Professional projects and institutional change in healthcare: the case of American dentistry

Soc Sci Med. 2012 Feb;74(3):372-380. doi: 10.1016/j.socscimed.2010.10.005. Epub 2010 Oct 23.


This paper combines resources from the organization studies and sociology literatures to advance understanding of institutional change processes in healthcare that emerge from the professionalization projects of occupations. Conceptually, we introduce a model that combines the 'archetype' approach to analyzing structural change with a framework for analyzing the agency of emergent professions. We then employ the model to frame a historical case analysis (1972-2009) of the highly contested process by which the occupation of dental hygiene in the US fought to introduce a new organizational form, the alternative practice hygiene (APH) archetype. This archetype challenges the traditional model (the dentist's office archetype) that is supported by the dominant dentistry profession. Our analysis contributes two main sets of empirical findings. First, we present a systematic comparison of the APH and Dentist's Office archetypes in terms of their belief systems, formal structures, agents, and policy implications (e.g., access to services). Second, we provide an account of the agency of dental hygienists' attempts to secure the APH model as part of their professionalization project.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Delegation, Professional
  • Delivery of Health Care / organization & administration*
  • Dental Hygienists*
  • Dental Offices*
  • Dentistry / organization & administration*
  • Dentistry / trends
  • Empirical Research
  • Health Services Accessibility
  • Humans
  • Models, Organizational
  • Organizational Innovation
  • United States