To break their destructive antagonism over issues of health service modernisation, doctors and managers should engage more directly with nursing and allied health professionals when responding to reform initiatives

The aim of this article is to outline in discursive-linguistic terms how doctor-managers (or 'physician-executives' as they are termed in the USA) manage the incommensurate dimensions of their boundary position between profession and organization. In order to achieve this we undertook a discourse analytical study of both recorded, situated talk and open interview data focusing on one doctor-manager navigating between profession and organization. The doctor-manager at the centre of this study locates himself on the boundary of at least three discourses which, in many respects, are incommensurate. These are the profession-specific discourse of clinical medicine, the resource-efficiency and systematization discourse of management, and an interpersonalizing discourse devoted to hedging and mitigating contradictions. While this multi-vocality in itself is not surprising, data show that the doctor-manager positions himself across these discourses and manages their inherent incommensurabilities before a heterogeneous audience and on occasions even within the one utterance. In this particular case, boundary management is achieved by weaving incommensurable positions together into the social and linguistic dynamics of a single, heteroglossic stream of talk. This highly complex and dialogic strategy enables the doctor-manager to dissimulate the disjunction between his reluctance to impose organizational rules on his medical colleagues and his perception that such rules, in the future (to some extent at least), will be the appropriate means for managing the clinical work, and through that the organization.A considerable body of now rather dated organizational research focuses on how professionals and trained experts institutionalize themselves or are institutionalized into organizations, and on how this differs from the socializations displayed by managerial, bureaucratic, and other kinds of lay personnel (see, for example, Parsons ). In this work, the position of professional experts is generally accepted to entail a compromise between their socio-collegial allegiance to professional standards and relationships, on the one hand, and their practical and financial dependence on organizationalmanagerial support and facilities, on the other. In contrast to this kind of dichotomization of profession and organization, more recent accounts of organizations and of their professional populations have begun to place centre Organization Studies 25(1): 15-33

The current focus on quality and safety means most doctors have negative views about clinical governance. But done properly, clinical governance has the power to improve NHS performance

This paper documents the resilience of medical and nursing profession-based subcultures and the extent of the differences between them. Against this background, we assess the capacity and willingness of medical and nursing managers to promote changes that will extend the accountability of clinicians and engender more evidence-based, financially driven and output-oriented approaches to service delivery.

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