Getting Leopards to Change their Spots: Co-creating a New Professional Role Identity

Abstract

We investigated how professional role identity change can be accomplished in highly institutionalized contexts characterized by resiliency. We show that the collective professional role identity of family physicians was changed through a process of reinterpreting multiple logics and their relationships. Through our inductive analyses, we identified four mechanisms that occurred through social interactions and collectively served to rearrange the constellation of logics guiding physician role identity: (1) revealing the influence of a hidden logic, (2) reinforcing the conflict between logics, (3) reframing the meaning of a dominant logic, and (4) re-embedding the new arrangement of logics. We found that the change in physician professional role identity required significant identity work by a group of actors, but particularly by the managers who had been charged with leading the reform initiative. We contribute to the professional role identity and institutional literatures by showing how others can engage in social interactions with professionals to facilitate the reinterpretation and rearranging of institutional logics that guide collective professional role identity. Key words: Professional role identity; Institutional logics; Social interactions INTRODUCTIONFamily doctors are the last bastion of "I'm going to run my own shop and do it my way" and "I've been expected all along to do everything so that's what I've done and I'm not about to change just because you say some nurse is going to come in here and do some work for me now. (Physician interviewed before change initiative) Yes, absolutely it's different [than before]. Physicians are still the key decision-maker, but involving other healthcare professionals. And I think it's almost like a family. You want to know who's in charge of the family. And make sure that there is one person ultimately that becomes kind of like the person to go to -we are that person. (Physician interviewed at end of our study)The above quotes illustrate how family physicians (called general practitioners or GPs in many countries) viewed themselves at the beginning of our study (T0) compared to the end (T3).It is notable that before the implementation of a Canadian government-designed initiative to reform primary health care and family physicians' role, physicians saw themselves as independent, autonomous professionals who treated patients one-by-one in their offices with little, if any, help from anyone else. The heart of the reform initiative was to create multi-3 disciplinary teams of health professionals that included physicians, thereby improving patient care and reducing health system costs. Initially, there was a small group of 'renegade' physicians who visualized a new role identity; however, the majority of physicians were skeptical or disinterested in change. Over the three years of our study, we heard from interviewees how managers became involved in the change initiative, and facilitated (together with renegade physicians and other professionals) the development ...

Identity work in organizations and occupations: Definitions, theories, and pathways forward

“…Individuals also target occupational or professional identities in their identity work, focusing on what it means to be a member of a particular occupational category. Empirical research on identity work has explored a variety of occupational identities ranging from knowledge work occupations such as scientists (e.g., Jain, George, & Maltarich, 2009), investment bankers (e.g., Alvesson & Robertson, 2016), medical professionals (e.g., Reay, Goodrick, Waldorff, & Casebeer, 2017), engineers (e.g., Jorgenson, 2002), architects (e.g., Vough, 2012), lawyers (e.g., Brown & Lewis, 2011), management consultants (e.g., Costas & Kärreman, 2016), academics (e.g., Knights & Clarke, 2014), and accountants (e.g., Gendron & Spira, 2010) to less prestigious occupations such as construction workers (e.g., Styhre, 2012), correctional officers (e.g., Tracy, 2004), exotic dancers (e.g., Grandy & Mavin, 2012), chefs (e.g., Fine, 1996), and miners (e.g., Wicks, 2002). Individuals in both stigmatized occupations (e.g., Ashforth et al, 2007) and well-respected occupations (e.g., Gill, 2015;Knights & Clarke, 2014;Morales & Lambert, 2013;Vough, Cardador, Bednar, Dane, & Pratt, 2013) engage in identity work to deal with identity-based insecurities, anxieties, and misconceptions.…”

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Decolonizing the Ethics of Intellectual Freedom: Exploring a New Intersectional Framework for Allyship and Ethical Practice

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Review of determinants of national medical leadership development

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