Doctoral Dissertation Research in DRMS: Can We Coexist? The Enactment of Professional Jurisdiction in Daily Work Life

University Of Southern California, Los Angeles CA

Investigators

Abstract

As modern organizations face greater complexity, the degree of specialization and coordination within organizations also increases. Accordingly, an effect of complexity is seen in the proliferation of Specialist professionals, and consequently, Generalists who coordinate Specialists' work. Prior research on the coordination of specialized work discusses the role of an integrator who serves to manage the functions of various Specialists. The literature on the integrator's role views this type of Generalist solely as a manager, and does not acknowledge the reality that greater complexity often yields overlapping work domains between Generalist integrators and the Specialists they coordinate. To explore this issue, the researchers study how Generalist and Specialist jurisdictions are established in the daily practice of work, and the performance outcomes that result from such negotiated work domains. This research is conducted at a metropolitan children's hospital where the integrator is represented by a relatively novel, yet prevalent profession: the Hospitalist, a Generalist physician devoted entirely to the hospital setting. There are three studies in this project, the first of which involves collection of ethnographic data to analyze the various factors that contribute to physician assignment decisions. The second study uses a survey the researcher administered to physicians in eight different specialties that asks what the "ideal" physician assignments should be for various diagnoses. The final study uses statistical analysis of patient data from electronic medical records to look at the quality and cost outcomes of assigning Hospitalist or Specialist physicians to treat different types of patient diagnoses. This project makes several contributions, including (1) deriving attributes of professionalization at the workplace level (whereas the vast majority of prior work focuses on the institutional level); (2) examining professionals' performance outcomes that result from actual versus ideal jurisdictions; and (3) applying multi-method and multi-level analyses to study core theoretical problems. Further, this project has broader implications for healthcare delivery and inpatient care. In particular, an immediate goal of this study is to enhance workplace processes at the children's hospital where this research takes place. Beyond the field site, this research seeks to improve processes that may be affected by physicians' negotiated work domains, such as the timeliness of treatment decisions, communication among medical professionals, coordination of care, and monitoring patient outcomes.