Silos and Social Identity: The Social Identity Approach as a Framework for Understanding and Overcoming Divisions in Health Care

Abstract

Context: One of health care's foremost challenges is the achievement of integration and collaboration among the groups providing care. Yet this fundamentally group‐related issue is typically discussed in terms of interpersonal relations or operational issues, not group processes. Methods: We conducted a systematic search for literature offering a group‐based analysis and examined it through the lens of the social identity approach (SIA). Founded in the insight that group memberships form an important part of the self‐concept, the SIA encompasses five dimensions: social identity, social structure, identity content, strength of identification, and context. Findings: Our search yielded 348 reports, 114 of which cited social identity. However, SIA‐citing reports varied in both compatibility with the SIA's metatheoretical paradigm and applied relevance to health care; conversely, some non‐SIA‐citers offered SIA‐congruent analyses. We analyzed the various combinations and interpretations of the five SIA dimensions, identifying ten major conceptual currents. Examining these in the light of the SIA yielded a cohesive, multifaceted picture of (inter)group relations in health care. Conclusions: The SIA offers a coherent framework for integrating a diverse, far‐flung literature on health care groups. Further research should take advantage of the full depth and complexity of the approach, remain sensitive to the unique features of the health care context, and devote particular attention to identity mobilization and context change as key drivers of system transformation. Our article concludes with a set of “guiding questions” to help health care leaders recognize the group dimension of organizational problems, identify mechanisms for change, and move forward by working with and through social identities, not against them.

GPs, nurses and pharmacists as prescribers in primary care: an exploration using the social identity approach / Hausärzte/-innen, Diplomierte Pflegefachpersonen und Apotheker/-innen als Arzneimittelverschreiber/-innen: eine Exploration mit dem Ansatz der Sozialen Identität

“…Once this preliminary inductive analysis had been conducted, MCW explored the emerging clusters of codes and related these to the key dimensions of the SIA. These dimensions included social identity, social structure, identity content, strength of identity and context (Kreindler et al, 2012). These were then further refined with the twin aim of maintaining the integrity of issues and themes emerging directly from the data while drawing out insights, which resonated with the SIA.…”

“…The context, in this case a mutually supportive and respectful working environment, can lead to enhanced levels of interactions between groups. The creation of a multidisciplinary team is in itself a context change (Kreindler et al, 2012). This is relevant not only between traditional prescribers and new prescribers, but also between the new prescribing groups themselves: As noted by Haslam et al (2012), the power of groups is unlocked by working with social identities, not across or against them.…”

“…While this attribute may constrain what they are able to do and have some negative connotations of doing something at a minimal level, these representations went far beyond this to a highly skilled and valued aspect of nurse and pharmacist prescribers' group identity. Indeed, the transformation of competence into a professional virtue is part of an ideology, which reaffirms their own positive distinctiveness and the group's social worth (Kreindler et al, 2012). It can also be seen as an example of social creativity where nurse and pharmacist prescribers, as the lower status group, seek to enhance their standing without challenging the higher status group of GP prescribers (Haslam, Reicher & Reynolds, 2012).…”

“…One perspective that has been increasingly used in health care is the social identity approach (Haslam, 2014). Kreindler et al (2012) argue that professionalization research has provided rich description of the strategies used by professional groups to increase their professional status. However, they suggest this literature focuses on groups' instrumental motivations to gain professional status (e.g.…”

“…SIA explores how we see ourselves, and others, in terms of social categories, and how this affects our perceptions, attitudes and behaviour. SIA has five key dimensions (Kreindler et al, 2012): social identity, how people categorise themselves into an 'in' or 'out' group; social structure, the structural status and power dimensions within a professional setting; identity content, which talks of group members internalising 'group norms', which are used to guide behaviour; strength of identification, the concept that professionals may be members of many groups, but are generally more affiliated with some than others; and context, which describes how organisational structure and working practices can change the way people view each other and alter patterns of group interaction (Kreindler et al, 2012). Haslam (2014) recently reviewed the social identity approach, discussing how previous research using SIT in social psychology can be used to inform practical applications of SIT in health.…”