Refinements to the study of the day-to-day life in organizations: Exploring a neo-institutionalist approach to doctors’ behaviour in hospital organizations

Abstract

The evidence gathered has not yet produced a clear picture of how the institutional (i.e. macro) and behavioural (i.e. micro) relationship/link works for doctors in hospital organizations, in particular with regard to their reasons for being for or against organizational change driven by managerial values. This article seeks to address this issue by looking at what structures the actions of doctors, in order to see possible reasons for the conflict and alliances among them and between them and? managers. Drawing on qualitative, in-depth research conducted in a hospital organization, with the focus on doctors from two wards (one surgery and one internal medicine), differences in their actions and discourses challenge the coherence associated, as a rule, with professional values and organizational culture. Rather than denying these influences/differences, we relate them to the way the medical professionals reflexively make use of their roles in situated circumstances. In sum, this presentation discusses not only the fact that the doctors’ medical rationale is crisscrossed by a diversity of influences – ethics, management itself and the organizational culture and subcultures – but also that they make reflexive deliberations about themselves and that their personal interest(s) are defined in relation to specific contexts. Theoretically, the analysis is aligned with other work on critical realism, which is expected to refine the study of organizations as inhabited spaces by adding empirical accuracy to theoretical arguments in social theory on reflexivity.