Do medical professional identities and identification predict organisational performance? Comparing senior psychiatrists in two mental health trusts.

Abstract

Background: Medical engagement is critical to high-performing organisational cultures in healthcare. However, the current literature on medical engagement is under-theorised and fails to take into account the role and impact of medical professional identities and identification in explaining organisational culture and performance in healthcare.

Aim: We provide and test an alternative theoretical explanation of medical engagement as professional identity and identification problems, rooted in doctors' responses to changing configurations of institutional logics in healthcare.

Methods: We conducted a cross-sectional, exploratory survey study comparing two UK National Health Service (NHS) mental health trusts with contrasting Care Quality Commission (CQC) ratings. Senior psychiatrists (n=119) employed at both trusts; 61 (Trust A) and 58 (Trust B) completed the survey (response rate: ~50% in both). Doctors' perceptions of institutional logics, medical professionalism, senior leadership and organisational identification were assessed using a questionnaire previously validated across senior doctors in all specialties in the UK. Organisational identification scores were compared across trusts, and predictors identified using multiple regression.

Results: Psychiatrists in the CQC higher-rated trust reported significantly greater acceptance of hybrid (managerial, financial and political) logics in decision-making, higher confidence in medical and managerial leaders and stronger organisational identification (each p<0.05). Multiple regression analysis (R²= 0.662) indicated doctors' identification with their trusts was independently associated with positive views on leadership quality, a balance between clinical and managerial priorities and willingness to integrate evolving definitions of medical professionalism into their identities. Importantly, psychiatrists in the higher-rated trust were also more likely to recommend their employer as a good place to build a medical career (p<0.01), which is a strong indicator of behavioural identification.

Conclusions: Medical professional identities and identification with their organisations enable high-performing mental health trusts by encouraging senior psychiatrists to integrate hybrid institutional logics and leadership roles into their professional identities. Leadership quality and organisational culture are also key mechanisms linking identification and performance.