Accountability

Evolving expectations of clarity, transparency and responsibility from medical doctors or governments towards goals or tasks achievements. Rewards or sanctions may result from met or unmet expectations.

Identify statements about targets, transparency, duties and responsibilities, performance management and the implication of these statements for the medical profession.

Agency

Generic and generative that focuses on the actions at a collective level from governments and medical doctors in the context of reforms.

Such actions aim at demonstrating reflections in regard to their positions and development of appropriate and related strategies.

Identify specific actions and strategies taken by governments and medical doctors within each phase of reforms. Manifestation of agency can be detected from various sources. For instance, a Position Paper by a medical association or an explicit act of opposition from the medical profession to a proposed piece of legislation, or even the use of new policy instruments by the government to influence medical doctors.

Agreements

The act or fact of achieving consensus through formal or informal arrangements and tools (eg, contracts, settlements, joint statements, partnerships, etc).

Identify statements that reflect explicit adhesion or support to the content of reform or some parts of a reform. Agreement also relates to support by both parties on process elements to settle divergence around reforms or explore policy options (for example, creation of an advisory committee composed of representatives of the government and the medical profession).

Alliance

Ad hoc or established coalition between healthcare actors with common values, interests or purpose.

Identify set of individuals, groups or organisations sharing a similar position in regard to the content and the process of a reform.

Autonomy

The manner in which the agency of the profession is related to the expression of some values. Agency builds on autonomy and can be deployed to defend and protect autonomy. Self-regulation, entrepreneurship and collegiality are markers of autonomy for the medical profession.

Identify references to the autonomy of medical doctors in documented or exchanges between the government and the medical profession in the context of reforms.

Change

A transition either induced, contemplated during, or following a reform that has a significant impact from the reformers or the medical profession’s standpoint.

Identify differences in pre and post reform conditions. Empirically documented changes highlighting elements of a reform impacting medical doctors. Assessment of the impact of these variations for the medical profession’s role, practices, status and autonomy.

Coercion

Change imposed on the medical profession as a consequence of a reform.

Identify situations where the government imposes a policy option without giving the medical profession an opportunity to negotiate or avoid a policy adjustment.

Compliance

Voluntary or non-voluntary adherence to a prescription within the context of reforms.

Situation of adoption by the medical profession of the content of reform (policy, rules, regulations etc).

Compromise

An agreement or settlement between the government and the medical profession that result from concessions.

Identification of the government’s and medical doctor’s position on the content or process of reforms. Assessment of change in reform as a result of diverging positions and demands from both parties.

Contestation

Strategy to formally oppose components of reforms that may involve political, economic or legal tools such as litigation, strikes, advertising campaigns, etc. More broadly, it is an overt opposition of the medical profession to policy reforms.

Identification of overt opposition by the medical profession through various strategies within each phase of reforms.

Context

Generic and generative concept including the social, legal, political, organisational and economical dimensions that intersect or may intersect with the development and unfolding of reforms. Elements of context can either be distal or proximal (see Chapter 1).

Identify arguments exposing the rational or motives behind a reform. Identify events or situations in the distal or proximal context that precipitated or shaped the content and trajectory of a reform.

Influence/power

Generic and generative concept that looks at the capacity to impact the evolution and development of a reform, or on the behaviour of an individual, a group or a circumstance or the effect itself. Manifestations of influence and power are multifaceted.

Identify manifestations of influence or power by the medical profession or the government on a reform (for example, active and successful contestation by medical doctors of productivity targets etc). Identify the adoption of a reform by the government in spite of resistance and opposition from the medical profession. Identifying the inclusion or exclusion within the reform’s process of sensitive elements for the medical profession will also be considered as an empirical marker of influence and power.

Interdependence

Varying level of dependence between individuals, tasks or groups with the objective of achieving a common goal.

Identify statements and situations where the need for cooperation between the medical doctors and the government is recognised or factual. Identify elements of sustained collaboration between medical doctors and the government over time in spite of disagreements or divergence.

Leadership

Action of leading a group, an organisation or a project.

Identify individuals taking on a leadership role within government or the medical profession during reforms. Leadership within reforms should manifest itself collectively and in a distributed phenomenon.

Medical profession

Organised bodies representing the interests of medical doctors and the profession within the context of a reform.

Identify groups, associations and organisations within the medical profession that play a role during each phase of the reform.

Negotiated and mediated space

Generic and generative concept that encompasses the interactive field emerging from relationships between governments and the medical profession within the context of a reform.

Empirical assessment of exchanges, negotiations and involvement of actors influencing the development and trajectory of a reform.

Negotiation

An informal and formal process between the medical profession and the government to define a policy that is consequential for reformers or the medical profession.

Identify situations of goal-driven exchanges between the government and the medical profession within a reform with the aim of developing satisfying policies for both parties.

Policy (including policy cycle and instrument)

‘Course of action or inaction chosen by public authorities to address a given problem or interrelated set of problems’ (Pal, 2006: 2). Reforms consist of a package of policies.

Identify policies that have implications for the role, practice, status and legitimacy of the medical profession.

Politics

Elements of distal and proximal context that relate to parliamentary politics, partisan politics with its own rules and priorities.

Identify situations of political shift in government following an election or political crisis. Also encompasses the political colours of the government in power during a reformative period.

Professionalism

Core values and interest shared by a professional group that may be explicitly introduced in a code of conduct. In our research, it also serves as a heuristic to interpret the voice of the medical profession.

Identify elements that relate to the predispositions of medical doctors and the rational provided by medical doctors to justify their involvement and reactions in the reform.

Proposed reform

Proposed policies, contracts, regulations and accountability mechanisms, part of the reformative process.

Identify content and process for each phase, as formulated by the government in the initial reform project.

Regulation

1) Elaboration or modification of norms in order to control or influence people’s behaviours and interactions in healthcare; or

2) The act or process of controlling by rule or restriction; or

3) A rule or order having legal force.

Identifiable regulations proposed or adopted within the context of reforms. Regulations can be identified through the government’s attention and reliance on various types of policy instruments or through the valorisation of various norms in discourses.

Relations

Interactions between the government and the medical profession within the negotiated and mediated space.

Identify interactions within the negotiated and mediated space that can be characterised as collaborative or confrontational, intense or sporadic. The characterisation of a relation can be linked to a specific phase of reform and/or around a specific policy option. Relations may also define a confrontational or collaborative trend across periods of reforms.

Status legitimacy

1) Lawful status of a government (or governmental actor), a profession or an organisation for the execution of a specific set of tasks; or

2) Publicly recognised status of a government (or governmental actor), a profession, an entity or a group for the execution of a specific set of tasks.

Identify legal substrate of government and medical doctor legitimacy. Identify the consequences of strategies used by the government and medical doctors within the negotiated and mediated space impacting their legitimacy.

Strategies

Course of actions developed by the medical profession or government-reformers to influence the development, unfolding and outcome of reforms.

Identify actions developed by the government or the medical profession to influence the content and process of reform.