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Aims to illustrate how the use of a social identity approach can help to refine our understanding of how organizational professionals experience the introduction of managerialism and the incorporation of managing specialist roles.

Draws on theories of social identity and social categorization to examine the process by which clinical directors tackle and assign meaning to their managing roles. Interviews were conducted with a sample of current and previous clinical directors over a five year period. Variations in doctors’ responses were explained by a range of self enhancement strategies that emerged to deal with tensions between prepared management identities and actual role experiences.

Reveals the importance of multiple self‐enhancement strategies as a way for doctors to protect self definitions in failing identity situations where immediate exit from a new role is not feasible. Concludes that a greater use of social identity and social categorization theory may add much to general explanations of how varied stances towards management interventions emerge and develop among professional workers.

Points to how we might achieve a deeper understanding of the diverse ways that the organizational professionals experience the introduction of managerialism and the incorporation of managing the specialist roles.

The purpose of this paper is to explore issues of medical engagement in the management and leadership of health services in the English National Health Service (NHS). The literature suggests that this is an important component of high performing health systems, although the NHS has traditionally struggled to engage doctors and has been characterised as a professional bureaucracy. This study explored the ways in which health care organisations structure and operate medical leadership processes to assess the degree to which professional bureaucracies still exist in the English NHS.

Drawing on the qualitative component of a research into medical leadership in nine case study sites, this paper reports on findings from over 150 interviews with doctors, general managers and nurses. In doing so, the authors focus specifically on the operation of medical leadership in nine different NHS hospitals.

Concerted attention has been focussed on medical leadership and this has led to significant changes to organisational structures and the recruitment and training processes of doctors for leadership roles. There is a cadre of doctors that are substantially more engaged in the leadership of their organisations than previous research has found. Yet, this engagement has tended to only involve a small section of the overall medical workforce in practice, raising questions about the nature of medical engagement more broadly.

There are only a limited number of studies that have sought to explore issues of medical leadership on this scale in the English context. This represents the first significant study of this kind in over a decade.

This article is drawn from doctoral research exploring the identity struggles faced by professionals who take on management and leadership roles. The research focused on the experience of medical directors – the most senior doctor‐manager with board responsibility for medical affairs. Based on the fact that a medical director is a hybrid manager this research has implications for any professional who takes on a managerial or leadership role while continuing to practice their profession. Some challenges of working as a hybrid are associated with the difference in orientations between professionals and managers. While the notion of who and what a professional is has changed and new forms of accommodation have been forged the hybrid identity remains a site of potential conflict for the individual and those they work with. The purpose of this paper is to explore the experience of the hybrid identity.

The experience of the hybrid identity is explored through social identity theory (Tajfel and Turner).

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. The importance of maintaining clinical credibility is both embraced 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.

The implications for the selection, training and development of doctors and medical directors are raised as are those for the relationship between doctors and patients, and doctors and the organisation. Some implications identified, specifically for leadership in practice are as follows: leadership/management is challenging and difficult compared to professional work; language use is significant for how leaders are perceived; language use has implications for leader effectiveness; early exposure to leadership for professionals is important; and leadership role definition is important for consistency and role credibility.

Based upon empirical research conducted in 1993, attempts to illustrate the implications of efforts to bring doctors into management. It addresses in particular the role of key appointments such as the medical director and clinical directors and the perceptions of these roles. Doctors continue to demonstrate themselves to be reluctant managers and this continues to pose problems for the aspirations contained in Working for Patients. Crucial questions must be asked about whether management represents a productive use of doctors′ time and whether the NHS can afford premium rates for largely inexperienced managers. Identifies changes that have taken place to date and indicates that doctors are, for the most part, still lukewarm about a career in medical management.

Uses an empirical investigation based on a survey of junior doctors in five NHS trust hospitals, to examine their attitudes towards both the general principle of clinical involvement in hospital management and the particular prospect of exercising such a role themselves. Finds that junior doctors, with few exceptions and irrespective of grade, were very positive towards clinical management roles in NHS trusts and were almost universally keen to assume management responsibilities when they were more senior. At the same time, finds junior doctors to have little concept of the doctor‐ manager role or the recognized and demanded specific preparation for assuming management responsibilities.

Considers progress made in involving doctors in management, drawing on available ethnographies of local health‐care systems and a small‐scale study of consultants who have moved into clinical director roles or the equivalent. Specifically considers the extent to which the sample believes consultant roles have changed as a result of the recent reorganization of the NHS and general concerns about the involvement of doctors in management.

Reviews the role of clinical directors from outside the usual managerial framework to challenge the managerial myth applied to professionals who take on these roles. Defines management, managing, managerialism and leadership and develops an empirical framework to compare the roles of doctors and managers. Uses the framework to identify the cognitive map that clinical directors use and how they perceive their role. An emergent model illustrates how clinical directors combine a new cognitive map with their existing professional behaviours to undertake their role. Clinical directors both perceived and described their role in terms of leadership rather than management reinforcing the inappropriateness of using managerial frameworks. Instead clinical directors should be developed and evaluated as professional leaders. This raises wider questions of whether management and the language of management are either useful or appropriate for professionals in the NHS or whether their value is really a myth.

Doctors are seen as key to embedding health improvement and patient safety initiatives and there has been much international debate over how best to engage doctors in healthcare leadership and management. This paper explores the current focus on leadership development programmes for doctors through taking a comparative approach to initiatives in New Zealand and the UK. It also considers the challenges to embedding leadership development programmes at all levels of training, education and continuing professional development and highlights some of the implications arising from the two approaches.

As a consequence of new public management reforms, leading professionals in public service organizations have increasingly been involved in management roles. The phenomenon of clinical directors in the healthcare sector is particularly representative of this, as this medical manager role has been adopted in many countries around the world. However, professionals’ managerial role taking still falls quite short of expectations. While most research has searched for the causes of this gap at the individual level by exploring the clash between management and professionalism, the purpose of the paper is to argue that a contextualized understanding of the antecedents at the organizational level, and particularly the existing medical management roles, provides a more thorough picture of the reality.

The paper adopts an institutional perspective to study the development of existing medical management roles and the rise of new ones (clinical directors). The analysis focuses on the case of Italy, a country with a tradition in medical management where, following the example of other countries, clinical director roles were introduced by law; yet they were not incisive. The paper is based on a review of the existing literature and extensive field research on Italian clinical directorates.

The paper shows how in contexts in which doctors in management roles exist and are provided with legitimacy deriving from legal norms, historical settlements between professions and taken for granted arrangements, medical management becomes institutionalized, stability prevails and change towards new doctor-in-management roles is seriously hampered.

The paper contributes to existing knowledge on professionals’ managerial role taking, underlining the relevance of contextual and nation-specific factors on this process. It provides implications for research and for policy making in healthcare and other professional public services.

In the collective or distributed leadership models that are now increasingly dominant in the literature about leadership in public services, the role of the “practitioner as leader” takes on powerful significance. The purpose of this paper is to address a gap in this corpus of research, which is a critical analysis of what constitutes the role of the practitioner leader, and the strengths and limitations of these informal leaders as agents of organisational change.

The paper develops a critical comparative analysis of the role of ordinary teachers and doctors as leaders, as a way of gaining purchase on what comprises and shapes the role of practitioner leader and the potential of this form of leadership to be a driver for quality improvements in the public sectors of education and health.

Traversing traditional academic divides and comparing medical and teacher leadership provides a clearer picture of how professional and organisational culture strongly influences the roles that practitioner leaders can take up and the influence they can wield. This comparison also shows that building capacity of practitioner leadership in the public services should be approached as an expansion of professional identity, rather than an “added extra” for keen few.

Importantly, this critical comparative review indicates that practitioner leadership is best understood and fostered as a particular ethical stance, rather than a special form of power or knowledge and that it occupies an interstitial space in between formal leadership structures and ordinary practitioners. This is both its strength and its weakness as a form of leadership.