Pushing for partnership: physician engagement and resistance in primary care renewal
Journal of Health Organization and Management
ISSN: 1477-7266
Article publication date: 7 February 2019
Issue publication date: 5 April 2019
Abstract
Purpose
Healthcare policymakers and managers struggle to engage private physicians, who tend to view themselves as independent of the system, in new models of primary care. The purpose of this paper is to examine this issue through a social identity lens.
Design/methodology/approach
Through in-depth interviews with 33 decision-makers and 31 fee-for-service family physicians, supplemented by document review and participant observation, the authors studied a Canadian province’s early efforts to engage physicians in primary care renewal initiatives.
Findings
Recognizing that the existing physician–system relationship was generally distant, decision-makers invested effort in relationship-building. However, decision-makers’ rhetoric, as well as the design of their flagship initiative, evinced an attempt to proceed directly from interpersonal relationship-building to the establishment of formal intergroup partnership, with no intervening phase of supporting physicians’ group identity and empowering them to assume equal partnership. The invitation to partnership did not resonate with most physicians: many viewed it as an inauthentic offer from an out-group (“bureaucrats”) with discordant values; others interpreted partnership as a mere transactional exchange. Such perceptions posed barriers to physician participation in renewal activities.
Practical implications
The pursuit of a premature degree of intergroup closeness can be counterproductive, heightening physician resistance.
Originality/value
This study revealed that even a relatively subtle misalignment between a particular social identity management strategy and its intergroup context can have highly problematic ramifications. Findings advance the literature on social identity management and may facilitate the development of more effective engagement strategies.
Keywords
Acknowledgements
This study was funded by an Applied Health Services Research grant from Research Manitoba. The authors are grateful to the policymakers and physicians who provided feedback on earlier drafts, and to Donald Benham and Shannon Winters for assistance with data collection, Sneha Abraham and Judy Dyrland for coordination and administrative support, and Reena Kreindler for her editorial advice.
Citation
Kreindler, S.A., Struthers, A., Metge, C.J., Charette, C., Harlos, K., Beaudin, P., Bapuji, S.B., Botting, I. and Francois, J. (2019), "Pushing for partnership: physician engagement and resistance in primary care renewal", Journal of Health Organization and Management, Vol. 33 No. 2, pp. 126-140. https://doi.org/10.1108/JHOM-05-2018-0141
Publisher
:Emerald Publishing Limited
Copyright © 2019, Emerald Publishing Limited