Den lægelige ledelsesreform og nye stilling som ledende overlæge: En analyse of oplevelser og modstand gennem reform og forandrings- samt professionsteori

Louise Lundby Christensen

Student thesis: Master executive thesis

Abstract

Background

After many years of preparation, the collective agreement negotiations between the Danish Regions and the Association of Specialist Physicians (‘Foreningen af Speciallæger’ FAS) resulted in the spring of 2021 in a new agreement, leading to implementation of a new medical middle management layer 'leading chief physician' (‘ledende overlæge’), whereas the former leading chief physician will change positions to 'chief doctor' (‘cheflæge’). The aim of the management reform is to strengthen the medical management in the Danish healthcare system, strengthening the strategic management, creating a more unambiguous management structure and ensuring a present and professional management. There are great expectations to the management reform, but it will not be easy, as Michael Bech, Professor of Health Economics and Management at VIVE, the national center for research and analysis for welfare, has expressed as follows:
'It's really really necessary, and then it's really really difficult, and then there's something that's going to hurt really really badly'. But why is the new medical management reform necessary? Why is it difficult? And why is something going to hurt? This will be the subject of analysis in this master's thesis.

Problem definition

What experiences and reflections do chief physicians have around the medical management reform and why does resistance arise? Using the reform and change theory as well as theory of professions, the perspectives of chief physicians in various positions concerning both resistance and support to the new management reform will be analyzed:
• How is the experiences with the reform and change process, the coalition of reform, the narrative and the implementation and why does resistance arise?
• What competing institutional logics exist, and can these along with the professional identity and hybrid role explain why resistance arises and why the new role of leading chief physician can be difficult?

Method

Empirical data for this study has been gathered through semi-structured interviews with chief physicians in different positions: A medical deputy director, a chief doctor, two new leading chief physicians, a chief physician responsible for education and two chief physicians with special responsibilities. All respondents are occupied at the same hospital in Region Zealand and six of the respondents at the same department. The semi-structured interviews are supplemented with a quantitative method, where all respondents quantify their sense of identity on a scale from 0 (professional identity strongest) to 10 (leadership identity strongest).

Analyzes and conclusion

Based on theories of reform and change, analyzes of the reform coalition, the reform narrative and the reform implementation shed light on possible reasons why resistance occurs. The reform coalition consists of FAS and Danish Regions. All respondents acknowledge positive elements in the management reform. However, the wording in the negotiation protocol is perceived as vague, which has led to an experience of different interpretations between the parties of the reform coalition. This is evident in particular three key areas regarding the new position as leading chief physician: First the opportunity for chief physicians responsible for education to become leading chief physicians, secondly requirements for personnel management and thirdly the suggested salary. This has led to resistance and a perception that the reform implementation has a rigidity that does not sufficiently take existing structures into account, which challenges a meaningful implementation. The chief physicians in particular experience a lack of and unclear communication around the reform narrative. In the reform implementation, there is doubt and concern whether the parties of the reform coalition want the same, and whether there are the necessary financial and personnel resources to support the implementation. Among the respondents, there are both strong professional and management logics, and these are sometimes seen as opposing and sometimes as supporting each other. In interviews with the new leading physicians, both the pure and the hybrid professional role co-exist as signs of how a fusion of the two logics can take place. Despite the fact that the choice of becoming a leading chief physician is reported as a random choice (‘incidental hybrid’), stories from their world of experience shows examples of a management behavior that indicates a ‘willing hybrid’ role. Although both the medical deputy director and the chief doctor expect that the leading chief physicians will experience a change in the relationships with the chief physician group, it is not something that is reported to a large extend among the new leading chief physicians.

Discussion and perspective

This thesis highlights how chief physicians, leading chief physician, chief doctor and medical deputy director experience that the management reform do not take existing structures and needs sufficiently into account. This leads to barriers and resistance. Surprisingly, it turns out that several chief physicians have opted out of the position of leading chief physician, and that both new leading chief physicians, chief doctor and medical deputy director similarly experience a number of problems that challenge a meaningful implementation of the reform in the departments. Hence, the thesis points in the direction of a further need to adapt the implementation of the management reform to the existing structures and the diversity in the departments' organizations and management structures. This can ease a meaningful implementation that strengthens the medical management.

Furthermore, the thesis highlights the identity work that is expected to accompany the new role as leading chief physician and how the management reform can increase the cross pressure between logics both in the relationship with other colleagues and internally within the identity of the individual. There is therefore both a need for - and great value in - following the development and well-being in the new role as leading chief physician for two reasons in particular. Firstly, to support the management reform and the new leading chief physicians as best as possible. Secondly, because the new management reform creates an organizational and empirical platform to create more evidence about the identity work that comes with new roles at a late stage in the career.

EducationsMaster of Public Governance, (Executive Master Programme) Final Thesis
LanguageDanish
Publication date2022
Number of pages52
SupervisorsAnne Reff Pedersen