Health Workers' Practices Among Diverging Institutional Logics in the Field Health and Migration. the Case of Piedmont.

The paper aims to analyse in what ways do health professionals negotiate among different or even diverging institutional logics in their daily encounter with irregular migrants, namely the policy framework on health and migration, the health organizations’ priorities, and health professionals’ values and codes of conduct. In the field of health in particular, ethical and professional values are considered as the fundamental institutional logic for discretionary practices. In such a case, discretion is an expression of a professional culture that orients and legitimizes workers’ practices, and professional codes of conduct often constitute the value system that represent professionals’ main source of legitimacy for action. However, health workers are often public workers, officially charged of policy implementation. They have the responsibility to abide by the law, adhering to given rules and procedures. Moreover, knowledge of their organization’s rules, mechanisms, and goals become relevant as well. In a period characterized by reforms of health systems toward managerialism, shortcuts in public spending, and restrictive policies on immigration, a tension between bureaucratic responsiveness (to the state, the policy, the organization) and bureaucratic responsibility to engage in professional and ethical practices (to the patients) seems to take place in several European countries, where health workers have to deal with a tension between professional values and gatekeeping practices. By presenting the first results of an organizational ethnography in three health organizations in Piedmont, a northern Italian region, the paper will give some insights on how health workers interpret their mission and role when they face conflictual institutional logics in their daily encounters with irregular migrants, highlighting the relevance that managerial decisions and organizational structures in particular may play in orienting and shaping health workers’ practices.