Managing identities in managed care: Top-management-team responses to organizational complexity and change

This thesis examines the phenomena of multiple and competing expectations in complex organizations through the lens of identity theory. I begin with the premise that the challenge of managing multiple interests in organizations is essentially one of managing multiple identities. My main research question is: How does a complex, pluralistic organization ‘ manage’ multiple and competing identities? I explore this issue in the context of healthcare organizations—chosen because of the industry's inherent degree of competing interests and the associated conflicts that have been raised by the managed care movement. In particular, I focus on the identity management strategies and mechanisms employed by the top management team in a large, physician-owned, integrated delivery system, using the Pratt and Foreman (2000) classification scheme as a reference point. Through a 18-month-long ethnographic case study, I gathered extensive qualitative data—including non-participant observations of management committee meetings and formal and informal interviews with upper-level managers and physician leaders. The data were analyzed primarily via a process of thematic coding and pattern-matching, using qualitative data analysis software. The analysis of the data are consistent with the Pratt and Foreman (2000) scheme and provide extensive “thick description” of the various strategies and mechanisms used to respond to multiple identities. Furthermore, an additional and highly valuable strategy emerged from the data, wherein managers simultaneously integrated and segregated multiple identities. This semi-integration response spans opposing quadrants and suggests that managers may employ highly complex responses that operate on different levels simultaneously. Lastly, the pattern of mechanisms used to implement the identity management the deletion-aggregation diagonal.