The microfoundations of institutional theory and discourse of professionalism: The case of physicians, medical scribes, and electronic health records

This dissertation draws together literature on institutional theory, practice theory, and profession to address the space between policy planning and lived experiences. Using the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 and its electronic health record based Meaningful Use Incentive Program as context, two studies were conducted to explore how professionals react to and within institutional arrangements, drawing on the microfoundations of institutional theory and the discourse of professionalism. More specifically, the first study considers meeting transcripts of policy planning and identifies oppositional forces within the discourse of professionalism that became embedded within electronic health records, which healthcare professionals were mandated to use. As a result of these embedded tensions I argue that physicians had opportunity to create their own discourse of professionalism that pushed back against policy intentions through the addition of medical scribes, which was the focus of the second study. Combined, these studies demonstrate the importance of profession in advancing our understanding of materiality and power within institutional scholarship, and in particular working to connect macro perspectives such as policy planning and micro perspectives such as day-to-day work routines.

Name thesis:degree_name

Ph.D.

Level thesis:degree_level

Dissertation

Discipline thesis:degree_discipline

Communication

Grantor

University of Illinois at Urbana-Champaign

Year dc:date

2022

Author dc:creator

• Bryan, Ann L

Contributors dc:contributor

• Lammers, John C
• Poole, Marshall Scott
• Jackson, Sally A
• Barley, William C

• Electronic health records
• physicians
• medical scribes
• institutional theory
• discourse of professionalism
• profession

Statement dc:rights

• Copyright 2022 Ann Bryan

Language dc:language

en, eng

Handle dc:identifier

https://hdl.handle.net/2142/115540

OAI record oai:identifier

https://www.ideals.illinois.edu/oai-pmh?verb=GetRecord&metadataPrefix=etdms&identifier=oai%3Awww.ideals.illinois.edu%3A2142%2F115540