Who wants to wash my white coat? Collective management of tinted activities. The case of clinical direction’s teams

Abstract

French hospitals’ governance reform has, directly or not, created new roles: clinical directors, senior nurse assistants, business managers and executive managers. These roles are still recent and not yet legitimate within hospitals. Furthermore, they are associated with a strong social stigma in those organizations: care management. Our work aims at better understanding the way clinical directions’ teams consider their management activities as dirty work; and the strategies through which they try to legitimate these activities in front of their colleagues. We carried out a case study of 7 “Mother-Child” clinical directions’ teams in France, through a qualitative methodology (56 interviews, including 25 interviews with targeted actors; 20 observations of directorate meetings). Our results show that activity legitimization strategies vary depending on actors and teams. They are both organizationally based (delegation) and discursively based (reframing, recalibrating, audience diversifying). We specifically suggest that these strategies depend on clinical directions’ team organization. We discuss two layouts of strategies: strategies of clinical director’s delegation and those of collective commitment. Tinted roles’ legitimization thus depends on both individuals’ discursive resources (and places for discussions) and individual’s power within the organization (and hierarchical and functional relationships).