Silos and Social Identity: The Social Identity Approach as a Framework for Understanding and Overcoming Divisions in Health Care
Open Access
- 18 June 2012
- journal article
- review article
- Published by Wiley in The Milbank Quarterly
- Vol. 90 (2), 347-374
- https://doi.org/10.1111/j.1468-0009.2012.00666.x
Abstract
One of health care's foremost challenges is the achievement of integration and collaboration among the groups providing care. Yet this fundamentally group-related issue is typically discussed in terms of interpersonal relations or operational issues, not group processes. We conducted a systematic search for literature offering a group-based analysis and examined it through the lens of the social identity approach (SIA). Founded in the insight that group memberships form an important part of the self-concept, the SIA encompasses five dimensions: social identity, social structure, identity content, strength of identification, and context. Our search yielded 348 reports, 114 of which cited social identity. However, SIA-citing reports varied in both compatibility with the SIA's metatheoretical paradigm and applied relevance to health care; conversely, some non-SIA-citers offered SIA-congruent analyses. We analyzed the various combinations and interpretations of the five SIA dimensions, identifying ten major conceptual currents. Examining these in the light of the SIA yielded a cohesive, multifaceted picture of (inter)group relations in health care. The SIA offers a coherent framework for integrating a diverse, far-flung literature on health care groups. Further research should take advantage of the full depth and complexity of the approach, remain sensitive to the unique features of the health care context, and devote particular attention to identity mobilization and context change as key drivers of system transformation. Our article concludes with a set of "guiding questions" to help health care leaders recognize the group dimension of organizational problems, identify mechanisms for change, and move forward by working with and through social identities, not against them.Keywords
This publication has 85 references indexed in Scilit:
- Role Transition and the Interaction of Relational and Social Identity: New Nursing Roles in the English NHSOrganization Studies, 2010
- Professional competition and modernizing the clinical workforce in the NHSWork, Employment & Society, 2009
- Identification as an organizational anchor: how identification and job satisfaction combine to predict turnover intentionEuropean Journal of Social Psychology, 2008
- Identity, Contract and Enterprise in a Primary Care Setting: An English General Practice Case StudyOrganization, 2008
- Planning and Studying Improvement in Patient Care: The Use of Theoretical PerspectivesThe Milbank Quarterly, 2007
- Individual identity and organisational control: Empowerment and Modernisation in a Primary Care TrustSociology of Health & Illness, 2004
- The Social Organization of Physician-Managers in a Changing HMOWork and Occupations, 1999
- Using ritual to reduce barriers between sub‐culturesJournal of Management in Medicine, 1996
- Barriers to physician-nurse collegiality: An anthropological perspectiveSocial Science & Medicine, 1987
- Games that professionals play: The social psychology of physician-nurse interactionSocial Science & Medicine, 1984