Professional identities and organizational performance in the operating theater: a comparative study in French hospitals

Introduction: Professional differentiation and identity differences (goal discordancy, competency separation, norm diversity, and work process dissonance and information opacity) in healthcare have been associated with poor coordination and decreased performance in operative suites (OS). As the major medical professional stakeholders involved in the management of OS, the aim of this study is to investigate the impact of surgeons' and anesthesiologists' professional identities (PI) on perceived performance. Methods: This is a qualitative comparative case study using semi-structural interviews and observations conducted in OS of four hospitals (two teaching, one public non-teaching and one private). PI were analyzed and compared between surgeons ( n = 13) and anesthesiologists ( n = 13). Differences in perceived performance (as described by stakeholders) were compared across the four facilities according to variations in PI. Results: The findings suggest that for-profit hospitals were associated with increased perceived performance. Moreover, differences in PI were associated with increased conflicts and differences in perceived performance. A lack of respect for shift end times for anesthesiologists in public hospitals and the need for additional operating shifts for surgeons were associated with lower perceived performance. However, these conflicts were often the result of organizational problems (human resources availability, optimization of operating shifts…etc.) rather than PI antagonism. Discussion: Resolving PI antagonism between anesthesiologists and surgeons is unlikely to have any influence on perceived OS performance. Rather than acting on PI, improved performance would be better achieved by improving management and leadership skills to facilitate information and communication between professionals.