Understanding hybrid roles: the role of identity processes amongst physicians

Increasing attention has been paid in both public administration and organizational theory to understanding how physicians assume a ‘hybrid’ role as they take onmanagerial responsibilities. Limited theoretical attention has been devoted to the processes involved in negotiating, developing, and maintaining such a role.We draw on identity theory, using a qualitative, five-year longitudinal case study, to explore how hybrid physician–managers in the English National Health Service and the organizations they are situated in achieve this. We highlight the importance of saliency – how central an identity is to an individual’s values and beliefs – in managing new identities.We found three differing responses to taking on a hybrid physician–manager role, with identity emerging as a mitigating factor for negotiating potentially conflicting roles. We discuss the implications for existing theory and practice in the management of public organizations and identify an agenda for further research.

Parents' experiences of their children's presence in discussions with physicians about leukemia

OBJECTIVE: We aimed to examine parents' views regarding their preadolescent child's presence during discussions about serious illnesses. METHODS: In-depth qualitative interviews with parents of children receiving treatment for acute lymphoblastic leukemia were conducted. Parents were sampled from 6 UK treatment centers. Analysis was informed by the constant comparative method and content analysis. RESULTS: We report on interviews with 53 parents (33 mothers, 20 fathers). Parents acknowledged the benefits of communicating openly with children, but few thought that their child's presence in discussions was straightforwardly desirable. They described how their child's presence restricted their own communication with physicians, made concentrating difficult, and interfered with their efforts to care for their child emotionally. Children's presence was particularly difficult when significant issues were being discussed, including prognoses, adverse results, and certain medical procedures. Parents felt that such discussions posed a potential threat to their child, particularly when they had not first had an opportunity to discuss information with the physician separately from the child. In contrast, separate meetings enabled parents to absorb information and to convey it to their child at an appropriate time and in a reassuring way. Some parents experienced difficulties in accessing separate meetings with physicians. CONCLUSIONS: The difficulties parents described could potentially be addressed by extending, beyond the diagnosis period, the practice of sequencing significant information so that it is communicated to parents in separate meetings before being communicated to the child and by periodically exploring with parents what information would be in each child's interests.