THE END OF PROFESSIONALISM

Increasingly questions are being raised about the ability of many curr ent health reforms to address the challenges that are facing health sy stems. We investigate this situation by exploring the role of professi onalism in the delivery of health services. In contrast to the dominan t approach of considering professionalism as a social phenomenon, prof essionalism is considered as primarily a task-related phenomenon. The characteristics of the task are identified as being high levels of unc ertainty and complexity. These characteristics are shown to lead natur ally to the key social features that typify professionalism. Hence, th e close link between professionalism and the nature of the task is arg ued. However, health reforms threaten professionalism. They have been based on considerable dissatisfaction with the performance of professi onals as well as the emergence of a number of new challenges. In addit ion, the reforms have been developed without significant consideration of the central role that professionalism has played, and reformers ha ve adopted a simplified view of the task. Thus, the centrality of prof essionalism has intrinsically been downgraded. However, this simplific ation can be shown to be inconsistent with the realities and complexit ies of health service provision, and thus the downgrading of professio nalism is unwarranted. This inconsistency generates many of the confli cts and contradictions being reported. The future of health service re form depends on an effective understanding of the nature of the task, recognition of the central role of professionalism and the development of professional and organisational structures that support each other . (C) 1998 Elsevier Science Ltd. All rights reserved.