Hybrid Manager–professionals' Identity Work: The Maintenance and Hybridization of Medical Professionalism in Managerial Contexts

Abstract

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.

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

“…Here, comparisons of northern and southern Europe (Kirkpatrick et al, 2009;Dent, 2006); and between Australia, England, New Zealand and China (Degeling et al, 2006) indicate that doctors' willingness to accept management roles is more nation-specific than originally supposed. Despite these advances, few attempts to explain differences in identification have been made at an individual level of analysis (Hallier and Forbes, 2005;Cascón-Pereira and Hallier, 2012;McGivern et al, 2015). McGivern et al (2015) for instance, attribute DMs' varied stances to the initial role claiming that leads doctors to take up a manager role with their subsequent role being influenced by institutional logics.…”

“…Despite these advances, few attempts to explain differences in identification have been made at an individual level of analysis (Hallier and Forbes, 2005;Cascón-Pereira and Hallier, 2012;McGivern et al, 2015). McGivern et al (2015) for instance, attribute DMs' varied stances to the initial role claiming that leads doctors to take up a manager role with their subsequent role being influenced by institutional logics. Cascón-Pereira and Hallier (2012) explain DMs' different stances in terms of the emotional experiences elicited by relationships with clinicians or senior managers.…”

“…This recognizes meanings, in particular role-meanings, as the core ingredients with which sensemaking, and identification as a critical element of the sensemaking process, occur (Weick, 1995). Drawing on McInnes and Corlett's framework (2012) which classifies identity work through two dimensions, organizational discourses and interactions, Figure 1 proposes that role-meanings incorporate the influence of established antecedents for DMs' different responses such as social discourses, role models and institutional logics (McGivern et al, 2015), and interpersonal relations (Cascón-Pereira and Hallier, 2012;Hallier and Forbes, 2005), constituting the basis for constructing role-meanings. Figure 1 also shows that attitudes to the hybrid role are mediated by role-meanings and therefore become a source of DMs' identity work.…”

“…While some advances have been made regarding categorising DMs' stances, the understanding of how different responses develop are at best partial. In particular, these studies have plotted variation in doctors' enthusiasm for entering and working in management and classified them into two types, variously described: that is investors versus reluctants (Forbes at al., 2004); adoption of, or alienation from, management values (Martinussen and Magnussen, 2011); cosmopolitans versus locals (Spehar et al, 2012); organization-compatible versus profession-compatible (Hoff, 1999); incidental hybrids versus willing hybrids (McGivern et al, 2015).…”

“…Hallier and Forbes, 2005;Cascón-Pereira and Hallier, 2012;Lewellyn, 2001;Spehar et al, 2012;McGivern et al, 2015). The research has drawn attention to the individual experiences and antecedents of identification with the managerial role.…”