title: Innovative doctors in Germany: changes through communities of practice.
abstract: OBJECTIVE
  The healthcare sector faces new financial and managerial accountability demands, along with their clinical accountability. Various studies show strong opposition by clinicians to new accountability tools, new structures and new ways of working. Less attention is paid to the innovative roles doctors can play in leading changes that use new managerial tools and techniques. The purpose of this paper is to analyse two original case studies illustrating how general practitioners (GPs) in Germany have led radical change.
  
  
  METHODS
  The paper draws upon original research in Germany to present two case studies using a qualitative method, which are analysed using Glaser and Strauss' conventions of grounded theory, structured by Wenger's communities of practice framework, supporting a comprehensive literature review.
  
  
  RESULTS
  GPs are found to be able to lead radical change in healthcare delivery models and organisation using entrepreneurial talents developed in their practice businesses and to embrace modernising tools and techniques and in the process redefine their identities to include management process in addition to medical competences.
  
  
  CONCLUSIONS
  The paper presents two original case studies of radical change leading to an integration of healthcare services in Germany. The approach adopted by the German GPs reveals important general lessons for practitioners, as does the analytical framework employed in the paper.
authors.affiliation: The Business School, University of Edinburgh, Edinburgh, UK. Iris.Bosa@ed.ac.uk
authors.forename: Iris M
authors.initials: IM
authors.lastname: Bosa
mesh_terms: D004059:Diffusion of Innovation; D005858:Germany; D018166:Health Care Reform; D009313:National Health Programs / Q000458:organization & administration; D010819:Physician's Role; D010821:Physicians, Family