Ruth Decady Guijarro and Ivy Lynn Bourgeault
Fostering diversity in health leadership is imperative as that not only enhances the quality of health care itself, but improves an organization's effectiveness and responsiveness…
Abstract
Purpose
Fostering diversity in health leadership is imperative as that not only enhances the quality of health care itself, but improves an organization's effectiveness and responsiveness to address the needs of a diverse population. Inequitable structures entrenched in health care such as sexism, racism and settler colonialism undermine efforts made by women from diverse backgrounds to obtain leadership roles. This paper identifies leading practices which support diverse health leadership.
Design/methodology/approach
A multi-methodological approach involving a targeted published and gray literature search undertaken through both traditional means and a systematic social media search, focused particularly on Twitter. A literature and social media extraction tool was developed to review and curate more than 800 resources. Items chosen included those which best highlighted the barriers faced by diverse women and those sharing tools of how allies can best support the diverse women.
Findings
Four core promising practices that help to disrupt the status-quo of health leadership include (1) active listening to hear and amplify voices that have been marginalized, (2) active learning to respond to translation exhaustion, (3) active observing and noticing microaggressions and their consequences and (4) active bystanding and intervention.
Social implications
When implemented, these practices can help to dismantle racism, sexism, ableism and otherwise challenge the status-quo in health leadership.
Originality/value
This paper provides an original and value-added review of the published literature and social media analysis of heretofore disparate practices of allyship, all while amplifying the voices of health leaders from marginalized communities.
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Ellen Kuhlmann and Ivy Lynn Bourgeault
This article aims to provide an overview on key trends in public sector policy and professional development and how they intersect with gender and diversity. It seeks to explore…
Abstract
Purpose
This article aims to provide an overview on key trends in public sector policy and professional development and how they intersect with gender and diversity. It seeks to explore new configurations in the relationship between gender and the professions and to develop a matrix for the collection of articles presented in this volume.
Design/methodology/approach
The authors link social policy and governance approaches to the study of professions, using the health professions and academics as case studies. Material from a number of studies carried out by the authors together with published secondary sources provide the basis of our analysis; this is followed by an introduction of the scope and structure of this thematic issue.
Findings
The findings underline the significance of public policy as key to better understand gender and diversity in professional groups. The outline of major trends in public sector professions brings into focus both the persistence of gender inequality and the emergence of new lines of gendered divisions in the professions.
Practical implications
The research presented here highlights a need for new models of public sector management and professional development that are more sensitive to equality and diversity.
Originality/value
This article focuses on the “making” of inequality at the interface of public policy and professional action. It introduces a context sensitive approach that moves beyond equal opportunity policies and managerial accounts and highlights new directions in research and policy.
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This article aims to explore the gendered dimensions of the heterogeneous path of non‐native graduates in nursing and medicine in the Portuguese National Health Service, including…
Abstract
Purpose
This article aims to explore the gendered dimensions of the heterogeneous path of non‐native graduates in nursing and medicine in the Portuguese National Health Service, including institutional factors like the process of credential recognition, the professional integration and internal labour market segmentation.
Design/methodology/approach
Biographical interviews with nurses and physicians (23 males and 35 females) from Spain and from some Eastern European countries who migrated to work in Portugal were conducted, and additionally semi‐structured interviews with 12 institutional participants to contextualise the experiential data.
Findings
The research highlights complex intersections between gender and the resources for action. Institutional conditions, like legal frameworks and the self‐regulatory mechanisms of the professions, and individual characteristics shape successful translation of foreign credentials into a new social and cultural context. The specific configurations may create gender traps that push women into low status professional segments and also new forms of inequality in the professions.
Research limitations/implications
The development of successful professional action and agency in a socio‐culturally different health care labour market can be differentiated by gender, place of graduation and citizenship status. The factors identified in this small‐scale qualitative study would need further investigation.
Practical implications
The findings highlight new demands for integration policies for foreign‐trained professionals, such as policies to promote equal opportunities for women and men in the workplace.
Originality/value
The article reinforces women as professional participants in the international migration process and examines the opportunities for successful integration.
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Patricia Khokher, Ivy Lynn Bourgeault and Ivan Sainsaulieu
This paper sets out to explore health professionals' views and experiences regarding the work culture that exists in their hospital units, and further how patients influence these…
Abstract
Purpose
This paper sets out to explore health professionals' views and experiences regarding the work culture that exists in their hospital units, and further how patients influence these experiences.
Design/methodology/approach
The paper employs a qualitative approach involving individual interviews with 60 health professionals in Canada employed in what is conceptualised as “open” (emergency room and maternity care) and “closed” (intensive care, head and neck surgery) units.
Findings
The paper finds that the influence of the hospital unit outweighs the influence of professional boundaries but for some groups more than for others. Health professionals in more open units tend to be less satisfied with their work, have more difficult relations with patients, and experience tensions with co‐workers and management. Those in closed units tend to be more satisfied with their work, have relatively better relations with patients and co‐workers, and tend to have more cooperative relations with management. The different structural conditions of work in open and closed units are also clearly important.
Research limitations/implications
The sample for the study was self‐selected from one hospital, which may limit the generalisability of some of the findings.
Practical implications
The insights garnered from the study may help professionals and managers to develop unit‐specific policies to create a more positive workplace culture.
Originality/value
There is a growing body of research on professional culture and oganisational culture that often does not clearly delineate how the two exist concurrently. The paper explicitly investigates this issue by examining work culture across various health professional groups and also across hospital units, and further how patients figure in these experiences.
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This article aims to address topical issues in the debate on gender (in)equality in higher education in Europe and beyond, and highlights future perspectives of research and…
Abstract
Purpose
This article aims to address topical issues in the debate on gender (in)equality in higher education in Europe and beyond, and highlights future perspectives of research and practice.
Design/methodology/approach
It is based on a conference report of the 5th European Conference on Gender Equality in Higher Education that was hosted by Humboldt University in Berlin, Germany, 28‐31 August 2007.
Findings
Number matters (“wore women into science”), but quality matters more: more women are needed in top positions in higher education, science, technology and engineering, and more female participation in higher education decision‐making processes. It is necessary to reveal gender biases of recent strategies in higher education. Exclusion happens also among women; an intersectional approach is therefore called for, which includes primary and secondary educations as well as labour market and careers in the academe.
Practical implications
Equality programmes have to consider the diversity of gender in higher education and to strengthen women's lobbying in European education and science politics.
Originality/value
This conference brought together about 350 participants from 56 countries. Thus, it provided an excellent opportunity for knowledge exchange with European scholars and beyond, which is reported in this paper.
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Ivy Lynn Bourgeault, Eugene Declercq, Jane Sandall, Sirpa Wrede, Meredith Vanstone, Edwin van Teijlingen, Raymond DeVries and Cecilia Benoit
Purpose – This chapter critically examines the purportedly growing phenomenon of Maternal Request Caesarean Sections (MRCS) and its relative contribution to the rising caesarean…
Abstract
Purpose – This chapter critically examines the purportedly growing phenomenon of Maternal Request Caesarean Sections (MRCS) and its relative contribution to the rising caesarean section (CS) rates.
Methodology – We apply a decentred comparative methodological approach to this problem by drawing upon and comparatively examining empirical data from Canada, the US, the UK and Finland.
Findings – We find that the general argument that has emerged within the obstetric community, evidenced in particular by a recent “State of the Science” conference, is that the reduced risks and benefits of MRCS are evenly balanced, thus ethically it could be seen as a valid choice for women. This approach, taken in particular in the North American context, negates the problematic nature of accurately measuring, and therefore assessing the importance of maternal request in addressing rising CS rates. Moreover, although some of the blame for rising CS rates has focused on MRCS, we argue that it has a relatively minor influence on rising rates. We show instead how rising CS rates can more appropriately be attributed to obstetrical policies and practices.
Originality – In presenting this argument, we challenge some of the prevailing notions of consumerism in maternity care and its influence on the practice patterns of maternity care professionals.
Practical implications – Our argument also calls into question how successful efforts to address MRCS will be in reducing CS rates given its relatively minor influence.
Kevin T. Leicht and Mary L. Fennell
The paper aims to argue that US colleges and universities resemble a “leaning tower” with ever expanding layers of administrators and managers who control and dominate university…
Abstract
Purpose
The paper aims to argue that US colleges and universities resemble a “leaning tower” with ever expanding layers of administrators and managers who control and dominate university life. This set of institutional changes has altered the way that college administrators are recruited.
Design/methodology/approach
The paper uses recent developments in institutional theories of organisations to explain the changing environment facing US colleges and universities and the role that college administrators play in this environment. The paper matches data from a sample of administrative positions advertised in the 2004‐2005 Careers section of the Chronicle of Higher Education with web‐based data on incumbents subsequently hired for each position. These data are supplemented with aggregate statistics provided by the Chronicle and the American Association of University Professors (AAUP).
Findings
Results suggest that only a small number of administrative positions advertised involve academic appointments with tenure and that the educational qualifications advertised span a surprisingly wide spectrum of credentials other than academic PhD's. Ethnically underrepresented groups and women are most likely to hold jobs requiring PhD's while whites and men occupy most of the positions where qualifications are ambiguous or classic academic qualifications are not called for.
Originality/value
The paper is the first to discuss the growing distinctive labour market for college administrators while providing preliminary data on the diversity effects of this labour market.
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This study seeks to examine the reconfiguration of professional groups in welfare service work through the lens of gendered inequalities in order to develop an inclusive research…
Abstract
Purpose
This study seeks to examine the reconfiguration of professional groups in welfare service work through the lens of gendered inequalities in order to develop an inclusive research horizon that extends to the middle grade of care workers.
Design/methodology/approach
The research design positions workforce change within a wider social and cultural context by highlighting occupational, educational and unionist orders from the viewpoint of Finnish practical nurses.
Findings
A weakening anchorage in the welfare state and a differentiation of the patterns of recruitment, employment and industrial relations create segmentation, particular forms of exclusion, and identity instabilities. The article identifies the special vulnerability of the practical nurses institutionally embedded “in‐between” the upper and lower grades, the social and health sector, and the union traditions.
Research limitations/implications
The national policy agenda on workforce change mainly follows the sectoral split and focuses on the established health professions. The unionist agenda of practical nurses in turn reflects interprofessional relationships and tribalism.
Practical implications
This analysis of welfare service work provides insight into social and cultural transformations related to workforce change in a segmented and culturally diverse labour force and offers reflections on the changing nature of craft unionism.
Originality/value
This article argues for the added value of historicised, gender and culture sensitive analysis of the tensions between policy aims, educational, occupational and unionist orders for understanding reconfiguration through inequality‐producing processes.
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Anémone Kober‐Smith and Isabelle Feroni
Taking into account strong intra‐European discrepancies between workforce models for women, such as part‐time work rates and the ability to have uninterrupted careers, this…
Abstract
Purpose
Taking into account strong intra‐European discrepancies between workforce models for women, such as part‐time work rates and the ability to have uninterrupted careers, this article aims to show how nursing careers are shaped differently by employment and gendered social policies in France and Britain. Using the case of state hospitals, it explores how French and British nurses reconcile sector‐specific work constraints and family life at different stages of their life and career cycle.
Design/methodology/approach
This paper compares nurses' career patterns using age, “early exit” and part‐time data drawn from national and European official sources, large‐scale surveys and secondary literature.
Findings
Although hospital employment policies prioritise entry‐level recruitment over retention of mature nurses in both countries, French nurses are more likely to have uninterrupted full‐time careers than their British counterparts thanks to the protective effect of state employment regulations and interventionist gendered policies. However, the positive impact of the French social model on nurses' careers is limited to the childbearing and rearing stage.
Research limitations/implications
The analysis of nursing careers is constrained by the scarcity of official longitudinal data in both countries. Although the study is limited to one profession in two countries, the method used is transferable to other professional groups and national contexts.
Originality/value
Thanks to the cross‐national comparative approach, the paper broadens profession‐centred analyses, highlighting the impact of employment and social policies on female professional careers.
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Recent scholarship reveals the imagery of the professional as the “ideal citizen”. The linkage between professionalism and citizenship is here approached from the perspective of…
Abstract
Purpose
Recent scholarship reveals the imagery of the professional as the “ideal citizen”. The linkage between professionalism and citizenship is here approached from the perspective of democratic social justice in order to examine the persistence of gendered inequalities in the health care system. The paper aims to examine the ideas framing professionalism, both in sociological theory and historically, asking what gendered hierarchies mean in modern health care systems, and why and how they persist in the conditions of liberal democracy.
Design/methodology/approach
The question is approached through both sociological literature and an analysis of historical framings of professionalism; the Finnish health care system is employed as a case. The reason for keeping the discussion close to a specific case is that different professional fields, countries and historic contexts differ from each other in democratically relevant respects.
Findings
Traditional sociological theory assumed that professional privilege was based on essentially neutral expertise that benefits democracy only if protected from bureaucracy and politics. The recent theoretical turn reframes professional knowledge as socially defined, but the destabilisation of professional knowledge claims is not without problems. The paper refers to the persisting tensions between changing governance and gendered hierarchies in health care and argues for new approaches that suggest ways through which professional expertise can be democratically represented in politics.
Originality/value
The interdisciplinary framework uses political theory on social justice to examine how health care politics frame professionalism.