of these students has a strong foundation of liberal education. This condition of liberal education can prepare professionals who can demonstrate the qualities of mind that are required to lead a free and fulfilling life. These professionals will also have the qualities of character which allows them to act in public interest and also contribute to the improvements in health care. The curriculum should also include sophisticated technical skills that are required in the present age of technology. This way the curriculum can provide opportunities to the students to develop attributes and values associated with professional autonomy and change (Locock et al, 2004).
Theoretical literature illustrates that professional autonomy as it phenomena which includes the development of the joint relationships with the patients and collegial relationship with others. The power of discretionary decision-making is a key element of professional autonomy. It is based on the knowledge and exercise of routine task by the professional and not on emotions. Autonomous professionals are responsible for their own decisions and they also feel empowered.
References:
Chally P.S. Nursing ethics: In Professional Nursing: Concepts and Challenges. W.B. Saunders, Philadelphia 1993
Chitty K.K. Professional Nursing: Concepts and Challenges. W.B. Saunders, Philadelphia. 1993
Coote W. General practice workforce. Med J Aust 2003
Dempster J.S. Autonomy: a professional issue of concern for nurse practitioners. Nurse Practitioner Forum 5 1994
Hernes G. The medical professional and health care reform: friend or foe? Soc Sci Med 2001
Hunter D. The changing roles of health care personnel in health and health care management. Soc Sci Med 1996
Lewis J, Marjoribanks T. The impact of financial constraints and incentives on professional autonomy. Inter Journal Health Planning Management 2003
Locock L, Regen E, Goodwin N. Managing or managed? Experience of general practitioners in English primary care groups and trusts. Health Serv Manage Res 2004
Marjoribanks T, Lewis J. Reform and autonomy: perceptions of the Australian general practice community. Soc Sci Med 2003
Miller W, McDaniel R, Crabtree B, Stange K. Practice jazz: understanding variation in family practices using complexity science. J Fam Pract 2001
Molony M.M. Professionalization of Nursing: Current Issues and Trends. Lippincott, Philadelphia 1992
Sturmberg J. Approaching the future of general practice: how systems thinking might help. Aust Fam Physician 2004.
White K. An introduction to the sociology of health and illness. London: Sage Publications, 2002.
KC15
But you can order it from our service and receive complete high-quality custom paper. Our service offers Organization Behavior essay sample that was written by professional writer. If you like one, you have an opportunity to buy a similar paper. Any of the academic papers will be written from scratch, according to all customers’ specifications, expectations and highest standards.”
