A profession refers to a vocation or an occupation that requires training and advanced study in a specialized field. In other words, an individual who has a guaranteed competence in a specific field or occupation is called a professional. Amitai Etzioni termed medicine and law as the traditional professions (Kovner, 2008, p.438). He also recognized engineering and nursing as professions, though he made distinctions relating to the length of professional training. Thus, he suggested that professions regarded as lesser needed less than five years of training. This paper applies the sociological theory of professions to examine the extent to which health care organizations have characteristics needed to support organizational learning. It focuses on the aspects of the theory that are significant for organizational learning in health care organizations.
Theories on Professions
The earliest attempt by Abraham Flexner to explain a profession led to many later works. As a basis for a profession, Flexner argued for six criteria, such as; an intellectual orientation, self-regulation and organization, use of institutionalized knowledge and techniques, teachable techniques, practical application of this knowledge and techniques, and service orientation (Kovner, 2008, p.438). Flexner did not consider social work as a profession since it did not meet any of these criteria.
There are other perspectives in the sociology of professions. These theories are instructive for the insight they offer us in understanding the structure of the professions. Professions are emphasized as a microcosm of the larger social system in the works of William Goode (Goode, 1957, p.194). A profession is viewed by this theory as a sub-society with many of the same features as the larger one. In addition, the theory also views it as maintaining a special relationship with the larger society since it has a considerable level of control over clients due to their helpless position (Goode, 1957, p.195). This special relationship to the larger society results in a strong socializing experience for those joining the profession. Those who turn to be professionals learn to abide by the strict code of regulations and become members of the local and national professional associations (Kovner, 2008, p.438).
One of the special features of professional roles is based on somebody of codified knowledge. All professional roles are viewed as institutionalized influence roles. In the health care profession, there is a strong dependence on the specialist expertise (knowledge) of the individual profession. Therefore, the institutionalized influence role enables members of the profession to have knowledge and expertise about the necessary sanctions over their patients. Thus, the act of offering a client advice based upon specialized medical knowledge makes up the main activity of the members of the profession (Rue, 1961, p.325).
Health care occupations are characterized by consensus, cooperation and interdependency as a function of complementary professional roles. It is characterized by increasingly fragmented specialized professional labor division (Armor, 1969, p.323). Each profession has a distinct role and socialized membership with an institutionalized set of hierarchical relations between them (Armor, 1969, p.324). Occupations such as law, management and teaching represent different forms of professionalism. Clearly, an occupation such as law is an established profession that has strategic profitable modes of organization, characterized by modes of salaried employment and stretched professional hierarchies (Ackroyd, 2007, p.34). Management occupation, on the other hand, is categorized as an inspiring profession that brings necessary people skills and expertise needed for enterprise success. Specializations in management, such as human resource management, marketing management, and others provide an avenue for professional progression and collective mobility(Armor, 1969, p.323). The occupation of teaching differs from law and management since it is a caring profession. This is reflected through lesser autonomy, status and rewards in teaching compared to law and management professions (Armor, 1969, p.324).
There are various studies that have contributed to the sociology of professions. For instance, Bolton (2008, p.283) describes the “paradoxical processes of feminizations in the professions”. The article is concerned about the feminization of the labor markets with particular interest concentrated on certain professions and sectors. It advances the knowledge of gender as in processes of occupational formation. Specifically, emphasizes the role of gender as a vital resource of professionalization. The entry of women to the labor market in large numbers has impacted heavily some professions and areas of work that typically marginalize women, particularly in higher ranks. Occupations such as law, management and teaching present different views of professions and the place of women within these professions. According to Davies (2000, p.336), these professions perpetuate masculinization. To become or aspire to become a professional requires an individual to comply with behavioral and interactional norms that support and sustain masculine visions of what it is to be a professional. In essence, men dominate senior positions and high-status specializations in established or aspiring professions while women are relegated to perform front-line positions and lesser areas of practice (Bolton, 2008, p.284).
According to Witz (1992, p.64), professionals as empirical entities have historically bounded character. The empirical entities may become entrenched through occupational claims of professionalization. In other words, different occupations may offer different processes, as well as different patterns of professionalization due to their own individual situations. Some professions such as medicine and law represent the archetypal model of the established profession. These occupations provide the formal traits traditionally associated with professionalism. Thus, they give an authoritative example and benchmark for occupations (Etzioni, 1969, p. 65). According to Etzioni (1969, p.70), nursing and other occupations such as teaching have been examined as semi-professions. Although teaching and nursing present many of the structural and organizational traits associated with trait-based theories to professionalism, it has traditionally enjoyed less autonomy over its work, limited control over its knowledge base, and weaker forms of professional association and governance, including fewer rewards and lower social status. Therefore, nursing and teaching appear as subordinate professions (Witz, 1992, p.64).
Lok (1999, p.) argues that professionalism is a social construct where the definition is grounded in its own set discourses, just like the culture. For instance, Freidson (1970, p.4) noted that the vital aim or characteristic of a profession was the autonomy and protection of independence. This forms the common part of the ideology of professionalism. As a result of this autonomy, different professional occupations will tend to embody different values, attitudes and orientations. In the health care context, professions and organizational cultures are products of their histories and are shaped similarly by internal and external factors (Bloor, 1994, p.275). The health care system as a social system is made up of a conglomeration of interacting subcultures, such as; nurses, consultants, nurse managers, and other health care professionals. Such coexistent in the health care system has enabled professionals to nurture new knowledge and stretch their cultural boundaries (Bloor, 1994, p.278).
Degeling et al. (2003, p. 76) demonstrates identified and profiled five occupational subcultures, which include; professional managers, medical managers, medical clinicians, nurse clinicians, and nurse managers. They associated these profiles with distinct attitudes and behavior patterns associated with clinical and managerial work and attitudes to change. Degeling et al. (2003, p.75) in a survey of hospitals in England, Wales New Zealand and Australia discovered that medical clinicians held individualistic conceptions of clinical work. This elaborates the role of professional subcultures in influencing and adapting to the promotion of management-reinforced change initiatives. Significantly, it stresses that professional loyalties of respective subcultures may be stronger than loyalty to the organization. This as such may impede lay managers’ authority in terms of influencing working practices (Bloor, 1994, p.278).
The nurses have a common belief in team-based approaches to patients. Doctors on the other hand prefer to take an individualistic and autocratic approaches to patient care. Doctors prefer a hierarchical relationship which puts them on top of the hierarchy. The importance of multidisciplinary teams is thought in medical schools to doctors, nurses and others in the medical team so that they can work together in the provision of patient care. In addition, this is thought to ensure that the patient is not put at risk because the team does not function properly (Bloor, 1994, p.279).
The extent to which Health Care Organizations Support Organizational Learning
In a health care environment, the ability to learn is very necessary and essential. This is because knowledge and skills in medicine and science need to be constantly updated due to continuous development in these fields. The infusion of businesses and institutions into learning organizations is an important strategy for enhancing efficacy and efficiency. This principle is a relatively new concept in health care whereas it is widely used in the corporate environment (Bloor, 1994, p.288).
A learning organization facilitates all members to learn and transforms or changes itself continually. There is a common belief that facilitating learning in organizations is viewed as the need to improve the number and quality of formal educational training courses available to workers. Whereas these courses are necessary for training and updating employees on new developments in their fields, the efforts to create learning organizations tend to be restrictive in ensuring that employees pursue such formal courses. In an actual sense, the focus on formal courses then turns to a constraint to making and institutionalizing learning that is based on the knowledge and experience of people working in a particular way. In addition, learning opportunities of formal nature offer additional challenges to people working in a rural setting due to the distance from academic institutions and towns. There is the need to overcome constraints such as transport, insufficient funding, and others by the institution and the individual (Witz, 1992, p.64).
There is also a common misconception that learning at the organizational level may be based on individual learning within the organization. In contrast, much research indicates that individual learning does not always result in organizational learning. The mechanisms of organizational learning offer the link between individual-level learning and organizational-level learning. In practice, the experiences and knowledge of individuals are shared, then analyzed collectively and translated by a group into the new standard operating procedure. The recording and distribution of these mechanisms is the last stage in the process of organizational learning. Within the health care environment, continued clinical or medical education or in-service training, mortality reviews, and academic meetings organized within the medical facility would be categorized as learning mechanisms of this nature (Witz, 1992, p.64).
Leadership committed to learning has been identified by research as facilitating informal learning in organizations. According to Amitay et al. (2005, p.57), there is a strong association between transformational leadership, organizational learning values and the existence of learning mechanisms. The learning opportunities on the job, supporting innovative suggestions, rewarding the type of learning, fostering a culture of change and supports innovative suggestions should be generated by the leadership of the learning institution. The changing culture refers to open-mindedness and readiness to transform routines and standard procedures of operation entrenched in organizational custom on the basis of emerging evidence. The health care sector embraces the culture of change which supports the need to unlearn established designs of doing things (Amitay et al., 2005, p.58).
Health care organizational levels encourage teamwork emphasizing mutual respect, trust and communication. According to Pisano et al (2001, p.752), learning is facilitated by cross-functional communication and team membership stability. All these aspects determine the extent to which health care organizations support organizational learning. Carroll (2002, p.51) postulates that organizational learning needs leadership not only from top management but also from senior management, throughout the organization. Whereas hospital management may develop strategy and create a vision, learning will not occur without a commitment from unit managers or senior doctors to encourage and support professional staff in their practical experiments and learning efforts on a routine basis. By supporting unit managers or senior doctors health care institutional management creates an organizational culture that supports organizational learning. This level of leadership offers guidance and support to health care staff in ongoing efforts to introduce change Carroll, 2002, p. 52).
Seniority among professional nurses in terms of years of experience and duration of service and teamwork are linked to the attendance of learning sessions. The nursing profession has strict hierarchical nature, thus, seniority is a major criterion for the selection for attendance of learning sessions. Attendance of learning sessions is the initial step toward organizational learning. Therefore, unit managers and senior doctors ensure that the content of learning sessions is accurate and relevant (Witz, 1992, p.68).
The Concept of Organizational Learning
Organizational learning refers to the procedure of finding and rectifying errors that occur. In this context, errors are features of knowledge that curtail learning. When the procedure allows the organization to execute its present policies or attain its intended objectives, the process may be referred to as single-loop learning.
Learning processes in organizations take place at three levels; individual level, team or group level, and organizational level. Learning at the individual level enables each health care professional to acquire a certain amount of knowledge through education and experience maintaining that professional knowledge up to date and expanding upon it. At the individual level, learning manifests itself in terms of improved professional work techniques and improved treatment results (Kovner, 2008, p.446).
Learning also takes place at team or group levels. At this level, a group or a team of health care workers who work together in a care process develop collective knowledge, skills and competencies. Learning involves collective knowledge and skills acquired in the process of collaboration of the group or team members and the mutually reinforcing competencies. At the team level, learning manifests itself in the improvement of results in a particular process under the team’s responsibility (Kovner, 2008, p.448).
Lastly, learning takes place at the organizational level. Organizational learning is centered upon the knowledge acquired and developed in order to be able to collectively implement the mission of the organization. Learning is directed at the achievement of organizational goals. Organizational learning includes improving the quality of an organization’s overall functioning and developing new services and products. Learning in organizations is manifested in the improvement of the performance of the organization as a whole. Kovner (2008) contends that “organizational learning relates to the experience based on the improvement of the implementation of organizational goal” (p. 438).
In its simple form, organizational learning occurs when an error is detected and consequently rectified. This process is referred to as single-loop learning. Single loop learning does not change the organization or the principle of the health care process. In single-loop learning, an assessment is made whether the health care process met the applicable standard; if it did not, adjustments are made. Many projects of quality improvement nature can be referred to as single-loop learning (Kovner, 2008, p.450).
Double-loop learning entails changing the underlying principles. Double-loop learning is about why health care is delivered in a certain way, why health care professionals collaborate in a particular manner, and to achieve more fundamental and sweeping changes. Learning managers in health care are able to discover and rectify the errors by identifying their own double loop hidden theories of action. Difficulties and the inability to discover faults or errors in health care arise because of poor organizational learning. Undesirable habits and attitudes that make organizations conceal their problems, result in rigidity and deterioration. This can be reversed by double lop learning (Kovner, 2008, p.438).
The theories of professions offer health care organizations a chance to improve the safety of their clients and the quality of care by making use of the knowledge of their workers by examining data on errors. The double-loop learning perspective enables health care services to be delivered in a prescribed way to avoid errors. In other occupations, organizational development and learning strategies have enhanced the focus on ways to effectively and efficiently extract and share what is to be learned about quality and safety. Based on single-loop learning, health care organizations support organizational learning, for instance, through identifying and rectifying events that are undesirable before they cause harm. Such a recovery may happen due to a specific safety investigation or by careful observation. Thus, health care organizations can make assessments to find out if the laid down standards are adhered to (Kovner, 2008, p.438).
Learning in organizations enhances knowledge management as a concept and set of practices. In the health care sector, the concept of knowledge management has penetrated into the fabric of managerial and organizational processes. Organizational learning in health care was centered on the nature of knowing. It is concerned with the highly fragmented and distributed nature of medical knowledge in the health care sector generally. Decisions made in health care related to the health and well-being of people. Clearly, the cost of poor decisions in this sector can be life-threatening. According to Meijboom et al (2004, p.33), the fragmented and distributed nature of medical knowledge creates the need for collaboration across organizational and professional knowledge boundaries. Tagliaventi (2006, p.294), suggests that health care settings are professionalized institutions in which different groups with specific rules, job representations, behaviors and values converge. In addition, Paul (2006, p.144) avers that health care delivery is a collaborative process with both explicit and tacit knowledge aspects, where practitioners of health care perform collaboratively to achieve incomes in terms of access, quality and cost that they would find difficult to accomplish on their own.
Tagliaventi (2006, p.291) highlights the important role of informal networks and communities in conveying evidence to nurses, clinicians, technicians and other health care personnel. Among health care practitioners, the circulation of knowledge relies on professional networks and communities of practice which can be applied as a mechanism for improving the ways in which health care organizations leverage their knowledge basis (Kenner, 2001, p.192).
In sum, progressive health care organizations must have characteristics required to support organizational learning. They can be characterized based on dimensions such as structure, capacity to absorb new knowledge, and receptive context for change at different levels. At the individual level, a health care professional gathers a specific amount of knowledge through education and experience. At the team level, health care workers are able to collaborate in a care process where they acquire collective knowledge, skills and competencies. Lastly, at the organizational level, organizational learning relates to creating knowledge about learning processes at the organizational levels (Kovner, 2008, p.448).
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