PPOL 8138/SOCY 6138

 

                                     SOCIAL ORGANIZATION OF HEALTH CARE

 

Instructor:  Dr. Teresa Scheid                                                 MW 5:30-9:30

Ext. 4297, email: tlscheid@email.uncc.edu                                            listserv:  dilorg-l                       

 

 

 

Description:

 

This course focuses on the structures and operations of health care institutions and providers.  The topics we will cover include the socio-historical development of the exiting health care system, health care occupations and professions, professional power and autonomy, inter-professional and provider-client relations, health care organizations, and how change affects health care services.

 

 

Texts:

Gary Albright, Ray Fitzpatrick, and Susan C. Scrimshaw. 2000 Handbook of Social

Studies in Health and Medicine. Sage Publications.  Referred to as Reader in outline.

 

Scott, W.R., M. Ruef, P. Mendel, and C.A. Caroneer. 2000. Institutional Change and Organizational Transformation of the Healthcare Field.  University of Chicago Press.

 

Evaluation

 

All work will be graded Pass (B) or High Pass (A).

 

I.  Summaries of Assigned Readings.  You will each be responsible for summaries of two of the assigned readings, and one chapter in the Scott et al. book (three summaries).  At the end of your summary, you should provide an assessment of the content of the reading and a discussion question.  Everyone in the class is to respond to the discussion question.  We will exchange the summaries via the list serve by Monday of the week the reading is assigned, and complete discussion by the following Wednesday.  (30 percent of your grade  @ 10 percent each).  Discussion via the listserv will count toward 10 percent of your grade.

 

II. Textual Analysis: You will complete a textual analysis of a health related book identified on the syllabus (5-7 pages) or a book subject to my approval.  The book must be closely related to the themes discussed in class.  Textual analyses will also be shared via the listserv.  (30 percent of final grade).  Due July 29th.

 

III. Research Paper or Literature Review.  You will also complete paper on a topic of your choice (subject to my review).  (30 percent of final grade). Due August 5th.

 

 

 

 

COURSE OUTLINE

 

July 1.  Introduction to the Course and Each Other.  No Class July 3.

 

Read Chapters 1-3 in Scott et al.

 

July 8-10:

 

I.  Inequalities in Health Care and The Medical Industry:  Focus on the socio-historical development of existing structural arrangements and the relationship of the medical and mental health care sectors to the prevailing political economy.

 

Reader 1.7.  AThe Social Causation of Health and Illness.@  J. Siegrist.

 

Reader 1.10. ACritical Perspectives on Health and Aging.@ C. Estres and K. Linkins.

 

Reader: 3.2 AThe Sociological Character of Healthcare Markets@ by Donald Light.

 

“Socioeconomic disparities in health for the US: An agenda for action.” Nancy Moss.  Social Science and Medicine 51: 1627-1638.

 

 

Recommended Readings:

 

Paul Starr.  1982.  The Social Transformation of  American Medicine. New York:         Basic    Books.

 

Paul Starr.  1994.  The Logic of Health Care Reform. New York: Whittle Press.

 

Waitzkin, Howard.  1983.  The Second Sickness: Contradictions of Capitalistic                         Health Care.  New York: The Free Press.

 

 

July 15-17:

 

II. The Experience of Illness and  Medical Care:  Examination of the patient=s experience of illness and the care provided by medical care providers and various professionals within the health care industry. 

 

Reader 1.1. AThe History of Changing Concepts of Health and Illness.@ Bryan Turner

 

Reader 1.2 ASocial Theorizing About Health and Illness.@ David Armstrong

 

Reader 2.3. APersonal Experience of Illness.@ Arthur Kleinman and D. Seeman.

 

Reader 2.9. AHealth-Care Utilization and Barriers to Health Care.@ J. Kasper

 

Reader 3.3 AMedical Uncertainty Revistied@ by Renee Fox.

 

Recommended Reading:

 

            Hafferty and Wolinsky.  The Changing Medical Profession.

           

            Freidson.  Medical Work in America

 

            Strauss, Anselm, Shizuko Fagerhaugh, Barbara Suczek, and Carolyn Wiener.                1985. Social Organization of Medical Work. Chicago:University of Chicago                      Press.

 

Mechanic, David and Mark Schlesinger. 1996. AThe Impact of Managed Care on

Patients= Trust in Medical Care and Their Physicians.@ JAMA 275 (21): 1693-1697.

 

Baszanger, Isabelle. 1985. "Professional Socialization as Social Control: From Medical Students to General Practioners."Social Science and Medicine 20: 133-143.

 

Findlay, William, Elizabeth Mutran, Rodney Zeitler and Christina Randall.  1990.  "Ques            and Care: How Medical Residents Organize their Work in a Busy Clinic." Journal of      Health and Social Behavior 31: 292-305.

 

Berkman, Barbara, Evelyn Bonander, Irene Ruthchick, Phyllis Silverman, Beth Kemler,             Leonard Marcus, Molly-Jane Isacson-Rubiner.  1990.  "Social Work in Health Care:

Directions in Practice." Social Science and Medicine 31: 19-26.

 

Hafferty, Frederic W. and Donald W. Light.  1995.       "Professional Dynamics and the             Changing Nature of Medical            Work." Journal of Health and Social Behavior (Special Issue)   154-167.

 

 

July 22: (No Class on the 24th.)

           

III.  Professional Power and Autonomy.  One of the perennial themes in the literature on medical professions is the sources of professional status and autonomy, and the threat to this autonomy posed by bureaucratic organizational forms.

 

Reader: 3.1" The Medical Profession: Knowledge, Power, and Autonomy@ by  Coburn

                        and Willis.

 

Reader 3.7. AConsumer and Community Participation.@ Deena White.

 

Light, Donald. 1997. AThe Rhetorics and Realities of Community Health Care: The

Limits of Countervailing Powers to Meet the Health Needs of the Twenty First

Centure.@ Journal of Health Politics, Policy and Law 22: 105-145.

 

Schlesinger, Mark J., Bradford H. Gray and Krista M. Perreira.  1997.  AMedical

Professionalism Under Managed Care: The Pros and Cons of Utilization Review.@

Health Affairs 16: 106-24.

 

Hartley, Heather. 2002. “The system of alignments challenging physician professional

dominance: An elaborated theory of countervailing powers.” Sociology of Health and

Illness 24: 178-207.

 

Recommended Reading:

 

Anderson, James G. 1992.  "The Deprofessionalization of American Medicine." Current            Research in Occupations and Professions 7: 241-256.

 

Hafferty, Frederic W. and Frederic D. Wolinsky, 1991. AConflicting Characterizations of           Professional Dominance." Current Research in Occupations and Professions 6: 225-249.

 

Halpern, Sydney A.  1992.  "Dynamics of Professional Control: Internal Coalitions and Crossprofessional Boundaries." American Journal of Sociology 97: 994-1021.

 

Feldman, Sanford E. and Douglas W. Roblin.  1992. "Standards for Peer Evaluation: The          Hospital Quality Assurance Committee." American Journal of Public Health. 82 (4):

525-527.

 

Waters, Malcolm.  1989. "Collegiality, Bureaucratization, and Professionalization: A      Weberian Analysis." American Journal of Sociology 94: 945-972.

 

 

July 29-31:

 

IV.  Health Care Organizations.  We will examine sociological theories of organizational behavior and focus on how the structure of health care affects medical work and the delivery of health care services.

 

Scott, W.R., M. Ruef, P. Mendel, and C.A. Caroneer. 2000. Institutional Change and Organizational Transformation of the Healthcare Field.  University of Chicago Press.

 

Recommended Reading:

 

Chambliss, Daniel F.   1996.  Beyond Caring: Hospitals, Nurses and the Social

Organization of Ethics.  University of Chicago Press.

 

Bennett, Chris and Ewan Fellie.  1994.  Managing Crisis and Change: The Organizational          Response to AIDS. Open University            Press.

 

Dill, Ann.  1994.  "Institutional Environments and           Organizational Responses to AIDS."     Journal of Health and Social Behavior 35:349-369.

 

Scott, R.A., L.A. Aiken, D. Mechanic and J. Moravcsik.  1995. "Organizational Aspects          of Caring." The Milibank Quarterly        73: 77-93.

 

August 5.

 

V.  Impact of Recent Changes on the Organization and Delivery of Health Care Services.

 

            Reader: 1.1.  “The Social Context of the New Genetics.” Cunningham-Burley and         Boulton.

 

Reader: 3.9. AResources and Rationing: Managing Supply and Demand in Health Care@             by S. Harrison and M. Moran.

 

Reader: 1.6 AThe Globalization of Health and Disease: The Health Transition and Global

Change@ by Zielinski and Kendal.

 

Recommended Reading:

 

Schlesinger, Mark and Bradford H. Gray. 1999. AInstitutional Change and Its

Consequences for the Delivery of Mental Health Services.@  Page 427-448 in

A Handbook for the Study of Mental Health. Edited by AV Horwita and TL

Scheid.  Cambridge University Press.

 

Mechanic, David and Mark Schlesinger. 1993. AChallenges for Managed Competition

from Chronic Illness.@ Health Affairs (Supplement) 12: 123-137.

 

Fennell, Mary L. and Jeffrey A. Alexander.  1993. "Perspectives on Organizational        Change in the US Medical Care Sector." Annual Review of Sociology 19: 89-112.

 

Flood, Ann Barry.  1996.  "The Impact of Organizational Managerial Factors on the      Quality of Care in Health Care Organizations." Medical Care Review 51 (4):

 

Haug, Marie R. 1994.  "Elderly Patients, Caregivers and Physicians: Theory and Research         in Health Care Triads." Journal of Health and Social Behavior 35: 1-12.

 

Light, Donald, Mary L. Fennell and Kristine M. Witkowski.  1995. "The Effects of        Hospital Characteristics and Radical Organizational Change in the Relative Standing of          Health  Care Professions." Journal of Health and Professions 36: 151-167.

 

Weiner, Carolyn L. and Jeanie Kayser-Jones.  1990.  "The       Uneasy Fate of Nursing            Home Residents: An Organizational Interaction Perspective." Sociology of Health and            Illness 12: 84-104.

                                                   SOME ADDITIONAL SOURCES

 

 

Abbott, Andrew. 1988.  The System of Professions.  Chicago: The University of Chicago Press.

 

Aday, Lu Ann, Charles E. Begley, David R. Lairson and Carl H. Slater.  1993.  Evaluating the Medical Care System. Ann Arbor: Health Administration Press.

 

Arney, William R.  1982.  Power and the Profession of Obstretics.Chicago: University of Chicago Press.

 

Atkinson, Paul.  1995.  Medical Talk and Medical Work. Thousand Oaks, CA: Sage Publications.

 

Becker, Howard S., Blanche Geer, Everett C. Hughes and Anselm L. Strauss. 1961. Boys in White: The Student Culture in Medical School. Chicago: University of Chicago Press.

 

Benner, Patricia.  1984.  From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Menlo Park, CA: Addison-Wesley Publishing Co.

 

Bennett, Chris and Ewan Fellie.  1994.  Managing Crisis and Change: The Organizational Response to AIDS. Open University         Press.

 

Broman, Clifford L., Hoffman, William S. and V. Lee Hamilton. 1994. "Impact of Mental Health Service Use on Subsequent Mental Health of Autoworkers" Journal of Health and Social Behavior 35: 80-95.

 

Bosk, Charles L.  1979.  Forgive and Remember: Managing Medical Failure.  Chicago: University of Chicago Press.

 

Bosk, Charles L.  1992.  All God's Mistakes: Genetic Counseling in a Pediatric Hospital. Chicago: University of Chicago Press.

 

Chambliss, Daniel F. 1996.  Beyond Caring: Hospitals, Nurses and the Social Organization of Ethics. Chicago: University of Chicago

 

Davies, Celia.  1995.  Gender and the Professional Predicament in Nursing. Bristol, PA:  Open University Press.

 

Davies, Celia. 1983.  "Professionals in Bureaucracies: The Conflict Thesis Revisited." Pg 117-194 in R. Dingwall and P. Lewis (eds), The Sociology of the Professions. New York: St. Martins Press.

 

Dowdall, George.  1996.  The Eclipse of the State Mental Hospital: Policy, Stigma and Organization. Albany, NY:            SUNY Press.

Freidson, Eliot.  1989.  Medical Work in America: Essays in Health Care. Chicago:       University of Chicago Press (this anthology contains the key historical arguments made     by Freidson about professional power and medical work).

 

Freidson, Eliot.  1986.  Professional Powers: A Study of the Institutionalization of Knowledge. Chicago: University of Chicago Press.

 

Freidson, Eliot.  1984.  "The Changing Nature of Professional Control." Annual Review of Sociology 10: 1-20.

 

 

Frohock, Fred.  1992.  Healing Powers: Alternative Medicine, Spiritual Community, and the State. Chicago: U of Chicago            Press.

 

Foucault, Michel. 1973.  The Birth of the Clinic: An Archaeology of Medical Perception. New York: Vintage Books.

 

Guy, Mary E. 1985.  Professionals in Organizations: Debunking a Myth. New York: Praeger.

 

Hafferty, Frederic W. and John B. McKinley.  1993. The Changing Medical Profession:            An International Perspective.      NY:  Oxford University Press.

 

Hasenfeld, Yeheskel (editor).  1991.  Human Services as Complex Organizations.         Newbury Park: Sage Publications.

 

Klass, Perri.  A Not Entirely Benign Procedure: Four Years As a Medical Student.  Penquin

 

Konner, Melvin.  Becoming a Doctor: A Journey of Initiation in Medical School. Penquin USA.

 

Larson, Magali Sarfatti.  1977.  The Rise of Professionalism. Berkeley: University of California.

 

Light, Donald.  1991. "Social Control and the American Health Care System." Pg. 456-472 in H.E. Freeman and S. Levine (eds.) Handbook of Medical Sociology. 4th Edition. Englewood Cliffs, NJ: Prentice-Hall.

 

Mechanic, David.  1976. The Growth of Bureaucratic Medicine. New York: John Wiley.

 

Millman, Marcia.  1977.  The Unkindest Cut: Life in the Backrooms of Medicine. New York: Morrow Quill Paperbacks.

 

Mizrahi, Terry.  1986.  Getting Rid of Patients: Contradictions in the Socialization of Physicians. New Brunswick: Rutgers University Press.

 

Norton, Thomas W.  1991.  "Understanding Professional Misconduct: The Moral Responsibility of Professions." Journal of Business Ethics 10(8) 620-625.

Ramprogus.  1995.  The Deconstruction of Nursing.  Brookfield, VT:Avebury Publishing.

 

Rosenthal, Marilynn M.  1995.   The Incompetent Doctor. Bristol,         PA: Open University Press.

 

Trice, Harrison M.  1993.  Occupational Subcultures in the Workplace. Ithaca, NY: ILR Press.

 

Turner, Bryan.  1987.  Medical Power and Social Knowledge. Sage.

 

Walsh, Mary Roth.  1977.  Doctors Wanted: No Women Need Apply.

 

Wright, Peter and Andrew Treacher.  1982.  The Problem of Medical Knowledge: Examining the Social Construction of Medicine. Edinburge University Press.