The regulation and reconciliation of hybrid professional-managerial identities in a public hospital: the case of Lean management

This study aims to examine how hybrid medical managers in a public hospital reconcile their identities and involvement in management-introduced top-down interventions to improve operational performance. In our study, Lean serves as an example of a management intervention through which we examine how hybrids shape the implementation of managerial interventions in a public hospital. Design/methodology/approach: We gathered our data from a longitudinal qualitative study of a Lean initiative implemented in an Australian public hospital. The current analysis is part of a larger case study which involved 87 in-depth semi-structured interviews over three years in a major Australian public hospital. These interviews explored experiences of Lean and included senior managers, middle managers, hybrids, clinical staff and others. In this paper, we focus specifically on the experiences of hybrid medical managers. Findings: We demonstrate how the Lean initiative sparks identity-reconciliation work that differs among hybrids working in different parts of the hospital and with various contractual arrangements and levels of participatory voice. The hybrids in our study responded to the introduction of Lean, with heightened identity reconciliation work, but in different ways. This appears to be attributable to the organisational context, and particularly the hybrids’ contractual arrangements with the hospital. Originality/value: There is a dearth of research in healthcare management that has sought to understand how hybrids reconstruct their identities in response to top-down implementations of managerial initiatives, such as Lean. Our findings offer healthcare managers practical insights into the engagement of hybrid-medical professionals through our novel understanding of the identity-reconciliation work necessary for hybrid professionals to engage with management initiatives.