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

Cascón‐Pereira, Rosalía; Chillas, Shiona; Hallier, Jerry

doi:10.1016/j.socscimed.2016.09.043

Cited by 19 publications

(20 citation statements)

References 44 publications

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“…Role theory describes typical behaviour patterns of social and working life (“roles”) [ 15 ]. Few studies have used role theory in understanding health service delivery [ 16 , 17 ], the implementation of health system innovations [ 18 ], or how clinical governance works. We engage with these issues in the South African context in light of the introduction and early implementation of the DCST role.…”

Section: Introductionmentioning

confidence: 99%

Implementation of district-based clinical specialist teams in South Africa: Analysing a new role in a transforming system

Oboirien

Harris

Goudge

et al. 2018

BMC Health Serv Res

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BackgroundImproving the quality of health care is a national priority in many countries to help reduce unacceptable levels of variation in health system practices, performance and outcomes. In 2012, South Africa introduced district-based clinical specialist teams (DCSTs) to enhance clinical governance at the lowest level of the health system. This paper examines the expectations and responses of local health system actors in the introduction and early implementation of this new DCST role.MethodsBetween 2013 and 2015, we carried out 258 in-depth interviews and three focus group discussions with managers, implementers and intended beneficiaries of the DCST innovation. Data were collected in three districts using a theory of change approach for programme evaluation. We also embarked on role charting through policy document review. Guided by role theory, we analysed data thematically and compared findings across the three districts.ResultsWe found role ambiguity and conflict in the implementation of the new DCST role. Individual, organisational and systemic factors influenced actors’ expectations, behaviours, and adjustments to the new clinical governance role. Local contextual factors affected the composition and scope of DCSTs in each site, while leadership and accountability pathways shaped system adaptiveness across all three. Two key contributions emerge; firstly, the responsiveness of the system to an innovation requires time in planning, roll-out, phasing, and monitoring. Secondly, the interconnectedness of quality improvement processes adds complexity to innovation in clinical governance and may influence the (in) effectiveness of service delivery.ConclusionRole ambiguity and conflict in the DCST role at a system-wide level suggests the need for effective management of implementation systems. Additionally, improving quality requires anticipating and addressing a shortage of inputs, including financing for additional staff and skills for health care delivery and careful integration of health care policy guidelines.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3377-2) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Implementation of district-based clinical specialist teams in South Africa: Analysing a new role in a transforming system

Oboirien

Harris

Goudge

et al. 2018

BMC Health Serv Res

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“…There is sensemaking involved in this process, e.g. leaders are processing their lived experience as a doctor, nurse, or administrator and forming strategies for future action based on these role interpretations, chalking out their 'comfort zone' in the process (Cascón-Pereira, Chillas & Hallier, 2016).…”

Section: Conceptual Framework: a Social Psychological Lens On Senior mentioning

confidence: 99%

“…Such clarity is also required for leaders at the higher echelons of their organizations, and needs to be set by the larger organization, in this case, the NHS. There is value in experimenting with provisional leader selves (Cascón-Pereira et al, 2016) and creating formative spaces such as 'action groups' for reflection and learning together in this regard.…”

Section: Implications For Practicementioning

confidence: 99%

Making sense of effective partnerships among senior leaders in the National Health Service

Mitra

Hoff

Brankin

et al. 2017

Health Care Manage Rev

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“…Alternative analyses have foregrounded more active professional responses to this changed political and social environment. Particular attention has focused on the emergence of clinical managers as new professional elites operating at the intersection between the medical profession and organisations ( Cascón-Pereira et al, 2016 ; Correia and Denis, 2016 ; Kuhlmann et al, 2013 ; Martin and Waring, 2013 ). Such ‘hybrids’ ( McGivern et al, 2015 ) offer insights how the medical profession has responded to regulatory and organisational reforms.…”

Section: Introductionmentioning

confidence: 99%

“…Such willing hybrids may be seen as embodying ‘organisational professionalism’ ( Evetts, 2009 ), working within organisational hierarchies and systems for the control of professional work. Research into the identity work of hybrid professionals has highlighted that identity formation in doctor-managers is strongly influenced by contextual and institutional factors ( Cascón-Pereira et al, 2016 ; Currie et al, 2009 ; Correia and Denis, 2016 ). Organisational context has been identified elsewhere as an important element in shaping how ROs' make revalidation recommendations ( Webster and McLachlan, 2011 ).…”

Section: Introductionmentioning

confidence: 99%

Policing the profession? Regulatory reform, restratification and the emergence of Responsible Officers as a new locus of power in UK medicine

Bryce

Luscombe

Boyd

et al. 2018

Social Science & Medicine

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Doctors' work and the changing, contested meanings of medical professionalism have long been a focus for sociological research. Much recent attention has focused on those doctors working at the interface between healthcare management and medical practice, with such ‘hybrid’ doctor-managers providing valuable analytical material for exploring changes in how medical professionalism is understood. In the United Kingdom, significant structural changes to medical regulation, most notably the introduction of revalidation in 2012, have created a new hybrid group, Responsible Officers (ROs), responsible for making periodic recommendations about the on-going fitness to practise medicine of all other doctors in their organisation.Using qualitative data collected in a 2015 survey with 374 respondents, 63% of ROs in the UK, this paper analyses the RO role. Our findings show ROs to be a distinct emergent group of hybrid professionals and as such demonstrate restructuring within UK medicine. Occupying a position where multiple agendas converge, ROs' work expands professional regulation into the organisational sphere in new ways, as well as creating new lines of continuous accountability between the wider profession and the General Medical Council as medical regulator. Our exploration of ROs' approaches to their work offers new insights into the on-going development of medical professionalism, pointing to the emergence of a distinctly regulatory hybrid professionalism shaped by co-existing professional, managerial and regulatory logics, in an era of strengthened governance and complex policy change.

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

Cited by 19 publications

References 44 publications

Implementation of district-based clinical specialist teams in South Africa: Analysing a new role in a transforming system

Implementation of district-based clinical specialist teams in South Africa: Analysing a new role in a transforming system

Making sense of effective partnerships among senior leaders in the National Health Service

Policing the profession? Regulatory reform, restratification and the emergence of Responsible Officers as a new locus of power in UK medicine

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