Medicinsk specialisering och läkares ledarskap : En longitudinell studie i professionell kollegialitet och konkurrens

Sammanfattning: This study explores specialization and leadership in the medical profession. Previous research shows that medical specialization leads to increased collegiality and competition within the profession and, to various degrees, in relation to other occupational groups. The objective is to find out how this affects physician leadership in health care organizations and how professional collegiality and competition are related. Leaders’ influence on the course of specialization is also investigated, as well as the relative influence of technological and social factors on the process. The empirical inquiry consists of three longitudinal case studies of medical departments at a teaching hospital that have been studied through extensive interviews, observations and examination of written records. The results indicate that professional collegiality in the wake of specialization has made physician leadership more participative, democratic and sometimes shared, particularly in specialties cooperating with relatively independent occupations. As the study shows, this can be reinforced by modest professional competition, whereas intense competition limits collegiality, fostering a person-based or even charismatic leadership for rivaling specialist groups. The study supports that specialization is driven both by technological and social factors. However, it also demonstrates that new technology can actually force organizational change, thus creating occasions for leaders to emerge and influence nascent specialty structures. Contrary to the common understanding of charisma and organizational change, the most fertile ground for charismatic and culturally influential leadership turns out to be groups of recognized specialists that are challenged and rally around an inspiring leader who defends the established order.