Doctors and nurses working together : a mixed method study into the construction and changing of professional identities

Abstract

This research investigates the relevance of professional subcultures in a climate of change at a large hospital in South-Western Sydney and addresses the question : 'How do changes associated with health reform impact upon cultural interdependence between professional identities?'. As a corollary, cultural interdependence between professional identities may have profound consequences for health reform and for hospital management. By exploring the two main ideas, Professional Sub-group culture and change, this research draws from existing theory in areas such as organisational culture and cultural change, professional identities and health reform. The thesis addresses three anthropological perspectives of cultural change. It addresses the integration perspective as a homogenous unity by analysing the organisation-wide key ideas (or myths) that make action possible, often espoused by senior management. It addresses the fragmentation perspective as a gathering of transient concerns, by acknowledging the ambiguity and anxiety associated with a state of constant flux. It analyses the differentiation perspective as a collection of subcultures and its commonalities and differences. The change discussed in the thesis was not of an archetypal nature. There was no transformation of the organisational business model at government level. However, at lower levels, actors in the organisation experienced jolts through decreed change from a small district level hospital to a large tertiary level trauma centre. This research re-evaluates the theory on professional identity by establishing to what extent environmental changes and organisational changes impact upon professional identity from three cultural perspectives. This research does this by first assessing the health care organisation for existence of occupational subcultures through survey. The research continues by investigating the relationships between occupational groups through focus group discussion and in-depth interviews. Participant observation is used to illustrate and reflect commonality and diversity. This combination of methods facilitates the analysis of change and professional identity