The role of social identity in doctors' experiences of clinical managing
| DOI | https://doi.org/10.1108/01425450510569300 |
| Pages | 47-70 |
| Published date | 01 February 2005 |
| Date | 01 February 2005 |
| Author | Jerry Hallier,Tom Forbes |
| Subject Matter | HR & organizational behaviour |
The role of social identity in
doctors’ experiences of clinical
managing
Jerry Hallier and Tom Forbes
Department of Management and Organization, Faculty of Management,
University of Stirling, Stirling, UK
Abstract
Purpose – Aims to illustrate how the use of a social identity approach can help to refine our
understanding of how organizational professionals experience the introduction of managerialism and
the incorporation of managing specialist roles.
Design/methodology/approach – Draws on theories of social identity and social categorization to
examine the process by which clinical directors tackle and assign meaning to their managing roles.
Interviews were conducted with a sample of current and previous clinical directors over a five year
period. Variations in doctors’ responses were explained by a range of self enhancement strategies that
emerged to deal with tensions between prepared management identities and actual role experiences.
Findings – Reveals the importance of multiple self-enhancement strategies as a way for doctors to
protect self definitions in failing identity situations where immediate exit from a new role is not
feasible. Concludes that a greater use of social identity and social categorization theory may add much
to general explanations of how varied stances towards management interventions emerge and develop
among professional workers.
Originality/value – Points to how we might achieve a deeper understanding of the diverse ways
that the organizational professionals experience the introduction of managerialism and the
incorporation of managing the specialist roles.
Keywords Doctors, NationalHealth Service, Hospital management, Responsibilities
Paper type Case study
Introduction
Over the last decade, research has drawn attention to a widespread decline in the
standing and autonomy of organizational professions. Driving much of this shift in
status has been a new right critique depicting professions as self serving and wasteful,
at a time of increased competition, deregulation, and concerns over public sector
performance and spending. With a rationale based on a more assertive management
ideology and a less predictable economic environment, employers in different sectors
have seized the opportunity to subject professional activity to performance monitoring
and organizational priorities (Deakin and Walsh, 1994). Yet, despite the widespread
imposition of internal markets, customer care practices, quality improvement
initiatives and the like, doubts continue to be expressed about whether such
interventions constitute a general expansion of management’s influence (Davies and
Kirkpatrick, 1995; Harrison and Pollitt, 1994).
Across a wide range of private and public service professions considerable variation
has been detected in the development and impact of managerialist agendas. Among the
factors seen as most critical to this uneven development has been the differing ability
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Social identity
47
Received October 2003
Revised June 2004
Accepted July 2004
Employee Relations
Vol. 27 No. 1, 2005
pp. 47-70
qEmerald Group Publishing Limited
0142-5455
DOI 10.1108/01425450510569300
of managements to routinise, codify and re-skill specialist knowledge (Fincham and
Rhodes, 1999; Dopson, 1996). Thus, in some settings management values and priorities
have made little headway because specialists have been able to maintain much of their
traditional control over the uncertainty of the task. In other contexts, however,
professionals have been less able to resist the introduction of best practice values. And
here the door has been opened to more formalised organizational controls because
unintentionally professionals have ended up collaborating with the codification and
routinisation of their own expertise.
At one level, then, some of this diversity simply reflects the varied degrees of power
and control over knowledge existing between managements and professionals in
particular occupations or sectors. Yet it would be mistaken to infer from this that
professionals are generally hostile to the notion of incorporating managerial
imperatives (Causer and Jones, 1996; Savage et al., 1992). In both the public and
private sectors, evidence of resistance to management initiatives is found to co-exist
with points of integration and accommodation between managers and professionals
(Glover and Hughes, 1996; Kirkpatrick et al., 1996). And it is in this area of
professionals’ own stances to management initiatives where the studies so far have
been less successful in illuminating the reasons for the variations in responses that
often surface both within and between organizational professional categories.
Undoubtedly, some professional groups have continued to hold out for the right to
professional autonomy and to determine task priorities even in the face of increases in
the power of general management. Elsewhere, as in local government for example,
professionals have been more willing to accept that a loss in autonomy to set overall
organizational goals may be inevitable (McNulty and Coalter, 1996). Yet even here
professional groups may sometimes seize opportunities to colonise management
territory as a way to retain control over core tasks and local priorities, or to become
more influential as managers of resources.
Taking these varied findings together, the dilemma for research has bee n that,
while studies have been able to identify a range of motives which may mediate
the professional group’s willingness and capacity to resist management
imperatives and ideological claims, we are still left unable to explain with any
precision the triggers responsible for the differential responses that often occur
even within the same sectors, specialisms, and work groups. Prominent among the
critical questions still left unanswered include why under some managerial regimes
senior professionals’ conditions and opportunities improve at the expense of those
at lower levels (Ackroyd, 1994); and explaining the factors that determine the
types of perceptions and responses that emerge when professionals assume a
managing role for the first time.
We believe that two features of the established approach to studying
professional-management relations are largely accountable for this inability to
explain and predict the variation between organizational contexts and even sub-g roups
that emerges, sometimes even within the same profession. First, the research has
operated predominantly at a collective professions level of analysis where the full
range of meanings comprising professionals’ stances and behaviours is neither
pursued as an aim in itself nor easily captured. In particular, this collective-professions
level approach is largely silent about the way that managerial interventions affect the
psychological process of individuals and groups. And so, while such an approach can
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