Role-meanings as a critical factor in understanding doctor managers' identity work and different role identities.

This study examines "identity work" among hybrid doctor-managers (DMs) in the Spanish National Health System to make sense of their managerial roles. In particular, the meanings underlying DMs experience of their hybrid role are investigated using a Grounded Theory methodology, exposing distinctions in role-meanings. Our findings provide evidence that using different social sources of comparison (senior managers or clinicians) to construct the meaning of managerial roles leads to different role-meanings and role identities, which are the source of the two established types of DM in the literature, the reluctant and the enthusiast. The contribution is twofold: our findings lead us to theorize DMs' identity work processes by adding an overlooked role-meaning dimension to identity work; and raise practical reflections for those who wish to develop enthusiast doctor managers.

Social identity and self-enactment strategies: adapting to change in professional-manager relationships in the NHS.

Significant variation has been identified concerning the impact of management agendas on health professionals in the National Health Service. While attempts to explain these responses among health professions have identified a range of factors to account for such differences, existing research is still unable to explain the sources of variation that can occur within professional groups. Current approaches to studying professional-management relations either attempt to explain variation between organizational contexts and subgroups at a collective level of analysis or they struggle because of the absence of a theoretical framework capable of integrating social, psychological and contextual elements that can explain the sources and purposes of differentiated individual and group behaviours. In the present study, we argue that if we are to go beyond the mere mapping of broad outcomes, we need to develop an understanding of how the effects of imposed managerial agendas on health professional groups come to evolve and take shape. In particular, this requires us to identify a social psychological process framework that can help explain how initiatives aimed at managerializing roles and responsibilities affect the professional employees' understandings of group membership and their relations with hospital management. By using interview data from a group of 18 hospital doctors and through a comparative grounded analysis we show how a social identity perspective may provide a suitable framework to develop verifiable explanations of this process and its implications for nurse managers.

Doctors as managers: investors and reluctants in a dual role.

Government reform of the NHS in the UK has sought to increase the involvement of doctors (clinicians) in hospital management. Using frameworks from the psychological contract and organisational misbehaviour literatures, this paper examines the processes involved when clinicians assume management roles. This literature seeks to explain breaches to expectations regarding prior agreements with management and subsequent actions of 'getting even' as a result of breaches to the employment relationship. A qualitative methodology using interviews was undertaken, which identified two distinct groups of clinician-manager. Investors actively pursued a management opportunity as an alternative to clinical medicine, whilst reluctants tended to assume a management role to protect particular specialities from outside influence or from those they thought would be inappropriate clinician-managers. Investors and reluctants often had very little prior experience of management and managers and had problems reconciling their dual clinician-management role. Poor relationships with hospital managers who often had no understanding of their dual responsibilities led to tensions and conflict, which questions continued developments in this important area of UK health policy. Suggestions for improving this process are outlined.