Hybrid manager-professionals' identity work : the maintenance and hybridization of medical professionalism in managerial contexts

We examine the ‘identity work’ of manager–professional ‘hybrids’, specifically medical professionals in managerial roles in the British National Health Service, to maintain and hybridize their professional identity and wider professionalism in organizational and policy contexts affected by managerialist ideas. Empirically, we differentiate between ‘incidental hybrids’, who represent and protect traditional institutionalized professionalism while temporarily in hybrid roles, and ‘willing hybrids’, who developed hybrid professional–managerial identities during formative identity work or later in reaction to potential professional identity violations. Questions about willing hybrids' professional identities led them to challenge and disrupt institutionalized professionalism, and use and integrate professionalism and managerialism, creating more legitimate hybrid professionalism in their managerial context. By aligning professionalism with their personal identity, and regulating and auditing other professionals, willing hybrids also position hybrids collectively as elite within their profession.

[1]  David A. Buchanan,et al.  Distributed leadership patterns and service improvement : Evidence and argument from English healthcare , 2013 .

[2]  Blake E. Ashforth,et al.  Role Transitions in Organizational Life : An Identity-based Perspective , 2001 .

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

[4]  R. Yin Enhancing the quality of case studies in health services research. , 1999, Health services research.

[5]  B. Townley The Institutional Logic of Performance Appraisal , 1997 .

[6]  F. Lega,et al.  Leadership research in healthcare: A realist review , 2014, Health services management research.

[7]  Justin Waring,et al.  Managing Expert Knowledge: Organizational Challenges and Managerial Futures for the UK Medical Profession , 2009 .

[8]  David J. Cooper,et al.  Business Planning as Pedagogy: Language and Control in a Changing Institutional Field , 1998 .

[9]  Mirko Noordegraaf,et al.  Risky Business: How Professionals and Professional Fields (Must) Deal with Organizational Issues , 2011 .

[10]  R. Kadyschuk Leadership Theory and Practice , 2015 .

[11]  Jane Broadbent,et al.  Professionals and the New Managerialism in the Public Sector , 2000 .

[12]  Y. Steinert,et al.  Role modelling—making the most of a powerful teaching strategy , 2008, BMJ : British Medical Journal.

[13]  S. Chreim,et al.  Interlevel Influences on the Reconstruction of Professional Role Identity , 2007 .

[14]  S. Harrison,et al.  Medical Autonomy and the UK State 1975 to 2025 , 2000 .

[15]  Jane C. Richardson,et al.  Towards ethical practice in the use of archived transcripted interviews , 2003 .

[16]  Louise Fitzgerald,et al.  PUBLIC POLICY NETWORKS AND ‘WICKED PROBLEMS’: A NASCENT SOLUTION? , 2011 .

[17]  I. Kirkpatrick,et al.  Medicine and management in a comparative perspective: the case of Denmark and England. , 2009, Sociology of health & illness.

[18]  A. Strauss Basics Of Qualitative Research , 1992 .

[19]  H. Ibarra,et al.  Identity As Narrative: Prevalence, Effectiveness, and Consequences of Narrative Identity Work in Macro Work Role Transitions , 2010 .

[20]  P. Thomas,et al.  Managerial Organization and Professional Autonomy: A Discourse-Based Conceptualization , 2011 .

[21]  Eliot Freidson,et al.  Professionalism Reborn: Theory, Prophecy and Policy , 1994 .

[22]  Liisa Kurunmäki,et al.  A hybrid profession—the acquisition of management accounting expertise by medical professionals , 2004 .

[23]  T. Reay,et al.  Managing the Rivalry of Competing Institutional Logics , 2009 .

[24]  I. Kirkpatrick,et al.  Introduction: Professions and organizations - a conceptual framework , 2011 .

[25]  Julie Battilana,et al.  The Enabling Role of Social Position in Diverging from the Institutional Status Quo: Evidence from the UK National Health Service , 2011, Organ. Sci..

[26]  Kevin G. Corley,et al.  Seeking Qualitative Rigor in Inductive Research , 2013 .

[27]  Blake E. Ashforth,et al.  Identification in Organizations: An Examination of Four Fundamental Questions , 2008 .

[28]  Stable Url A Theory of Structure: Duality, Agency, and Transformation , 2007 .

[29]  Tom Forbes,et al.  In Search of Theory Development in Grounded Investigations: Doctors’ Experiences of Managing as an Example of Fitted and Prospective Theorizing , 2004 .

[30]  Henry Mintzberg Mintzberg on management : inside our strange world of organizations , 1991 .

[31]  H. Dickinson,et al.  Are we there yet? Models of medical leadership and their effectiveness , 2013 .

[32]  G. Teasdale Learning from Bristol: report of the public inquiry into children's heart surgery at Bristol Royal Infirmary 1984-1995 , 2002, British journal of neurosurgery.

[33]  R. Friedland Bringing Society Back In : Symbols, Practices, and Institutional Contradictions , 1991 .

[34]  M. Hogg,et al.  Social Identity and Self-Categorization Processes in Organizational Contexts , 2000 .

[35]  Louise Fitzgerald,et al.  Professionals: Back to the Future? , 2000 .

[36]  B MilesMatthew,et al.  Qualitative Data Analysis , 2009, Approaches and Processes of Social Science Research.

[37]  Renate E. Meyer,et al.  The SAGE Handbook of Organizational Institutionalism , 2017 .

[38]  Justin Waring,et al.  Institutional Work to Maintain Professional Power: Recreating the Model of Medical Professionalism , 2012 .

[39]  S. Llewellyn `Two-Way Windows': Clinicians as Medical Managers , 2001 .

[40]  Y. Dufour,et al.  Clinical management as boundary management. A comparative analysis of Canadian and UK health-care institutions. , 1997, Journal of management in medicine.

[41]  M. Pratt,et al.  Constructing Professional Identity: The Role of Work and Identity Learning Cycles in the Customization of Identity Among Medical Residents , 2006 .

[42]  A. V. D. Ven,et al.  Institutional Work: Institutional work as the creative embrace of contradiction , 2009 .

[43]  Alana Northrop,et al.  Public Administration , 1968, The Journal of Politics.

[44]  T. Lawrence,et al.  Institutions and Institutional Work , 2006 .

[45]  Mustafa Emirbayer,et al.  What Is Agency?1 , 1998, American Journal of Sociology.

[46]  K. Montgomery A Prospective Look at the Specialty of Medical Management , 1990 .

[47]  Rosemary Deem,et al.  Knowledge, Higher Education, and the New Managerialism: The Changing Management of UK Universities , 2007 .

[48]  Karen Golden-Biddle,et al.  Legitimizing a New Role: Small Wins and Microprocesses of Change , 2006 .

[49]  Mary Ann Glynn,et al.  Beyond Constraint: How Institutions Enable Identities , 2008 .

[50]  N. Nicholson A Theory of Work Role Transitions. , 1984 .

[51]  Michael Lounsbury,et al.  Legitimating Nascent Collective Identities: Coordinating Cultural Entrepreneurship , 2011, Organ. Sci..

[52]  Patricia H. Thornton,et al.  The Institutional Logics Perspective , 2015 .

[53]  J. Walsh,et al.  The Academy of Management annals , 2008 .

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

[55]  Kath Checkland,et al.  Rethinking collegiality: restratification in English general medical practice 2004-2008. , 2009, Social science & medicine.

[56]  Bill Doolin,et al.  Enterprise Discourse, Professional Identity and the Organizational Control of Hospital Clinicians , 2002 .

[57]  W. Wiegand : The System of Professions: An Essay on the Division of Expert Labor , 1990 .

[58]  D. Buchanan Pure plays and hybrids: Acute trust management profile and capacity , 2013 .

[59]  E. Ferlie,et al.  Managing Change and Role Enactment in the Professionalized Organization , 2006 .

[60]  E. Ferlie,et al.  Bringing Anglo-Governmentality into Public Management Scholarship: The Case of Evidence-based Medicine in UK Health Care , 2014 .

[61]  Trish Reay,et al.  Constellations of Institutional Logics , 2011 .

[62]  H. Rao,et al.  Institutional Change in Toque Ville: Nouvelle Cuisine as an Identity Movement in French Gastronomy1 , 2003, American Journal of Sociology.

[63]  H. Dickinson,et al.  Are We There Yet? Models of Medical Leadership and their effectiveness: An Exploratory Study , 2013 .

[64]  T. Hoff Professional commitment among US physician executives in managed care. , 2000, Social science & medicine.

[65]  A. Langley,et al.  The Dynamics of Collective Leadership and Strategic Change in Pluralistic Organizations , 2001 .

[66]  E. Ferlie,et al.  Networks in health care : a comparative study of their management, impact & performance , 2010 .

[67]  Kathleen Montgometry Physician executives: The evolution and impact of a hybrid profession , 2001 .

[68]  H. Ibarra Provisional Selves: Experimenting with Image and Identity in Professional Adaptation , 1999 .

[69]  Amanda H. Goodall,et al.  Physician-Leaders and Hospital Performance: Is There an Association? , 2011, Social science & medicine.

[70]  M. Noordegraaf From “Pure” to “Hybrid” Professionalism , 2007 .

[71]  K. Eisenhardt Building theories from case study research , 1989, STUDI ORGANIZZATIVI.

[72]  Matt Williams,et al.  Knowledge to Action? Evidence-Based Health Care in Context , 2006, BMJ : British Medical Journal.

[73]  Martin James Kitchener,et al.  The `Bureaucratization' of Professional Roles: The Case of Clinical Directors in UK Hospitals , 2000 .

[74]  Thomas B. Lawrence,et al.  Institutional Work: Actors and Agency in Institutional Studies of Organizations , 2009 .

[75]  Louise Fitzgerald,et al.  Beyond Acceptance and Resistance: Entrepreneurial Change Agency Responses in Policy Implementation , 2013 .

[76]  Mustafa Emirbayer What Is Agency ? ' , 2008 .

[77]  M. Gilmartin,et al.  8 Leadership Research in Healthcare: A Review and Roadmap , 2007 .

[78]  Ewan Ferlie,et al.  Playing tick-box games: Interrelating defences in professional appraisal , 2007 .

[79]  Dermot O’Reilly,et al.  The Grit in the Oyster: Professionalism, Managerialism and Leaderism as Discourses of UK Public Services Modernization , 2011 .

[80]  Jeffrey Braithwaite,et al.  ‘It’s an Interesting Conversation I’m Hearing’: The Doctor as Manager , 2004 .

[81]  Rosemary Deem,et al.  Knowledge, Higher Education, and the New Managerialism , 2007 .

[82]  Katherine C. Kellogg Operating Room: Relational Spaces and Microinstitutional Change in Surgery1 , 2009, American Journal of Sociology.

[83]  S. Halford,et al.  Professionals and the new managerialism in the public sector , 1998 .

[84]  H. Ibarra,et al.  Identity-Based Leader Development , 2010 .

[85]  S. Clegg The SAGE Handbook of Organization Studies , 2006 .

[86]  W. E. Douglas Creed,et al.  Being the Change: Resolving Institutional Contradiction through Identity Work , 2010 .