Abstract

This article enhances our understanding of institutional work, through a study of professional health commissioners in the English National Health Service. Using a case study of mental health policy implementation, commissioners are conceptualized as institutional agents involved in shaping the organizational field and its boundary. Health service commissioners face a series of challenges as institutional agents. Commissioning is a relatively new health profession. It lacks a strong professional association and has predominantly been externally professionalized. Commissioners have limited direct organizational strategic management control. In the case study, commissioners were charged with leading implementation of the policy, which required them to address fragmentation in the field. Using existing typologies as an analytical frame, activities by commissioners in the case study are identified and explored as different modes of institutional work. Commissioners created a new normative network and instigated specific processes to embed and routinize cross-organization working. They undertook boundary-spanning cognitive institutional work, creating new knowledge by commissioning education of school staff in the basics of children’s mental health. Their institutional work involved challenging existing working practices, both in the health field and in the contiguous education field. The article elucidates connections between different modes of institutional work and attends to boundary work by commissioners in parallel with institutional work in the field. It also outlines how a profession seemingly lacking many of the ingredients of institutional power might pursue its own professional project through institutional work. Findings have resonance in other geographical and policy areas and fields.

中文翻译：

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“不是一个行动而是许多行动”：英语NHS中儿童心理健康服务专员的机构工作

摘要

本文通过对英国国家卫生局专业卫生专员的研究，加深了我们对机构工作的理解。通过对精神卫生政策实施的案例研究，专员被概念化为参与塑造组织领域及其边界的机构代理。卫生服务专员作为机构代理人面临着一系列挑战。调试是一个相对较新的卫生专业。它缺乏强大的专业协会，并且主要是外部专业化的。专员对组织的战略管理直接控制有限。在案例研究中，专员负责领导该政策的实施，这要求他们解决实地的零散问题。使用现有的类型学作为分析框架，案例研究中专员的活动被识别和探索为不同的机构工作模式。专员们创建了一个新的规范网络，并启动了具体流程来嵌入和规范跨组织的工作。他们开展了跨越边界的认知机构工作，通过委托对学校员工进行儿童心理健康基础教育来创造新知识。他们的机构工作涉及在卫生领域和连续教育领域挑战现有的工作实践。这篇文章阐明了不同形式的机构工作之间的联系，并着重于专员与现场机构工作同时进行的边界工作。它还概述了一个看似缺乏机构力量的要素的职业如何通过机构工作来追求自己的专业项目。研究结果在其他地理和政策领域和领域引起共鸣。