title: Dialogues and dialetics: limits to clinician-manager interaction in healthcare organizations.
abstract: This paper examines clinician-manager interactions within healthcare organizations in the U.K. and contrasts the notions of dialetics and dialogues within such interactions. We draw particularly on Bakhtin's work on dialogue to frame our focal research question, which considers the extent to which clinician-manager interactions are dialogic. Using data drawn from a thirty-two month study of five U.K. healthcare organizations we suggest that clinician-manager interactions are more dialectic than dialogic in their orientation. Further, we suggest that, despite the appearance of dialogical possibility between clinicians and non-clinicians, the tendency to dialectic positioning reinforces opposition between these groups and we conclude that local, rather than system-wide interventions, offer the best means of disrupting these dialectics and fostering productive dialogues.
authors.affiliation: University of Glasgow Business School, Gilbert Scott Building, University Avenue, Glasgow G128QQ, United Kingdom. Electronic address: robert.macintosh@glasgow.ac.uk.
authors.forename: Robert
authors.initials: R
authors.lastname: MacIntosh
authors.affiliation: Department of Management, University of St Andrews, UK. Electronic address: pnhb@st-andrews.ac.uk.
authors.forename: Nic
authors.initials: N
authors.lastname: Beech
authors.affiliation: University of Glasgow Business School, Gilbert Scott Building, University Avenue, Glasgow G128QQ, United Kingdom. Electronic address: graeme.martin@glasgow.ac.uk.
authors.forename: Graeme
authors.initials: G
authors.lastname: Martin
mesh_terms: D003142:Communication; D003695:Delivery of Health Care; D017144:Focus Groups; D006270:Health Facility Administrators; D006801:Humans; D007400:Interprofessional Relations; D007802:Language; D008503:Medical Staff; D036301:Qualitative Research; D006113:United Kingdom