title: Uncovering paradoxes from physicians' experiences of patient-centered ward-round.
abstract: Purpose The purpose of this paper is to uncover paradoxes emerging from physicians' experiences of a patient-centered and team-based ward round, in an internal medicine department. Design/methodology/approach Abductive reasoning relates empirical material to complex responsive processes theory in a dialectical process to further understandings. Findings This paper found the response from physicians, to a patient-centered and team-based ward round, related to whether the new demands challenged or confirmed individual physician's professional identity. Two empirically divergent perspectives on enacting the role of physician during ward round emerged: We-perspective and I-perspective, based on where the physician's professional identity was centered. Physicians with more of a We-perspective experienced challenges with the new round, while physicians with more of an I-perspective experienced alignment with their professional identity and embraced the new round. When identity is challenged, anxiety is aroused, and if anxiety is not catered to, then resistance is likely to follow and changes are likely to be hampered. Practical implications For change processes affecting physicians' professional identity, it is important for managers and change leaders to acknowledge paradox and find a balance between new knowledge that needs to be learnt and who the physician is becoming in this new procedure. Originality/value This paper provides increased understanding about how physicians' professional identity is interacting with a patient-centered ward round. It adds to the knowledge about developing health care in line with recent societal requests and with sustainable physician engagement.
authors.affiliation: Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University , Gothenburg, Sweden, Institute of Stress Medicine, Gothenburg, Sweden and Sahlgrenska University Hospital , Gothenburg, Sweden.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Bååthe
authors.affiliation: Institute of Medicine, Sahlgrenska Academy, Gothenburg University , Gothenburg, Sweden and Institute of Stress Medicine , Gothenburg, Sweden.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Ahlborg
authors.affiliation: Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University , Gothenburg, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Edgren
authors.affiliation: Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University , Gothenburg, Sweden.
authors.forename: Annica
authors.initials: A
authors.lastname: Lagström
authors.affiliation: Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University , Gothenburg, Sweden.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Nilsson
mesh_terms: D006801:Humans; D007388:Internal Medicine; D018802:Patient-Centered Care; D010817:Physician-Patient Relations; D010820:Physicians
keywords: Bio-medical; Change; Complex responsive processes; Complexity; Paradox; Patient-centered; Physicians; Professional identity; Team-based; Ward-round