Who do we think we are?: Analysing the content and form of identity work in the English National Health Service

PURPOSE The language used by National Health Service (NHS) "commissioning" managers when discussing their roles and responsibilities can be seen as a manifestation of "identity work", defined as a process of identifying. This paper aims to offer a novel approach to analysing "identity work" by triangulation of multiple analytical methods, combining analysis of the content of text with analysis of its form. DESIGN/METHODOLOGY/APPROACH Fairclough's discourse analytic methodology is used as a framework. Following Fairclough, the authors use analytical methods associated with Halliday's systemic functional linguistics. FINDINGS While analysis of the content of interviews provides some information about NHS Commissioners' perceptions of their roles and responsibilities, analysis of the form of discourse that they use provides a more detailed and nuanced view. Overall, the authors found that commissioning managers have a higher level of certainty about what commissioning is not rather than what commissioning is; GP managers have a high level of certainty of their identity as a GP rather than as a manager; and both GP managers and non-GP managers oscillate between multiple identities depending on the different situations they are in. ORIGINALITY/VALUE This paper offers a novel approach to triangulation, based not on the usual comparison of multiple data sources, but rather based on the application of multiple analytical methods to a single source of data. This paper also shows the latent uncertainty about the nature of commissioning enterprise in the English NHS.

[1]  K. Lewin,et al.  Field Theory in Social Science: Selected Theoretical Papers , 1951 .

[2]  C. Mills.  The Sociological Imagination , 1959 .

[3]  M. Bakhtin,et al.  The Dialogic Imagination: Four Essays , 1981 .

[4]  Michael Halliday,et al.  An Introduction to Functional Grammar , 1985 .

[5]  D. Snow,et al.  Identity Work Among the Homeless: The Verbal Construction and Avowal of Personal Identities , 1987, American Journal of Sociology.

[6]  Phillip K. Tompkins,et al.  Coming to terms with organizational identification and commitment , 1987 .

[7]  N. Fairclough.  Discourse and social change , 1992 .

[8]  P. Atkinson,et al.  Making sense of qualitative data , 1996 .

[9]  E. Murphy,et al.  Qualitative research methods in health technology assessment: a review of the literature. , 1998, Health technology assessment.

[10]  S. Lamb.  Pathways of the brain , 1999 .

[11]  N. Fairclough,et al.  Discourse in Late Modernity: Rethinking Critical Discourse Analysis , 1999 .

[12]  H. Arksey,et al.  Interviewing for social scientists , 1999 .

[13]  M. Alvesson,et al.  Taking the Linguistic Turn in Organizational Research , 2000 .

[14]  Julio Frenk,et al.  World Health Report 2000: a step towards evidence-based health policy , 2001, The Lancet.

[15]  M. Alvesson,et al.  Identity regulation as organizational control: Producing the appropriate individual , 2002 .

[16]  Mats Alvesson,et al.  Managing Managerial Identities: Organizational Fragmentation, Discourse and Identity Struggle , 2003 .

[17]  Andrew D. Brown,et al.  A Narratological Approach to Understanding Processes of Organizing in a UK Hospital , 2003 .

[18]  N. Fairclough.  Analysing Discourse: Textual Analysis for Social Research , 2003 .

[19]  Ray Robinson,et al.  Purchasing to improve health systems performance , 2005 .

[20]  N. Fairclough.  Peripheral Vision , 2005 .

[21]  M. Edwards,et al.  Organizational Identification: A Conceptual and Operational Review , 2005 .

[22]  S. Bolton.  ‘Making up’ managers , 2005 .

[23]  Exhausting management work: conflicting identities. , 2005, Journal of health organization and management.

[24]  Nerina L. Jimmieson,et al.  Middle managers' uncertainty management during organizational change , 2006 .

[25]  S. Tengblad,et al.  Is There a New Managerial Work? A Comparison with Henry Mintzberg's Classic Study 30 Years Later , 2006 .

[26]  Glen E. Kreiner,et al.  Where is the “Me” Among the “We”? Identity Work and the Search for Optimal Balance , 2006 .

[27]  J. Waring.  Adaptive regulation or governmentality: patient safety and the changing regulation of medicine. , 2007, Sociology of health & illness.

[28]  S. Harrison,et al.  Practice-based commissioning in the national health service: report of a qualitative study , 2008 .

[29]  K. Checkland.  Practice-based Commissioning in the National Health Service: interim report of a qualitative study , 2008 .

[30]  D. J. Myers,et al.  Identity Work in Social Movements , 2008 .

[31]  M. Alvesson,et al.  Identity Matters: Reflections on the Construction of Identity Scholarship in Organization Studies , 2008 .

[32]  Nicola Beech.  On the Nature of Dialogic Identity Work , 2008 .

[33]  Brigid Carroll,et al.  Defaulting to Management: Leadership Defined By What It Is Not , 2008 .

[34]  Pamela Lutgen-Sandvik,et al.  Intensive Remedial Identity Work: Responses to Workplace Bullying Trauma and Stigmatization , 2008 .

[35]  S. Harrison,et al.  Professional legitimacy claims in the multidisciplinary workplace: the case of heart failure care. , 2008, Sociology of health & illness.

[36]  S. Floyd,et al.  The Middle Management Perspective on Strategy Process: Contributions, Synthesis, and Future Research , 2008 .

[37]  T. Watson,et al.  Managing Identity: Identity Work, Personal Predicaments and Structural Circumstances , 2008 .

[38]  James Reveley,et al.  Between narration and interaction: Situating first-line supervisor identity work , 2009 .

[39]  S. Harrison,et al.  ‘We can't get anything done because…’: Making sense of ‘barriers’ to Practice-based Commissioning , 2009, Journal of health services research & policy.

[40]  S. Harrison,et al.  ‘Structural Interests’ in Health Care: Evidence from the Contemporary National Health Service , 2009, Journal of Social Policy.

[41]  S. Harrison,et al.  Local histories and local sensemaking: a case of policy implementation in the English National Health Service , 2010 .

[42]  C. Paton.  Commissioning in the English NHS , 2010, BMJ : British Medical Journal.

[43]  S. Tietze,et al.  Identity, identity work and the experience of working from home , 2010 .

[44]  S. Harrison,et al.  Management practice in primary care organisations: the roles and behaviours of middle managers and GPs , 2011 .

[45]  S. Harrison,et al.  Changing the Ties That Bind? The Emerging Roles and Identities of General Practitioners and Managers in the New Clinical Commissioning Groups in the English NHS , 2014 .