Mobilising identities: the shape and reality of middle and junior managers working lives - a qualitative study

Background: Social identities shape how individuals perceive their roles and perform their work. Yet little is known about the identities of various types of NHS managers and even less about how they may influence how they carry out their work to achieve effectiveness. Objectives: To chart the work of middle and junior clinical and non-clinical managers; to describe how their identities are constructed and shape the performance of their roles; to explore how they mobilise their identities to achieve effectiveness. Design: Qualitative research. Setting: Two large English hospital trusts. Participants: Data consisted of 91 semistructured interviews with four primary categories of managers [junior clinical (JC), junior non-clinical (JNC), middle clinical (MC), and middle non-clinical (MNC)], shadowing of a small subsample, observations of meetings. For some analyses the four categories were broken down into finer-grained ‘work groups’. The data were analysed both qualitatively, using the constant comparative method, and quantitatively, using the method of ‘quantitising’ (the numerical translation of qualitative data). Results: Respondents’ identities as managers were not particularly strong. Results reveal a more nuanced and widely spread portrait of the ‘reluctant manager’ than hitherto reported. The picture of what managers do was complex and multifaceted. On some dimensions, such as ‘span of responsibility’, ‘span of control’ and cross-site working, internal variations by ‘work group’ indicate that comparisons between the four primary categories were not particularly meaningful. Variety was added to by internal diversity even within ‘work groups’. Analyses of self-reported effectiveness revealed that ‘hard’, demonstrable measures of performance (‘transactional effectiveness’) were important to all four categories of managers; however, many were also concerned with ‘softer’ indicators involving enabling, supporting and developing a team (‘processual effectiveness’). Many felt ‘processual effectiveness’ fed ‘transactional effectiveness’. It was also regarded as a form of effectiveness in its own right that could be compromised by undue attention to ‘transactional effectiveness’. Across all categories respondents mobilised both managerial identities and ‘other’ professional identities (e.g. nurse, doctor, accountant or scientist) for effectiveness. Although mobilisation capacities of ‘other’ identities were fairly explicit, managerial identity often appeared ‘in disguise’. There was a tendency to refer to experience or tenure within the organisation as a resource to influence others and to cite ability to communicate as their personality trait, yet this implies skilled knowledge of organisational context. Equally, identifying, for example as a ‘people person’, encompasses a raft of management skills such as the ability to translate specific demands placed on their subordinates by the organisation in terms that are clear and meaningful. The research also revealed that the ‘mobilising capacities’ of the ‘facets of identity’ of the various ‘work groups’ were subject to identity constraints arising from others ‘above’, ‘below’ and ‘laterally’, as well as from the wider organisation (such as culture, resources) and their workload. For clinical managers, it was also constricted by juggling clinical and non-clinical work within time constraints. Conclusions: Many respondents struggled with their identities as managers. Given that a strong identity is associated with uncertainty reduction and employee strengthening, more work is needed to improve how positive identities can be fostered both among managers themselves and amongst those with whom they interact. To fully comprehend the relationship between self-perceived identities and how managers carry out their work it is recommended that future research gives attention not only to variation across but also within primary categories and work groups. Funding: The National Institute for Health Research Health Services and Delivery Research programme