This research explores how medical directors discursively construct their identity in the challenging context of the National Health Service (NHS). The role of NHS medical manager was created as a hybrid bringing together the conflicting roles of doctor and manager and to help overcome medical resistance to management. The medical director, as the most senior doctor-manager, is a board appointment with responsibility for medical affairs. While this is presented as a high status position allowing doctors to take responsibility for managing their institutions the different demands and identifications could be a site for conflict between the role of doctor and manager within the medical director identity construction. The experience of medical director identity is explored through social identity theory (SIT) (Tajfel & Turner, 1986) and Butler's (1999) theory of performativity. This allows exploration of identity as both enduring and fleeting. Documents outlining the medical director role were examined and several conferences aimed at medical directors observed to provide context. Twenty incumbents were interviewed to explore how they understand their role and experience their identity. Discourse analysis was used to uncover identity experiences and to highlight power struggles enacted through the hybrid. The analysis reveals that the medical director role is ambiguous, that medical identity is robust and that medical management is difficult compared to clinical work. Managerial identity in general, is constructed negatively and from the perspective of doctors. In authoring their own managerial identity medical directors emphasise the positive intellectual challenges of the role but struggle with relationships with their medical colleagues, particularly those in difficulty. The importance of maintaining clinical credibility is both embraced and contested as a resource which bolsters and maintains medical identity and so distinguishes medical directors from the taint associated with the pejorative managerial identity that doctors construct of managers. Medical directors identify themselves as a bridge between management policies and medical professionalism. However, analysis of this discourse demonstrated the ways in which it might maintain separation and preserve medical uniqueness. In conclusion, while the identity of doctor is best understood through SIT as powerful, desirable and stable, medical director identity is seen to be a less stable performative achievement. The hegemonic struggle is localised in the identity of the medical director where the dominant discourse of medicine retains its ascendant status in the very role designed to reduce the divide between medicine and management.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:556749 |
| Date | January 2010 |
| Creators | Joffe, Megan |
| Contributors | MacKenzie-Davey, Kate |
| Publisher | Birkbeck (University of London) |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
Page generated in 0.0019 seconds