Professional projects and institutional change in healthcare: The case of American dentistry

Kitchener, Martin James ORCID: https://orcid.org/0000-0001-6249-557X and Mertz, Elizabeth 2012. Professional projects and institutional change in healthcare: The case of American dentistry. Social Science & Medicine 74 (3) , pp. 372-380. 10.1016/j.socscimed.2010.10.005

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Abstract

This paper combines resources from the organization studies and sociology literatures to advance understanding of institutional change processes in healthcare that emerge from the professionalization projects of occupations. Conceptually, we introduce a model that combines the ‘archetype’ approach to analyzing structural change with a framework for analyzing the agency of emergent professions. We then employ the model to frame a historical case analysis (1972–2009) of the highly contested process by which the occupation of dental hygiene in the US fought to introduce a new organizational form, the alternative practice hygiene (APH) archetype. This archetype challenges the traditional model (the dentist’s office archetype) that is supported by the dominant dentistry profession. Our analysis contributes two main sets of empirical findings. First, we present a systematic comparison of the APH and Dentist’s Office archetypes in terms of their belief systems, formal structures, agents, and policy implications (e.g., access to services). Second, we provide an account of the agency of dental hygienists’ attempts to secure the APH model as part of their professionalization project.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Business (Including Economics)
Subjects:	H Social Sciences > H Social Sciences (General) H Social Sciences > HD Industries. Land use. Labor H Social Sciences > HM Sociology J Political Science > JK Political institutions (United States) R Medicine > R Medicine (General) R Medicine > RA Public aspects of medicine R Medicine > RK Dentistry
Uncontrolled Keywords:	Organization theory ; Medical sociology ; Health policy ; Institutional theory ; Sociology of the professions ; USA ; Dental health
Publisher:	Elsevier
ISSN:	0277-9536
Last Modified:	19 Oct 2022 09:03
URI:	https://orca.cardiff.ac.uk/id/eprint/19870

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