Routines As Competency. New Medical Routines for Hybrid Health Care Professionalism

Organizing health care services increasingly encompasses hybrid forms of medical professionalism. Relations between managers and medical professionals become less binary and oppositional; organizational forms become less performance-based and less strictly managerial; medical professionalism itself becomes more organizational. In this paper we focus on the latter trend, as most studies on hybrid professionalism tend to focus on the other two. The rise of ‘organizing professionalism’ (i.e. medical professionalism that includes organizational and managerial capabilities) is usually approached in terms of new competencies. New competency models, such as the CanMEDS model for medical professionalism, circumscribe the new roles and acts that (medical) professionals have to perform, including collaborative and managerial roles. We take another approach; we see competency as an institutional phenomenon, instead of an individual one, and we focus on medical routines in order to analyze institutional competency. Medical routines represent institutionalized aspects of medical acts and practices and might help of hinder the rise and spread of (innovative) hybrid service  delivery that is collaborative and well-organized. We especially focus on the many practical and everyday sides of medical routines. We focus on the everyday sides of organizing health care by medical professionals, including multi-professional collaboration and quality and safety management. We (a) explain what we mean by medical routines as institutional competency, (b) describe current changes in medical routines that enable the rise and spread of collaboration and quality and safety management by medical professionals, and (c) trace effects on medical outcomes. Empirically, we focus on changing routines in a Dutch academic medical center.