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Professional
Professional identity product identity
of structure, product of choice
Linking changing professional identity
and changing professions 721
Sabine Hotho
Dundee Business School, University of Abertay Dundee, Dundee, UK

Abstract
Purpose The purpose of this paper is to extend the discussion of the recursive relationship between
the identity of a profession and the professional identity of individuals in the context of change.
Design/methodology/approach The paper draws on qualitative data collected as part of a pilot
study into change in the NHS. It draws on structuration theory and insights from social identity theory
(SIT) to propose that the relationship between the collective level of the profession and the individual
level of the professional is recursive.
Findings The data suggest that individual professionals use and rewrite scripts of their profession
but also draw upon new scripts as they engage with local change. To that extent they contribute from
the local level upwards to the changing identity of their profession. Further more detailed micro level
studies are required.
Research limitations/implications The argument is based on a limited data set and points
towards the need for further microlevel studies which examine the recursive relationship between
professionals identity and the identity of a profession.
Practical implications Further research can contribute to better understanding of local variance
as professionals engage with change.
Originality/value The paper fuses structuration theory and SIT and examines the
agency/structure nexus in a specific change context.
Keywords Work identity, Professional services, National health service
Paper type Research paper

Introduction
The changing nature of professions, and of the relationships between professions,
professionals and society have been widely studied by sociologists (Abbott, 1988;
Freidson, 1994; MacDonald, 1995; Broadbent et al., 1997; Malin, 2000; Reed, 1996). More
recently, professions in the public sector have been the focus of much attention. This is
not surprising as the public sector, in the UK as elsewhere, continues to undergo
radical transformation (Ackroyd, 1996; Reed, 1996). The medical profession has
attracted particular interest, perhaps because, as some would argue, it qualifies as an
almost prototypical profession (Harrison and Pollitt, 1994; Eve and Hodgkin, 1997;
Fitzgerald and Ferlie, 2000). An equally rich body of research is concerned with the
impact of change on individual professionals, and once more the public sector and the Journal of Organizational Change
medical profession figure prominently (Brooks, 1996; Bolton, 2000, 2003; Forbes et al., Management
Vol. 21 No. 6, 2008
2004; Forbes and Hallier, 2006). pp. 721-742
What links macro- and micro-level perspectives is the pervasive interest in q Emerald Group Publishing Limited
0953-4814
change, and a tendency to see professions and professionals as recipients rather than DOI 10.1108/09534810810915745
JOCM as agents of change. Macro-level changes are seen as affecting status and substance
21,6 of professions, and consequently much of the sociological debate on the future of
professional work emphasises structure over agency, while, mutatis mutandis, much
of the micro-level research is concerned with psychological or behavioural change
impacts (Shilling, 1992).
What separates these perspectives is the tradition of methodological conventions
722 (Shilling, 1992; Harrington, 2005). Studies concentrate either on change responses as
properties of collectives, or of situated individuals, leaving the exploration of a possible
nexus between individual and collective level analyses both under-examined and
under-theorised (Duberley et al., 2006).
Only few studies try to narrow this gap as they focus on interrelations between
collective and individual levels of analyses (Kelly and Glover, 2000; Rosenthal, 2001).
These studies challenge the dominance of structure over agency, and reclaim agency
for the individual professional both in terms of change response and change initiation.
This paper aims to explore further how the study of individual-level change responses
of professionals might contribute towards a more situated understanding of how
professions reconstitute themselves. It follows Giddens in articulating the macro-and
micro levels of analysis as a duality rather than an epistemological and ontological
dualism (Giddens, 1984), and proposes that such conceptualisation of the structure-agency
nexus can add to our understanding of the change dynamics within a profession as the
profession evolves, and as individual professionals shape and are shaped by, reproduce
and produce the norms and scripts of their profession. A theoretical bridge between the
collective and the individual level is offered by social identity theory (SIT) which is used
here as an integrating device that might enable this shift from dualism to duality.
The paper draws on data collected as part of a pilot study that examines
change experiences of Scottish general practitioners (GPs) in the context of primary
care reform. The paper is organised as follows: firstly, the main positions in the
literature are summarised to show how the current separation of micro and macro
levels has limited our insight into change dynamics but also point towards new
directions. Secondly, structuration theory and SIT will be introduced to reposition the
individual professional as an agent rather than a mere recipient of change (Giddens,
1984; Duberley et al., 2006). Finally, data from the pilot study will then be drawn upon
to illustrate the theoretical argument and to point to new directions.

The professions today

Sociological studies have shifted from early functionalist and trait theories concerned with
the essence of a profession (Freidson, 1994, p. 24) and the basis of professional privilege
as grounded in such properties, to viewing these as part of an apparatus of techniques,
discourses and practices professions construct and use to gain, legitimise and maintain
control over professional work, political and economic autonomy, a relative dominance
over other professional groups (Larson, 1977; Freidson, 1994, p. 81; Reed, 1996), and
consequently privileged economic and societal status (MacDonald, 1998).
Central to this shift in perspective are Freidsons and Larsons work. Based on Freidson,
Larson defines the process of professionalisation more specifically as a market project in
which professionals engage to create and control a market for their professional expertise
expert skills and knowledge as the means to secure their privileged social and
economic position (Larson, 1977). Vital for the achievement of the professional project is
control over specialised scientific or expert knowledge (Abbott, 1988; Reed, 1996; Professional
McDonald, 1999). Abstract knowledge demarcates the professions sphere of jurisdiction, identity
the basis of its technical and political autonomy and professional identity as it
differentiates itself from competing occupational groups (Abbott, 1995, 1988, pp. 59ff.).
To remain successful, professions strive to maintain their jurisdiction through, for
instance, the control over access to education, training, and the professional labour market
(MacDonald, 1995; McDonald, 1999, p. 163), through mechanisms of knowledge 723
formalisation such as professional accreditation (Daniels and Johansen, 1985), and the
prescription of career paths (Daniels and Johansen, 1985). The argument here is that this
apparatus of techniques and strategies embodies the power/knowledge nexus from which
professions draw their legitimacy (Freidson, 1994), and shape the behaviour, action and
identity of individual professionals. In this perspective the individual professional is
submerged in the collective and a recipient of structure.
More recent work examines the future trajectory of the professional project in the
context of wider change and increasing inter-profession competition (Abbott, 1995).
The future of the traditional professions, and their hold over technical, political and
economic autonomy has been widely debated, and some foresee the gradual if not
terminal decline of traditional professional power (Kanter, 1990, 1997; Coburn et al.,
1997), and the deskilling and commodification of professional work (Parker and Jary,
1995; Prichard and Willmott, 1997; Forrester, 2000). Others argue that professions
might see change as an opportunity to renew themselves (Elston, 1991; Harrison and
Pollitt, 1994; Forrester, 2000; Fournier, 2000; Freidson, 2001; Farrell and Morris, 2003;
Nancarrow and Borthwick, 2005). The future of medical dominance remains of
particular interest in this context (Allsop, 2006; Coburn, 2005; Willis, 2006).
As a more differentiating picture emerges (Fournier, 2000; Freidson, 2001;
Rosenthal, 2001; Nancarrow and Borthwick, 2005), overly determinist positions such as
Haugs deprofessionalisation theory (Haug, 1973) and Johnsons proletarianisation
thesis (Johnson, 1972) are critiqued (Freidson, 1994). Freidson argues that changes are
likely to the quality and nature, less than the scope and extent of, professional control
and refers to the medical profession to illustrate how professions re-stratify in response
to change, creating more sharply divided intra-professional hierarchies than had been
the case earlier (Freidson, 1994). This argument is continued elsewhere (Fitzgerald and
Dufour, 1997; Allsop, 2006).
With reference to public sector professions, the effectiveness of managerial
interventions (Harrison and Pollitt, 1994; Forrester, 2000; Bolton, 2003; Hallier and
Forbes, 2005), varying degrees of accommodation between professions and
management and of change engagement or resistance have been examined (Calnan
and Williams, 1995; Lawler and Hearn, 1995; Preston and Loan-Clarke, 2000; Skalen,
2004 Hallier and Forbes, 2005), and with little evidence that professional power is in
decline. Rather the contest between professions and the state is seen in terms of a
constant dialectic between autonomy and heteronomy (Flynn, 1999, p. 22).
Nonetheless, professions appear as unitary blocs concerned with self-defence of a
status quo rather than rejuvenation.
Efforts to preserve the profession take place at its boundaries. Here, strategies are
applied to maintain the status of the profession and its identity. Professional boundaries
have a cognitive and a social dimension (Abbott, 1988, p. 98; Ferlie et al., 2005).
They are constituted by the knowledge domain and by the rules, norms and conventions
JOCM which socialise individuals into the profession and which differentiate the profession
21,6 from other groups. Boundaries are neither fixed nor non-permeable (Gieryn, 1983) but as
malleable and expandable as the spheres of expert knowledge they demarcate
(Fournier, 2000, p. 83). Where context changes, professions deploy defensive strategies
to protect boundaries, make claims to new areas of knowledge or reject them (Abbott,
1988; Fitzgerald and Ferlie, 2000; Fournier, 2000; Nancarrow and Borthwick, 2005;
724 Coburn, 2005). Such activity serves to reconstitute boundaries along which the
professions can build new strategies of legitimisation (Fournier, 2000, p. 82) and remake
themselves (Freidson, 1984; Hanlon, 1996; Fournier, 2000; Caglio, 2003). Professions
become the collective entrepreneurs of their own professional project (MacDonald, 1995;
McDonald, 1999, p. 187). Such entrepreneurial activity redefines the relation between
profession and others, and has consequences for intra-professional structures.
Restratification, and inter-professional conflict between strata, are emerging themes
as specialists and generalists, elites and rank and file seek opportunities to reconfigure
themselves in changing contexts (Freidson, 1994; Mahmood, 2001; Nancarrow and
Borthwick, 2005).
The sociological discourse provides abstract and disembedded analyses of the
cognitive and social strategies employed by professions in the contest over their
jurisdiction (Abbott, 1995; Reed, 1996; Allsop, 2006; Coburn, 2005). The interest lies
with professions as collective actors, even where they are debated as stratified
collectives (Freidson, 1984; Abbott, 1995; Mahmood, 2001). Change contexts as well as
local variance cannot be captured in this perspective.

Professionals as actors in change contexts?

Where individuals response to change is concerned, studies focus on resistance to or
accommodation with managerial agendas, issues around work identity and the
formation and reformation of work identity, role transition, role stress, role ambiguity or
role conflict (Fitzgerald and Dufour, 1997; Forbes, 1999; Preston and Loan-Clarke, 2000;
Bolton, 2003; Kirpal, 2004). More recently, SIT has been used to explain various degrees
of accommodation among doctors with managerial change agendas, and local
variations in the response to change initiatives (Forbes et al., 2004; Hallier and Forbes,
2005; Forbes and Hallier, 2006). The antagonism between management and professions,
and the medical profession in particular, remains a particular theme of interest, both
from managerial and critical perspectives (Thorne, 1997; Davies and Harrison, 2003;
Degeling et al., 2003; Edwards, 2003; Millward and Bryan, 2005).
Much of the existing research focuses on face-to-face relationships (Dopson, 1996,
p. 185), on the demands of new roles (Fitzgerald, 1994; Bolton, 2000, 2003; Hallier and
Forbes, 2005), or on the motivations of individuals to take on management roles
(Fitzgerald, 1994). That medical professionals interact in local contexts as socialised
members of their profession is acknowledged (Bolton, 2003) and this in part accounts
for the widely reiterated doctors versus managers conflict. The relation between local
level change response of individual professionals and changes to the profession as a
consequence is little researched. In part, this is due to the fact that any such links
between individual local action and institutional change is difficult to ascertain. In part,
however, such links have remained under-researched because the dominant
perspective from which organisational change has been considered does not
encourage to do so. Alternative views of organisational change point the direction.
Perspectives on change Professional
The predominant perspective on organisational change is managerial-functional, and identity
infused by managerial ideology. From this perspective, change is seen as a business
necessity, or, in the case of the public sector, as the prerequisite for greater efficiency and
effectiveness in the delivery of public services (Diefenbach, 2007). In either case, change
is presented as an objective fact that happens to the organisation, either as a
consequence of external drivers, or as an outcome of management choice. Change 725
management is the prerogative of the managerial elite, based on its access
to more complete information, higher expert knowledge and consequently the ability
to make rational design and implementation choices. As Townley has argued, this
strand of change literature and its discourse of rational instrumentality are replete with
polarised antinomies (Townley, 1999, p. 290) that are of particular resonance in public
sector contexts. Dichotomies like old versus new, administration versus management,
change resistance versus innovation, rational versus irrational, are abundantly used and
reveal how the managerial discourse aims to relegate non-managerial positions to the
margins of obsolescence by labelling them broadly as anti-change or obstructive
(Martin, 1999; Hotho and Pollard, 2007). In consequence, much of the change
management literature is devoted to the management of change resistance if not its
effective elimination (Dearlove, 1998; Meyer, 2002; Hotho and Pollard, 2007). More
specifically, where it deals with the professional in contexts of change, mainstream
literature focuses on the individual as victim of change, as change obstructive or as
trying to accommodate or reconcile tensions between the requirements of the changing
context and the tenets of his or her professional schooling or ideology (Hotho and
Pollard, 2007). This strand of literature frames professional identity as other and mostly
non-reconcilable with management interests, without reflecting on interfaces or any
recursive relations between professional identity adjustments at the local level of the
individual and the profession which he or she represents in that context.
The reductivist position of the functional perspective on change has been challenged
by writers like Cyert and March since the 1960s, and with increasing persistence for the
past 10 or 15 years (Koch, 2000). The prevailing change management discourse and its
practice have been critiqued from radical poststructuralist, interpretive and from
conflict theory perspectives. What links these positions is the rejection of change as an
objective event occurring in a context-disembedded purpose-designed organisation. The
unitary model of the organisation as a rational and basically consensual system
is replaced with a structurally embedded political model (Pfeffer, 1981) which frames
organisational behaviour around plurality of interests, conflict and contest. Change is
consequently redefined as either individually constructed, brought about and given
meaning in interaction with other social agents and context contingencies (Martin, 1999
Taylor, 1999; Weick, 1995), or as an organisational context which brings to the fore and
gives particularly sharp profile to the competing and conflicting interests and ideologies
of groups of organisational members as the base of their status in the organisation, and
their concomitant resource base, are challenged (Burns, 1961; Watson, 1982; Koch, 2000).
The latter perspective draws attention to similarities between organisations as
microcosms and social and political structures and to the micro-politics that structure
organisational reality and that, ultimately, constitute change (Burns, 1961).
The micro political perspective on organisations and change is of particular interest
here to the extent that it serves as a reminder that individual action is mediated by the
JOCM structures, norms and conventions or ideologies (Watson, 1982) of the group or
21,6 groups with which the individual associates in the given organisational context, and
these may range from departmental groupings to social class membership (Watson,
1982). Professional membership would consequently be one of the most significant
extra-organisational group ideologies mediating individual action.
The discussion of organisational micro-politics can make a significant contribution
726 to deepening the understanding of professionals engagement with change in local
contexts. However, to elaborate further how the link between individual professionals
and their change engagement on the one hand, and a changing profession might be
captured, a framework is required that accentuates this relationship or link from a
more dialectical perspective. Structuration theory and SIT may offer precisely this
perspective to capture such recursive relations.

Structuration theory a way forward?

Giddens structuration theory aims to overcome the epistemological and implicitly
ontological divide between functionalism and structuralism on the one hand, and
interpretative sociologies on the other (Giddens, 1984). Giddens proposes to replace the
notion of dualism between societal structure and individual experience by a notion of
duality which sees human social activities and social structure as recursively related:
structure is neither external to nor separate from human agency, both are interdependent to
the extent that they both constitute and are constituted by the other: Structure qua
institution, organisation, patterns of social practice is neither external to the individual
(Giddens, 1984, p. 25), nor brought into being by social actors (Giddens, 1984, p. 2) but is
continually recreated by them via the very means whereby they express themselves as
actors (Giddens, 1984, p. 2). Human beings thus are purposive agents (Giddens, 1984, p. 3)
who reproduce social practices but are also capable of reflexivity or knowledgeability
(Giddens, 1984, p. 3) about social practice. It is such knowledgeability that endows humans
with agency as it makes them capable of purposive action and choice (Whittington, 1994)
and thus actors in the recursive ordering of social practices (Giddens, 1984).
Structure and agency form a mutually producing and reproducing duality, and
change is an outcome of this duality. It is the product of structure and of individual,
situated choice or exertion of discretion and deviation (Yuthas et al., 2004), intentional
or unintentional, from the established norms of social practice (Giddens, 1984; Barley,
1989; Whittington, 1994, p. 62; Duberley et al., 2006). Individuals are capable of
transforming structures through their choices, decisions and actions (Whittington,
1994; Forrester, 2000; Yuthas et al., 2004). Structuration theory can therefore assist in
overcoming reductivist interpretations of individuals as change recipients or victims
of change through redefining the relation between social structure and human actors as
reciprocal interaction (Yuthas et al., 2004, p. 231).
Structuration theory focuses on the process dynamics of the structure/agency duality
through the notions of structure, modality and interaction (Giddens, 1984). Implicitly
this becomes a theory of change. The social system comprises three interlinked forms of
structure or rules for action, namely signification, domination and legitimation.
Signification structures provide the meaning codes for the interpretation of reality,
domination structures refer to resources, and legitimation structures to normative rules
of conduct and action. Social action or reproduction of structure is termed interaction
and expressed or enacted through communication, power or sanction. Giddens refers to
modalities of structuration as the means on which knowledgeable actors draw as they Professional
engage in social practice, and reproduce structure through their action. Interpretative identity
schemes as symbolic systems mediate between signification and communication,
resources between domination and forms of power, and norms between legitimation
rules and interactions of sanction, disapproval or approval.
Structuration theory provides a sensitising device to examine this recursive
relationship between human agency and social structure, between situational social 727
practice and macro-level phenomena. It provides a lens to examine how professionals
reproduce and modify through their situated deployment of structuration modalities
the very structures that shape their action. This can be illustrated by reference to
applications of structuration theory to the study of careers where the various career
scripts encapsulate Giddens modalities of structuration (Barley, 1989). Figure 1, based
on Duberley et al. (2006) and linked to Barley (1989), gives a schematic representation
of the argument. Professions represent the codified level of structure or institutional
realm that is mediated through a range of professional scripts. The professional is
knowledgeable of these, through socialisation into the profession, education, training
and continuous re-enactment of the rules of signification, of power hierarchies and
norms of his or her profession. Situated enactment has intended as much as unintended
consequences and thus reverts back to the institutional level. The individual actor does
not mirror structure but interprets or interacts with it, enabled or constrained by both
structure, self and circumstances at the local level. At local level, structure is both
reflected and refracted in situated action. If such refractions are conditioned by
individual level interpretation and local context, change is a product of the cumulative
effects of such local refractions. More specifically, local variance and diversity can be
explained if we combine structuration theory with insights from SIT.

Complementing structuration theory: insights from SIT

SIT complements structuration theory as it proposes a similarly recursive relation
between individual and collective identity (Jenkins, 1996). It brings individual and

Profession

encodes
constitutes

Professional Identity
Structures
Modalities

fashion
enacts
(selects, rewrites)

Professional in action, interaction Figure 1.

(local, self, committees ) Mapping recursive
relationships
Source: Based on Duberley et al. (2006)
JOCM social structure into the same analytical space (Jenkins, 1996, p. 25) by emphasising
21,6 that human behaviour is, ultimately, social behaviour, determined by processes of
social cognition. It defines the link between individual and macro level, and thus social
action and social practice, as a product of the synergetic interaction between person
and societal-cultural context (Operario and Fiske, 1999, p. 42). If structuration theory
takes a top down view from structure to individual behaviour, SIT takes the bottom-up
728 view from individual to structure level.
Individuals make choices as to the resources and identity scripts they draw upon to
ascribe themselves to their salient social groups. Such choices are neither entirely
idiosyncratic nor entirely determined by structural properties (Whittington, 1994).
This is at the core of both structuration theory and SIT which is embedded in a conflict
structuralist tradition (Hogg and Abrams, 1988). SIT posits that salient social groups
are defined by social categories which establish power, status and prestige relations
between these groups. Individuals locate themselves within and against such groups to
produce and maintain their social identity. SIT implies a dialectic, and consequently
dynamic, relationship between social and psychological reality (Haslam, 2001).
Where personal identity is about differentiation from others, social identity is defined
as that part of an individuals self-concept which derives from his [sic] knowledge of his
membership in a social group (or groups) together with the value and emotional
significance attached to that membership (Tajfel, 1982, quot. in Jussim et al., 2001, p. 6).
Salient groups are various, including the organisations, institutions or work groups with
which they are associated (Ashforth and Mael, 1989; Hogg and Terry, 2000). Professional
groups are prime sites for the formation of social identity (Hogg and Terry, 2000).
Social identity is not given but constructed as individuals engage with social contexts
and in social interaction (Operario and Fiske, 1999). Ashforth and Mael (1989) refer to the
process of social classification which allows individuals to define themselves in the
social environment. What drives the process of social classification is the individuals
need to achieve a social self-concept and a sense of self-esteem (Operariro and Fiske,
1999). Relevant cognitive strategies are social comparison and social evaluation of group
status. Individuals will seek maximum differentiation between the groups most salient
to their social identity and sense of self-esteem, and non-salient out-groups from which
they wish to differentiate themselves. Close identification with one group results in
de-individuation or depersonalisation as individuals adopt the norms of behaviour,
attitudes and beliefs that are vital to construct the boundaries between salient in-group
and non-favourable out-groups (Hogg and Abrams, 1988; Hogg and Terry, 2000). These
strategies are the fabric of social practice.
Social self-categorization is driven by notions of accessibility and best fit in terms
of meaningfulness of characteristics, similarities and dissimilarities (Hogg and
McGarty, 1990, p. 31). This best fit pragmatism might account for the malleability of
social identity or the fact that individuals hold multiple, shifting and hierarchically
organised social identities: the self concept is expandable and contractable across
different levels of social identity with associated transformations in the definition of
self and the basis for self-evaluation (Brewer, 2001, p. 247).
Sources of perceived group salience are manifold and located in broader societal
value systems and in context-specific conditions (Haslam, 2001). Within organisations
salient groups can exist within or across boundaries of units, work groups, functions,
and hierarchies. For professional workers co-professionals constitute a prime group
holding salience for the individuals. Group salience may change if the comparative Professional
context changes (Hogg and Terry, 2000). Context change creates uncertainty, identity
ambiguity and shifts in power, influence and status. Consequently, individuals will
re-examine the relevant salience of social groups in their environment (Ethier and
Deaux, 2001; Hogg and Terry, 2000). Change contexts may result in reconstructions of
social identity as the individual detach[es] the identity from its supports in the former
environment (Ethier and Deaux, 2001, p. 257). 729
How individuals respond to changes depends on their cognitive evaluation of these
changes, on the social identities they hold, and on the consequences of organisational
change on the relations between salient social groups (Haslam, 2001). Where change
alters relations between groups, individuals will activate different strategies to retrieve
social identity and self-esteem (Milner, 1996, p. 263). Tajfel and Turner (1979) identify
three strategies of self-enhancement, i.e. individual mobility, social creativity and
social competition, which are mobilised by the individual in situations of
organisational change to maintain self-integrity (Haslam, 2001, p. 37). Individuals
responses and choice of strategy will be shaped by the social mobility and social
change belief systems they hold; depending on their perception of change and cognitive
evaluation of the shifting group relations and relative status of in- and outgroups,
individuals will activate social cognitive strategies of self-enhancement (Haslam, 2001,
p. 37) to adjust their social identity in the changed context.
Where group boundaries are seen as permeable, individuals in low status groups
will engage individual social mobility strategies to access the higher level group.
To that extent a new enhanced social identity is achieved through disidentification
with the erstwhile ingroup (Milner, 1996, p. 263). Alternatively if the individual
perceives the current ingroup as high status ingroup, social identity of the high status
group will be maintained. Where boundaries are seen as non-permeable groups are
forced to deal with the group-based reality that confronts them (Haslam, 2001, p. 39).
If the ingroups status is unchallenged by organisational change, social creativity
strategies are activated, including comparison with new groups, or redefining the
values associated with groups, or the dimensions of comparison, to ensure continued
favourable comparison of the ingroup with the outgroup. Alternatively new outgroups
are selected with which the ingroup is compares (Haslam, 2001, p. 265). Where the
ingroup is seen as challenged by change, social competition strategies are activated
which serve to challenge the outgroups superiority (Haslam, 2001, p. 37). Individuals
will accept change if optimum group distinctiveness remains sustainable (Brewer,
2001). Change per se, potentially, contains both opportunity for and threats to an
individuals sense of social identity.

SIT and professional identity

Professional identity is one of the multiple social identities an individual holds.
Socialisation into the professional community provides a sense of stability, belonging,
and values, and it reduces ambiguity. Professional identity clearly fulfils the status
need driving social identity ascriptions. Traditionally professional groups have the
characteristics of a high status group, which explains in part their historical stability.
The profession as an institution provides the scripts on which individual professionals
draw in their daily practice. They form the practical knowledge that informs their
action, and the basis of evaluation.
JOCM Changing professional identities and professional identity the study
21,6 The ongoing radical changes in the NHS have, over the past 25 years, substantially
altered the comparative context in which medical professionals work and seek to
maintain their professional identity. The literature has discussed this around the
struggle for control over professional autonomy and jurisdiction. SIT can provide
some insight into how professions such as clinicians interact at local level with
730 these changing contexts, and to what extent challenges to their professional identity
have resulted in redefinitions, dilutions or punctures of the boundaries traditionally
demarcating the professional and other organisational domains. These issues will be
explored in the following sections in which data gathered as part of ongoing research
into wider issues concerning change and change responses in the NHS (Scotland), and
more specifically in the context of Scottish primary care reform, will be drawn upon.
The reform of primary care began in 1997 with the establishment of Local Health Care
Co-operatives (LHCCs; Goldie and Sheffield, 2001). These have now been replaced by
Community Health Partnerships (CHPs; Scottish Office, 1998). Our research took place at
the time of migration from LHCC to CHPs. The specific change context is paradigmatic for
the change experience in the NHS. LHCCs were the centre-piece of the NHS (Scotland)
reforms announced in 1997. Six years later, in 2003, only little [was] known about how
these new organisations in health care operate (Simoens and Scott, 2003, p. 26). Yet by
2004 the Scottish Executive had decided that the existing 79 LHCCs were to be replaced
with fewer but larger CHPs, with the migration process complete by 2005. As LHCCs
migrated into CHPs, transition issues were particularly pertinent for those medicial
professionals who actively participated in the formation and running of LHCCs and whose
further commitment to change is now expected. Of particular interest are those GPs who,
as chairs, and vice-chairs, combined clinical-professional and LHCCs management (in a
wider or narrower sense) functions, and whose role is now set to change. These GPs had
played a leading and committed role in the LHCC operation. How change affected and
continues to affect their sense of professional identity is the interest of the ongoing study
and feeds into the discussion here. Their reflections will provide an insight into how and
why professionals do boundary work as they experience organisational change.
As the purpose of this paper is not to report in detail on research findings, a
summary account of the study will suffice. The ongoing project is designed to track
GPs change engagement as the reform of primary care in Scotland evolves. For the
purpose of this study we were concerned with the group of GPs who had positively
supported the formation of LHCCs and had assumed leading managerial roles as chairs
and deputy chairs of these co-operatives. The group comprised five chairs and five
deputy chairs. Their change experience spanned a period of almost eight years, from
the initial formation of LHCCs as voluntary bodies to the current migration to the
significantly more formalised CHPs. In this process of migration their former roles as
chairs had disappeared and clinical lead roles had been created which were offered to
this group as a means to remain involved in the process of primary care
transformation. For the study, qualitative semi-structured problem-centred individual
interviews were used. The interview schedule was piloted and adjusted on the basis of
the pilots. Interviews lasted approximately 90 min and were conducted by two
researchers. Interviews were subjected to iterative thematic content analysis to identify
the recurring themes through which participants reflected on their identity as
professions in the context of change experience.
The bridge between structuration theory and SIT Professional
Legitimacy provides the foundation for professional jurisdiction, its absence increases the identity
likelihood of interference by outside parties (Abbott, 1988, p. 57). Comparative context
change alters the parameters which define a professions legitimacy and render it
vulnerable to outside intervention. Structuration theory suggests that change participants
are therefore likely to draw upon strategies and scripts to reassert and (re)legitimise their
professional identity. SIT expands this by suggesting that individuals may also realign 731
their social identity according to the options the change context offers. This may result in a
confirmation of or change to the currently held hierarchy of social identity salience.
Structuration theory proposes that the strategies drawn upon will be expressions of
structure, mediated through interpretative scripts, and modalities of resources and norms.
SIT suggests that the agency reflected in the choices individuals make as to the scripts
they draw upon, is motivated by needs of maintaining social status and self-esteem, of
effectively conducting social comparisons which serve to define the relative status and
power of ingroups and outgroups, and the direction of their self ascriptions to the groups
that are available. These are the dynamics that reconstitute or reshape the boundaries of
professional identity from the bottom up: they consequently frame collective and
individual professional identity as an outcome of the dialectical interplay of processes
of internal and external definition (Jenkins, 1996, p. 25). In the following we will be
interested in how participants drew upon scripts of signification to make sense of change,
establish hierarchies and boundaries and articulate legitimation structures.

The findings the emergent themes

Professional versus managerial
Participants reflected on their commitment to the LHCC operation, and their experience of
change from LHCC to CHP operation as an imposed external change driven by NHS
change agendas. Having played a leading management role in the LHCC era, participants
identified themselves as clinicians first. The ethos of patient care, embedded in the
principles of general public and local community service, provides the basis of
signification structure from which the signification scripts are produced on which
individual professionals draw to state their professional identity. This combines with the
notion of the selfless professional who puts client care over and above the pursuit of
individual motives, committing yourself emotionally or intellectually to a wider
healthcare system. This script was consistently restated as participants talked about
their dedication to their patients, their locality and the services they provided as a
contribution to the wider health of the community. As they experienced change,
participants reasserted their professional self as public servants and around traditional
Durkheimian notions of a moral basis of professional legitimacy (MacDonald, 1995). The
long tradition of public sector ethos provided the script to assert their professional purpose
around a collectivity orientation (MacDonald, 1995, p. 2). The moral basis of the medical
profession was deemed superior to management. Management was seen as driven by
accounting logic and politics rather than devotion to service, and career managers were
pandering constantly to the Executives agenda, more concerned with producing the
correct sound bites [which] change from year to year somewhat passively [. . .] allowing
themselves to be dominated [by local politics] and self interests.
As NHS management was to an extent categorized in terms of political
dependence GPs echoed the interpretative scripts prevalent in their professional group
JOCM that demarcates management and medical domains, and constructs a moral hierarchy
21,6 between the two domains. The hierarchy between medical us and managerial them
was further enacted as participants drew on scripts of medical collegiality to describe,
explain and legitimise their engagement in the LHCC and the related decision making
processes and achievements as democratic, collective and collegial. Service- and
patient-focused collegiality was emphasised as characteristic of this change episode
732 where everybody had a voice and everybody felt that their voice was being listened
to and heard. This combined with a local culture of cooperation across agencies within
the community where we had a very good relationship within a network of agencies.
Service ethos, collegiality, patient focus, collaborative engagement with local
partners and other health professionals provided the powerful scripts which
professionals used here to set their profession apart from NHS management. The
relative political power of NHS managers over the medical profession was accepted but
in this context significantly reinterpreted as this structure was contrasted with the
moral superiority of the medical profession. To that extent interviewees enacted or
reproduced the familiar scripts of their profession. What is institutionalised through
professional codes served also to make sense of the local context.

Asserting the superiority of expert knowledge over generic management skills

As interviewees reflected on their active engagement in LHCCs they did not see
themselves as managers but as deploying practical skills that were inherent to the
accomplishment of their profession: interviewees commented frequently on the fact
that many so-called management skills were skills medical professionals used in their
professional practice routinely and without particular effort. Management skills were
therefore not seen as separate from, or superior to, the medical knowledge base but as a
sub-set of lesser-order skills, either easily doable or easy to learn.
Management was not given the status of an expert knowledge domain. Instead,
interviewees incorporated those technical or practical skills of which NHS managers often
say that they are poorly developed or poorly deployed among professionals. Here,
professionals appropriated and thereby subjugated such skills. This allowed interviewees
to do management as medical professionals rather than become managers.
Management, already politically tainted was thus not seen as an opportunity to gain
higher status. As a skills-set it became part of the professional activity without challenging
its boundaries.

New scripts of meaning

LHCCs were an opportunity to assert medical autonomy and control at least at local
level. However, participants were not merely drawing on the traditional scripts of their
profession but seemed keen to incorporate new scripts of service innovation and
change, thus expanding or stretching boundaries. Change and innovation provided the
powerful vocabulary of motive (Barley, 1989, p. 55) from which they redefined their
own activity as medical professionals as anchored in a general enthusiasm of
improving what we do. From this starting point LHCCs where seen as collaborative
grass roots movements in which participants were prime movers, trouble makers
or even upstarts who had become more streetwise as LHCCs matured. The local
LHCC context seemed to be a space that enabled participants to achieve something that
was different, avantgarde:
 [. . .] we were the first place in Scotland to be successful in [tape recording flawed] Professional
applications, we had the New Ways team [. . .] so that was really wonderful to be involved in
that. [. . .] I got a lot of enjoyment and satisfaction from being involved [. . .] we did actually identity
I think shape or influence the character of the LHCC [. . .] it was really good.
LHCCS were spaces of change that enabled local professionals to write their own
scripts. An an idealistic feeling among the practices here a feeling that you could do
better jointly [. . .] rather than compete resulted which provided cohesion among the 733
professionals we talked to.
LHCCs were the site where professional identity could be rewritten, even if this
applied to only to few individuals who played a proactive role within them. To that
extent the organisational change was by and large experienced as creating opportunity
for a positive redefinition of professional identity. Individuals drew upon conventional
ideal type scripts of professional service, but they also drew upon the service
innovation scripts the government and NHS managers as change agents claims as their
own as they criticise the medical profession of change averse. Here, GPs turned the
world upside down by defining themselves as more innovative then the government.
As a group of medical professionals they included innovation and service improvement
within their professions jurisdiction and this too preserved the moral superiority and
thereby higher status of medical over managerial groups. Participants deployed a
range of scripts that served to maintain the position of GPs as a high status group and
which, implicitly, confirmed the lower status of the out-group of NHS management in
the widest sense.

Challenging scripts of the profession

While the medical profession remained the salient ingroup, interviewees were
ambiguous as to the status of being a GP in terms of social identity and esteem
enhancement. The repetitive nature of GP work was frequently commented on and
interviewees distanced themselves from colleagues caught in the comfort zone of
routine GP work and change reluctance. In contrast they saw themselves as the change
agents battling against the inertia within their profession (I do think that actually,
bringing about change rather than just talking about it is a big challenge), as part of
yet separate from fellow GPs: What is frustrating is that you cant just change them,
you have to take them [other GPs] along and you have to persuade them of what they
should do. There has to be change and there are so many things we could do
differently. The prevailing inertia was largely seen as a result of institutionalisation
and codification of routines in the medical profession, of career scripts and power
scripts re-enacted by large parts of the professional fraternity. Interviewees seemed
to sense that such lack of engagement with the change agenda might make claims to
the professions superior status fragile as change continues. Moreover, change
reluctance, the routine knowledge base, and associated behaviours among GPs also
seemed to reduce the attractiveness of standard GPs as a salient in-group. As
individuals, interviewees had embraced the leading roles in LHCCs as a means to
separate themselves from mainstream GPs, and to forge a new social identity which
was part of, yet separate from the larger professional group. This manifested itself in
the use of new scripts around challenge, movement and service innovation.
Separate from the rank and file GPs, interviewees carefully defined themselves,
as potential leaders: I did feel a sense of responsibility that I should stay involved
JOCM and provide a bit of leadership where I felt it was appropriate. This leadership role was
21,6 firmly located in the medical profession but defined as a boundary spanning activity
between medical and corporate NHS domains. Interviewees thus drew on scripts of
hybrid professionalism as a means to establish a new salient in-group within their
main social referent group of medical professionals. Being a GP was no longer enough,
becoming a manager was not attractive enough. Instead, this group refashioned itself
734 as a local elite of change-driving clinician: without bumping myself up, I think I have
brought a lot to it, and I do think that it would be a shame to lose that.
As LHCCs were abolished and subsumed into the much larger and much more
managerially organised CHPs, the role of LHCC chairs of deputies disappeared.
Interviewees were highly critical of the change process. Yet despite many reservations,
they remained engaged with the evolving process. Becoming just a GP again was not
an option. Their social identity remained anchored between the domains of medicine
and management, superior as outsiders to the politicised world of management and the
change-averse medical profession. What anchored them was the conviction that they
could be change agents within their profession:
[. . .] the medical world is to a certain extent sticking its head in the sand, ignoring the changes
around them which I think will be unfortunate. I feel very strongly that as a profession we
need to embrace the changes which are happening and to direct them in ways that we would
like them to go. I would like to be part of that as well.
As such they occupied a hybrid space between medical community and management,
bringing a clinical perspective to the management, and a management perspective to
the clinical world and living in both. The hybrid clinical role allowed a much more
attractive position in between the corporate and the medical world where the reference
to the wider perspective, typical of all boundary-spanning, afforded a sense of higher
status in comparison to both management and rank and file GP and a new social
identity. In the context of change, their professional identity remained the most salient
of social identities available in the context but it was also a professional identity that
had changed as the comparative context created opportunity for individuals to rewrite
their own professional scripts and to ascribe themselves to a newly formed
professional in-group of change activists.

Discussion
Individuals use interpretative schemes to make sense of events and actions, and to
communicate and interact with others within the social system. These scripts consist of
frames of reference, and scripts of knowledge shared by the respective community, and
constitute the group prototypical of that community (Haslam, 2001).
The scripts individuals use are socially grounded, not subjectively generated.
They provide a shared cognitive framework which allows that communication to be
mutually beneficial and productive (Haslam, 2001, p. 126). In contexts of change, the
scripts individuals draw upon or choose not to use in order to assert and
differentiate their social identity from other groups become of interest as they can
provide insight into processes of boundary demarcation, of boundary malleability and
the recursive interplay between structure, agent and change. They thus reflect
structures and their mediating modalities but as the individual demonstrates agency
through exerting choice and discretion, these scripts are also or can be refracted.
In contexts of change however, existing and new modes of signification or legitimation Professional
might be drawn upon to either defend or reconfigure the boundaries that demarcate identity
social groups and articulate them in constellations of power and status. Such dynamics
will vary from context to context. As professions such as the medical profession are
exposed to external change, we can expect both similarities and differences as these
dynamics are played out at a local level where professionals have to defend or
reconfigure their professional identity in the face of their locally specific change 735
context. In this paper, I have tried to shed some light on these dynamics through
bringing micro- and macro levels of analysis into the same analytical space.
Interviewees exerted agency in drawing upon specific scripts of signification and
deployed these to both assert and expand the boundaries of their professional identity
as medical professionals. Adopting management roles was neither a matter of going
over to management nor of accommodating management, it was a matter of
reasserting the superiority of the medical profession and consequently the salience
of the medical profession as a social identity referent group. Cognitive strategies of
reduction, discussed by Abbot as typical cognitive strategies where professions seek to
secure their jurisdiction (Abbott, 1988) were deployed to confirm the superior status of
medical over management activity. Participants could draw on these as conventional
interpretative scripts of their profession, and they served, in the local level, to locate the
medical rather than managerial domain as the source of social identity and the
maintenance of self esteem within the social system (Haslam, 2001).
Yet the participants did not merely enact the scripts of interpretation and
legitimation. The very knowledge base of their profession was obviously problematic
and the change context afforded an opportunity to deal with this issue. While an
extreme level of knowledge abstraction and indeterminacy might be problematic for a
profession, the same applies where knowledge becomes too practical (Abbott, 1988;
MacDonald, 1995). At either end of the spectrum, professions risk their credibility as
too great abstraction appears to be mere formalism, too great concreteness is judged
to be not more that a craft (MacDonald, 1995, p. 165). Participants sense of
professional self-esteem, so we argue, seemed somewhat challenged by the experience
of routine work and boredom with these routines. One participant even pointed out
that he often felt a tape recorder could do his job. Defined knowledge domain and
socially grounded self esteem were in conflict, and the change context of the LHCC era
allowed interviewees to seek and establish a new salient in-group which kept them part
of yet separate from mainstream or rank and file GP practice.
Such attempts to differentiate from existing referent groups and to seek new salient
ingroups is a typical consequence of change. Brewer points out that in larger groups of
high status a tendency towards the formation of smaller salient sub-groups is frequent
as a means to achieve optimum group distinctiveness (Brewer, 2001), and this was
the case here where chairs and deputy chairs of LHCCs saw themselves as part of the
GP collective yet also as being different. This need to differentiate from the
professional collective was also extended beyond the LHCC phase into the new CHP
phase. Interviewees thus worked towards institutionalising their special status within
the new structure despite the fact that these new structures and roles were still highly
ambiguous. This was seen as a more attractive option than reverting to mainstream
GP professional work. At local level a professional elite formed which saw
themselves, however tentatively, as potential leaders of their profession even if only
JOCM at local level and thus as avantgarde. Current professional scripts were seen as
21,6 constraining rather than enabling and there was a sense of need for change to the
profession and the way it defines itself. Freidson argues that professions can respond
to change through re-stratifying themselves and becoming internally more hierarchical
than hitherto. At local level this case illustrates how such restratification might
gradually emerge as individuals locally claim and maintain elite status (Freidson,
736 1994; Mahmood, 2001). This resonates with Fitzgerald and Ferlies observation that
intra-professional competition might become one of the drivers for change to
professional identity (Fitzgerald and Ferlie, 2000). Furthermore, Dent notes how there
is now real and substantial change in medical education . . . and possibly in career
structure (Dent, 2005, p. 11) the case presented here illuminates how individual
dissatisfaction might be a source of such change as individual professionals enact but
also challenge the scripts of signification, the rules of legitimation and thereby the
structure of their profession.
The study reports on a group of GPs engaged in NHS change. As professionals who
have traditionally held an independent contract status, their relationship with the NHS
differs from that of professionals directly employed by the NHS (Goldie and Sheffield,
2001). Yet in one key respect both groups are similarly affected by the governments
reform agenda: in all areas of the NHS, professionals have been offered, presented with
an opportunity to or pushed towards combining clinical and more managerial roles and
responsibilities, or the opportunity to move over to management (Goldie and Sheffield,
2001; Forbes and Prime, 1999). In the health sector as in any other area of the new public
sector a new type of professional manager has emerged, the professional managing
peer-professionals and their performance (Fitzgerald and Ferlie, 2000). These hybrid
managers, no matter which sub-group of the medical profession they belong to, are of
interest for our question as it is such professionals in boundary-spanning roles who
engage with, change and thus, ultimately, challenge the boundaries of managements
domain as much as those of their profession. SIT has been used as a lens through which
the transition issues of individual professionals can be examined (Forbes and Prime,
1999). Here, we suggests that its combination with structuration theory can shift the
focus from issues of alignment and transition and further an understanding of
professionals interaction with change as one of consequence not only to the individual
professional but, eventually to the profession at large.

Limitations
The study has clear limitations, as it reports on a very small group of professionals and
using the data collected at an early stage in the project. Although small, however, the
group interviewed illustrates how individuals may see organisational change as
challenge to their professional identity and opportunity to revise and rewrite it. In so
doing, they have used and revised the scripts or modalities offered by their profession.
New scripts of innovation, entrepreneurship, change activism were tried out as
professional scripts to make sense of local change and assert a revised professional
identity that satisfies individual needs for social membership, status and self-esteem.
Change response thus seems a composite of structural and individual motivation, as
participants position themselves as recipients and interpreters of structure, in part to
gain or preserve power, status and self-esteem. Interviewees never spoke as a group,
they were at different stages in their careers, and there may be a whole range of
individual issues and motivations beyond those that were voiced. To that extent, this Professional
paper presents these professionals as a more homogeneous group than they actually identity
were. Given the consistency with which all interviewees pursued the same themes and
issues, this seemed justified for the purpose of this paper.

Outlook 737
This question of recursiveness between individual and collective professional identity
needs further discussion and studies which explicitly link micro and macro levels.
What needs to be examined is how individual professionals communicate with, are
involved and engaged with their professional community, what roles they play for
instance in professional bodies, and how they translate their individual change
experience into collective-level discussions around the future of their profession and its
future agenda. One of the research participants spoke eloquently about
his participation in agendas such as the modernisation of medical education. His
individual professional identity project clearly shaped what he had to say at
professional fora or conferences. A more systematic investigation into such interface
engagements should shed new and interesting light on the as yet under-researched
recursiveness between profession and professions in the context of change.
The quest for more efficient and more effective public services is set to continue for
years to come, and managing professionals will remain a topic of high priority for
senior managers. Studies that try to explore how professionals read and interact with
the change initiatives issued by senior management, and how these change initiatives
in turn serve as opportunities for professionals to re-enact, revise or reject the scripts of
their profession must therefore, ultimately, be of interest and utility for management
practice.

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About the author

Sabine Hotho is Senior Lecturer in Management at Dundee Business School, University of
Abertay Dundee. Her research interests are in the field of change and change management, in
both the public and the private sectors. She has published on organisational change, academic
middle management and professional identity in the NH. Sabine Hotho can be contacted
at: bstsh@tay.ac.uk

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