We examine the ‘identity work’ of manager–professional ‘hybrids’, specifically medical professionals in managerial roles in the British National Health Service, to maintain and hybridize their professional identity and wider professionalism in organizational and policy contexts affected by managerialist ideas. Empirically, we differentiate between ‘incidental hybrids’, who represent and protect traditional institutionalized professionalism while temporarily in hybrid roles, and ‘willing hybrids’, who developed hybrid professional–managerial identities during formative identity work or later in reaction to potential professional identity violations. Questions about willing hybrids' professional identities led them to challenge and disrupt institutionalized professionalism, and use and integrate professionalism and managerialism, creating more legitimate hybrid professionalism in their managerial context. By aligning professionalism with their personal identity, and regulating and auditing other professionals, willing hybrids also position hybrids collectively as elite within their profession.

The last two decades have seen a shift in public services organizations from hierarchies to networks. Network forms are seen as particularly suited to handling 'wicked problems'. We make an assessment of the nature and impact of this shift. Using recent evidence from the United Kingdom (UK) National Health Service (NHS), we explore the nature and functioning of eight different public policy networks. We are also interested in whether there has been a radical transition -or notfrom hierarchical to network forms.Most networks were found to relate to 'wicked problems'. We identify from the literature three key domains needed to support a full transition: (1) cross-organizational Information and Communication Technologies (ICTs)/databases (where we found little change);(2) strong Inter Organizational Learning (IOL) (where we also found little change); and (3) a shift from vertical management to lateral leadership (where we found more change). So, hybrid forms, which mix hierarchy and network, endure. We discuss academic and public policy implications. Despite this mixed pattern, public policy networks should be given time to develop, given the many 'wicked problems' faced.

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We here examine the introduction of appraisal for senior medical professionals. Our recent qualitative field research found four main experiences of appraisal (developmental, disappointed reflection, defensive assessment and cynical dismissal of appraisal as a waste of time), which we developed into a typology. We argue many professionals `play tick-box games' to give the impression of auditable practice while continuing to practise in a traditional way. We develop existing theory on the `audit society', social defences and `mock bureaucracy' to explain interrelating defences which occur in appraisal as a reaction to the risks and conflict experienced in professional regulation.

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Managed networks are increasingly common in the British National Health Service (NHS) as a means of streamlining and standardizing patient care across organizational and professional boundaries. However, there has been limited research regarding whether this technique is the most appropriate management style for delivery of health services. This article draws upon the authors' research on managed clinical networks for cancer in the UK-a model that set out to guide and develop knowledge flows across cancer service providers. It examines how the initial purpose of these networks was distorted by the broader function of New Labour's 'modernization agenda', which has ultimately focused on organizational restructuring and adhering to government targets. Our analysis, which develops Lozeau, Langley and Denis's model of the corruption of managerial techniques, suggests that the initial knowledge-sharing purpose of networks underwent top-down 'distortion' by the demands of central government. This resulted in superficial bottom-up adoption of the networks model and limited impact upon organizational processes.

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