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Paragons, mavericks and innovators – a typology of orthopaedic surgeons’ professional identities. A comparative case study of evidence-based practice
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Grove, Amy L., Pope, Catherine, Currie, Graeme and Clarke, Aileen (2022) Paragons, mavericks and innovators – a typology of orthopaedic surgeons’ professional identities. A comparative case study of evidence-based practice. Sociology of Health & Illness, 44 (1). pp. 59-80. doi:10.1111/1467-9566.13392 ISSN 0141-9889.
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Official URL: https://doi.org/10.1111/1467-9566.13392
Abstract
Clinical guidelines, as vehicles for evidence-based practice (EBP) attempt to standardise healthcare practice, reduce variation and increase quality. However, their use for surgery has been contested, and often resisted. This paper examines professional responses to EBP in hip replacement surgery using data from case study observations and interviews in three English orthopaedic departments. A professional identity perspective is adopted to explain how standardisation through EBP, represents an empirical phenomenon around which surgeons enact their identities as Paragons, Mavericks or Innovators, to enhance legitimacy and stratify themselves in their response to EBP. Attention is drawn to variation between Paragon surgeons working in university (teaching) hospitals and Maverick and Innovator types located in general hospitals, and the ways this interacts with adoption of EBP. The typology shows how practice variation is related to surgeons’ tendencies to align to characteristic types, with distinct social processes, power and prestige, and which are in turn influenced by organisational context. The dynamics of EBP and professional identity continues to limit attempts to standardise surgical practice. The typology contributes to the understanding of failures to follow EBP, as associated with the identities individuals create and negotiate, and with identity narratives used to legitimise differing responses to EBP.
Item Type: | Journal Article | ||||||||
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Subjects: | R Medicine > R Medicine (General) R Medicine > RD Surgery |
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Divisions: | Faculty of Social Sciences > Warwick Business School | ||||||||
Library of Congress Subject Headings (LCSH): | Orthopedic surgery, Orthopedists , Orthopedists -- Professional ethics , Hip joint -- Surgery, Evidence-based medicine | ||||||||
Journal or Publication Title: | Sociology of Health & Illness | ||||||||
Publisher: | Wiley | ||||||||
ISSN: | 0141-9889 | ||||||||
Official Date: | January 2022 | ||||||||
Dates: |
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Volume: | 44 | ||||||||
Number: | 1 | ||||||||
Page Range: | pp. 59-80 | ||||||||
DOI: | 10.1111/1467-9566.13392 | ||||||||
Status: | Peer Reviewed | ||||||||
Publication Status: | Published | ||||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||||
Date of first compliant deposit: | 27 October 2021 | ||||||||
Date of first compliant Open Access: | 10 November 2021 | ||||||||
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