Organisational professional conflict and hybrid clinician managers

Kippist, Louise; Fitzgerald, Anneke

doi:10.1108/14777260911001653

Cited by 87 publications

(57 citation statements)

References 31 publications

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“…We define professional hybrids as individuals with a professional background who have moved into formal managerial roles, which also require them to retain leadership influence within their professional group (Kippist and Fitzgerald ; Marinetto ; Tummers et al . ).…”

Section: Background Literaturementioning

confidence: 99%

Broken ‘Two‐way Windows’? An Exploration of Professional Hybrids

Croft

Currie

Lockett

2014

Public Administration

128

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Professional hybrids are situated between managerial and professional groups, potentially enabling them to move between different organizational groups. Extant research assumes that professional hybrids undergo identity transition to overcome the conflicts associated with influencing two distinct organizational realms. However, how these identity conflicts are managed remains unclear. To explore how professional hybrids manage such identity conflicts we consider the experience of nurse hybrids. Drawing on the concept of liminality we argue that influence across multiple groups relies on the construction of a positive liminal space. In contrast, we demonstrate how nurse hybrids occupy a perverse liminal space, perpetuating identity conflict, preventing identity transition, and undermining their effectiveness as hybrids. Our work calls into question the reliance on professional hybrids as an organizational panacea for reform and develops our understanding of individual hybrids.

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Section: Background Literaturementioning

confidence: 99%

Broken ‘Two‐way Windows’? An Exploration of Professional Hybrids

Croft

Currie

Lockett

2014

Public Administration

128

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“…Within healthcare, the term “hybrid” reflects an underlying assumption that medicine and management represent two different logics, and that a hybrid manager is able to embody, translate and mediate between the logics of management and medicine [5,11-14]. The term is used to refer to doctors [10], but has also been used to describe nurses and other professionals [15,16].…”

Section: Introductionmentioning

confidence: 99%

“…Savage and Scott [17] have defined hybrid management as “a new type of management in which non-medical health care professionals engage in aspects of general (or ‘generic’) management, combining this with their clinical management responsibilities”. While there are national differences in how clinicians have reacted to top-down initiatives, new hybrid roles have appeared in several countries, including Denmark, Finland, England and Australia [4,14,18]. …”

Section: Introductionmentioning

confidence: 99%

Clinicians in management: a qualitative study of managers’ use of influence strategies in hospitals

Spehar

Frich

Kjekshus

2014

BMC Health Serv Res

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BackgroundCombining a professional and managerial role can be challenging for doctors and nurses. We aimed to explore influence strategies used by doctors and nurses who are managers in hospitals with a model of unitary and profession neutral management at all levels.MethodsWe did a study based on data from interviews and observations of 30 managers with a clinical background in Norwegian hospitals.ResultsManagers with a nursing background argued that medical doctors could more easily gain support for their views. Nurses reported deliberately not disclosing their professional background, and could use a doctor as their agent to achieve a strategic advantage. Doctors believed that they had to use their power as experts to influence peers. Doctors attempted to be medical role models, while nurses spoke of being a role model in more general terms. Managers who were not able to influence the system directly found informal workarounds. We did not identify horizontal strategies in the observations and accounts given by the managers in our study.ConclusionsManagers’ professional background may be both a resource and constraint, and also determine the influence strategies they use. Professional roles and influence strategies should be a theme in leadership development programs for health professionals.

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“…7 Given the historical power and influence of the medical profession within health-care organisations, 100 it is perhaps not surprising that this purported shift has received a great deal of research attention. 27,28,60 However, it also bears on a number of important themes in our research concerning the experience of being a manager in health care. These relate to the importance of managerial identity in understanding management practice, how middle management work and leadership are related, what these processes mean for managing the professional-managerial divide and the professionalisation of management itself in the NHS.…”

Section: Discussionmentioning

confidence: 99%

“…59 The dependence on management and markets to drive health care reform has meant that a range of hybrid managerial roles have emerged that require combinations of clinical expertise, public administration and business acumen. 60 Furthermore, there is little standardisation of role titles between and even within trusts, and few people with managerial responsibility actually carry the formal title of manager. 61 As a consequence, the identification of distinct cohorts of managers is a difficult problem in a setting as complex as the NHS.…”

Section: Identifying Managerial Cohortsmentioning

confidence: 99%

Being a manager, becoming a professional? A case study and interview-based exploration of the use of management knowledge across communities of practice in health-care organisations

Bresnen

Hodgson

Bailey

et al. 2014

Health Services and Delivery Research

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BackgroundUnderstanding how managers in the NHS access and use management knowledge to help improve organisational processes and promote better service delivery is of pressing importance in health-care research. While past research has examined in some depth how managers in the NHS perform their roles, we have only limited understanding of how they access management knowledge, interpret it and adapt and apply it to their own health-care settings.ObjectivesThis study aims to investigate how NHS middle managers encounter, adapt and apply management knowledge in their working practices and to examine the factors [particularly organisational context, career background and networks of practice (NoPs)/communities of practice (CoPs)] which may facilitate or impede the acceptance of new management knowledge and its integration with practice in health-care settings. Our research was structured around three questions: (1) How do occupational background and careers influence knowledge receptivity, knowledge sharing and learning among health-care managers? (2) How do relevant CoPs enable/obstruct knowledge sharing and learning? (3) What mechanisms are effective in supporting knowledge receptivity, knowledge sharing and learning/unlearning within and across such communities?Design and settingThree types of NHS trust were selected to provide variation in organisational context and the diversity of services provided: acute, care and specialist foundation trusts (FTs). It was expected that this variation would affect the knowledge requirements faced by managers and the networks likely to be available to them. To capture variation amongst managerial groups in each trust, a selection framework was developed that differentiated between three main cohorts of managers: clinical, general and functional.ParticipantsAfter initial interviews with selected key informants and Advisory Group members, the main empirical phase consisted of semistructured interviews combined with ethnographic observation methods. A purposive, non-random sample of managers (68 in total) was generated for interview, drawn from across the three trusts and representing the three cohorts of managers. Interviews were semistructured and data was collated and analysed using NVivo 9 software (QSR International, Warrington, UK).Main outcome measuresThe analysis was structured around four thematic areas: context (institutional and trust), management (including leadership), knowledge and networks. The research underlines the challenges of overcoming fragmentation across a diffuse managerial CoP in health care, exacerbated by the effects of organisational complexity and differentiation. The research highlights the importance of specific training and development initiatives, and also the value of NoPs for knowledge sharing and support of managers.ResultsThe main findings of the research stress the heterogeneity of management and the highly diverse sources of knowledge, learning, experience and networks drawn upon by distinct management groups (clinical, general and functional); the particular challenges facing general managers in establishing a distinct professional identity based around a coherent managerial knowledge base; the strong tendency for managerial knowledge – particularly that harnessed by general managers – to be more ‘home grown’ (localised) and experiential (as opposed to abstract and codified); and the tendency for this to be reinforced through the difficulties facing general managers in accessing and being actively engaged in wider networks of professionals for knowledge sharing, learning and support.ConclusionsManagement in health care is a complex and variegated activity that does not map onto a clear, unitary and distinct CoP. Improving flows of knowledge and learning among health-care managers involves taking account not just of the distinctiveness of managerial groups, but also of a number of other features. These include the complex relationship between management and leadership, alternative ways of bridging the clinical–managerial interface, the importance of opportunities for managers to learn through reflection and not mainly through experience and the need to support managers – especially general managers – in developing their networks for knowledge sharing and support. Building on the model developed in this research to select managerial cohorts, future work might usefully extend the research to other types of trust and health-care organisation and to larger samples of health-care managers, which can be further stratified according to their distinct occupational groups and CoPs. There is also scope for further ethnographic research that broadens and deepens the investigation of management using a range of observation methods.FundingThe National Institute for Health Research Health Service and Delivery Research programme.

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Organisational professional conflict and hybrid clinician managers

Cited by 87 publications

References 31 publications

Broken ‘Two‐way Windows’? An Exploration of Professional Hybrids

Broken ‘Two‐way Windows’? An Exploration of Professional Hybrids

Clinicians in management: a qualitative study of managers’ use of influence strategies in hospitals

Being a manager, becoming a professional? A case study and interview-based exploration of the use of management knowledge across communities of practice in health-care organisations

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