Edinburgh Napier University

  Purpose
Using theory on institutional logics and identity work, we examine why many doctors disengage from their organisations. We also develop a research-based, practical tool to improve medical engagement and medical leadership.

Method
Drawing on earlier qualitative research with senior doctors, we developed the medical identity toolkit (MIT) and tested it by analysing responses from 268 senior doctors (55% response rate) in a case organisation. Our analysis employed exploratory factor analysis (EFA), binary logistic regression, AUROC on quantitative data and thematic analysis of free text items.

Findings
We found doctors’ identity work in response to shifting logics predicted overall levels of medical engagement. Doctors’ overall levels of medical engagement also predicted their advocacy of their employer as a good place to build a medical career. An EFA produced four factors with eigenvalues greater than three, explaining 32.4% of the variance. Significant differences in the mean factor scores for the first three factors were found across the MIT tertiles (each p < 0.001). Additionally, using binary logistic regression and stepwise selection we developed a medical engagement index (MEI) containing the sum of scores of four questionnaire items. The AUROC for the MEI model was 0.9687 (95% CI: 0.9478 to 0.9896), with a threshold of 13 (sensitivity and specificity of 88.6% and 90.9% respectively).

Originality
The paper enhances our understanding of medical engagement among senior doctors by examining it through the lenses of medical professional identities, identity work and institutional logics.

Practical Implications
The MIT has strong practical implications for medical professionals in the NHS and other countries. It is grounded in the perspectives of doctors and provides immediate feedback for individual and collective reflection on medical engagement and doctor’s suitability for medical leadership.