Social identity and self-enactment strategies: Adapting to change in professional-manager relationships in the NHS

Abstract

Significant variation has been identified concerning the impact of management agendas on health professionals in the National Health Service. While attempts to explain these responses among health professions have identified a range of factors to account for such differences, existing research is still unable to explain the sources of variation that can occur within professional groups. Current approaches to studying professional-management relations either attempt to explain variation between organizational contexts and subgroups at a collective level of analysis or they struggle because of the absence of a theoretical framework capable of integrating social, psychological and contextual elements that can explain the sources and purposes of differentiated individual and group behaviours. In the present study, we argue that if we are to go beyond the mere mapping of broad outcomes, we need to develop an understanding of how the effects of imposed managerial agendas on health professional groups come to evolve and take shape. In particular, this requires us to identify a social psychological process framework that can help explain how initiatives aimed at managerializing roles and responsibilities affect the professional employees' understandings of group membership and their relations with hospital management. By using interview data from a group of 18 hospital doctors and through a comparative grounded analysis we show how a social identity perspective may provide a suitable framework to develop verifiable explanations of this process and its implications for nurse managers.