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The purpose of this paper is to study how the expression “integrated management systems” is interpreted in literature, what it means to have an integrated management system (IMS) and what the results of this are.

A literature review was conducted based on Scopus using the search term “Integrated Management Systems.” In the chosen articles, effects of integration, scope, level and extent of integration and if the approach is inside-out or outside-in, have been analyzed.

Most articles on IMS conclude that integration is beneficial regarding cost saving, operational benefits and improved customer satisfaction. The general approach in the articles, describes an inside-out approach with focus on integrating existing management standards. The scope of integration covers typically management systems for quality, environment and occupational health and safety.

An IMS is found to be a system that integrates existing management standards based on an inside-out approach. This indicates possibilities for both practical improvement and research in exploring how integrated stakeholder needs could be managed, possibly as process-based IMSs.

This paper sheds light on the ambiguous interpretation of the IMS concept.

The purpose of this paper is to uncover paradoxes emerging from physicians’ experiences of a patient-centered and team-based ward round, in an internal medicine department.

Abductive reasoning relates empirical material to complex responsive processes theory in a dialectical process to further understandings.

This paper found the response from physicians, to a patient-centered and team-based ward round, related to whether the new demands challenged or confirmed individual physician’s professional identity. Two empirically divergent perspectives on enacting the role of physician during ward round emerged: We-perspective and I-perspective, based on where the physician’s professional identity was centered. Physicians with more of an I-perspective experienced challenges with the new round, while physicians with more of a We-perspective experienced alignment with their professional identity and embraced the new round. When identity is challenged, anxiety is aroused, and if anxiety is not catered to, then resistance is likely to follow and changes are likely to be hampered.

For change processes affecting physicians’ professional identity, it is important for managers and change leaders to acknowledge paradox and find a balance between new knowledge that needs to be learnt and who the physician is becoming in this new procedure.

This paper provides increased understanding about how physicians’ professional identity is interacting with a patient-centered ward round. It adds to the knowledge about developing health care in line with recent societal requests and with sustainable physician engagement.