Interprofessionalism, cooperation or struggling for professionalism in Danish hospitals

This article addresses a particular area of welfare institutions, namely the hospitals, which are characterized by major change processes. Politically, the focus is on performance management, which can be seen as an accentuation of key elements of NPM with waiting list guarantees, increased productivity and budget compliance. In the hospital context, patients are seeking cure and influence, and the employees expect professional challenges and a good working environment. In this context of new rationalization and organizational forms, the appearance of some management technologies focus particularly on developing collaboration among the hospital staff and an awareness of each other's roles in the performance of the work. Particularly the concepts of relational coordination IPLS have emerged in response to the discursive shifts. These concepts are based on the idea that, through common goals, hospital employees ensure the best possible coordination of work, which improves productivity, quality and work environment. They are launched as evidence-based effective methods challenge silo thinking, professional centricity and specialization in return for establishing coherent patient outcomes that provide 'better results', 'enhances quality and work satisfaction' and improves patient satisfaction through patient involvement and improved patient safety. Thus, a re-orientation is made in relation to professional standards and workflows, and the concepts thus address some structures and frameworks that determine the conditions of possibility of health professionals.
Based on an empirical work where we interviewed differently positioned health professionals at three major hospitals in Denmark, we draw on Bourdieu’s concept of fields to better understand how the introduction of the new concepts involves displacements in the various health professionals' space for action with both match and also mismatch between the different dispositions and what the 'new' job position implies. Our data shows how a focus on interdisciplinary cooperation is instrumental in strengthening the mono-professionalism of the health care professionals. This clarifies and visualizes the particular professionalism of each profession, and creates mutual recognition and knowledge of each other's strengths and weaknesses, which are beneficial to the health care professionals. Our empirical focus is on the two professions of nurses and doctors. Here, cooperation is improving and both groups experience only few conflicts when considering the values of their own profession and the new concepts. As for the nurses, we see that the professional foundation for nursing care is redefined in a way that more closely matches their own ideals of good nursing work.
This process, however, is heavily challenged by the introduction of a new IT-system, which can be considered as a representative of the field of power /the bureaucratic field with its own agenda. We see that especially the professionalism of physicians and their working conditions are challenged by this technology, as they have to perform new work functions that were previously done by other professions and move the attention from the patient to fulfill the demands from the IT system. This new comprehensive technology challenges the doxa of the field and the work of strengthening interprofessional cooperation