Inconsistency in health care professional work: Employment in independent sector treatment centres.

PURPOSE: The purpose of this paper is to investigate the impact of recent outsourcing and public-private partnership (PPPs) arrangements on the consistency of professional employment in health care. DESIGN/METHODOLOGY/APPROACH: A case study methodology is applied. FINDINGS: The paper finds that multiple arrangements for employment within the ISTC creates numerous sources for inconsistency in employment: across the workplace, within professional groups and with national frameworks for health care employment. These are identified as having implications for organisational outcomes, threatening the stability of current partnerships, and partially stymieing intended behavioural change. RESEARCH LIMITATIONS/IMPLICATIONS: The study is a single case study of an independent sector treatment centre. Future research is required to investigate wider trends of employment in heterogeneous outsourcing and PPP arrangements. PRACTICAL IMPLICATIONS: The paper informs both managers and clinical professionals of the unanticipated complexities and practical challenges that can arise in partnerships and outsourcing arrangements. ORIGINALITY/VALUE: The paper presents a unique in-depth investigation of employment within recently established ISTCs, and highlights important employment changes for the core health care workforce and high-status professionals in the evolving health care organisational landscape.

The contingencies of medical restratification across inter-organisational care networks.

The contemporary social organisation of medical work is characterised by internal hierarchies and stratification in the form of professional elites and managerial hybrids. This paper examines the changes in medical restratification brought about by the introduction of inter-organisational care networks. The study focuses in particular on the social position of doctors and the contingencies that enable or constrain intra-professional hierarchies across inter-organisational boundaries. This ethnographic study of major system change within the English healthcare system finds that a relatively small group of 'multiplex' elites have significant influence in both national policy-making and regional service re-configuration based upon multiple sources of clinical and reputational capital. Subsequent forms of restratification at the regional level are found to mirror such status markers whilst also revealing important local contingencies, especially where professional markers of distinction are coupled with and dependent upon organisational markers of distinction.