Silos and Social Identity: The Social Identity Approach as a Framework for Understanding and Overcoming Divisions in Health Care

• Published in: The Milbank quarterly 2012-06, Vol.90 (2), p.347-374
• Main Authors: KREINDLER, SARA A., DOWD, DAMIEN A., DANA STAR, NOAH, GOTTSCHALK, TANIA
• Format: Article
• Language: English
• Subjects: Collaboration; Cooperative Behavior; Delivery of Health Care; Drivers; Group identity; Health care; Health care organizations; Health Personnel; Health services; health services organization and administration; Humans; Identification; Identity; Identity theory; Integration; Interpersonal relations; Interprofessional Relations; Medical service; Membership; Nurses; Organization; Organizational identity; Original; Physicians; Self esteem; Silos; Social Identification; Social identity; Social integration. Social relations. Social participation; Social organization. Social system. Social structure; Social policy; Social psychology; Social structure; Sociology; Sociology of health and medicine
• ISSN: 0887-378X; 1468-0009
• DOI: 10.1111/j.1468-0009.2012.00666.x

Context: One of health care's foremost challenges is the achievement of integration and collaboration among the groups providing care. Yet this fundamentally group-related issue is typically discussed in terms of interpersonal relations or operational issues, not group processes. Methods: We conducted a systematic search for literature offering a group-based analysis and examined it through the lens of the social identity approach (SIA). Founded in the insight that group memberships form an important part of the self-concept, the SIA encompasses five dimensions: social identity, social structure, identity content, strength of identification, and context. Findings: Our search yielded 348 reports, 114 of which cited social identity. However SIA-citing reports varied in both compatibility with the SIA's metatheoretical paradigm and applied relevance to health care; conversely, some non-SIA-citers offered SIA-congruent analyses. We analyzed the various combinations and interpretations of the five SIA dimensions, identifying ten major conceptual currents. Examining these in the light of the SIA yielded a cohesive, multifaceted picture of (inter)group relations in health care. Conclusions: The SIA offers a coherent framework for integrating a diverse, far-flung literature on health care groups. Further research should take advantage of the full depth and complexity of the approach, remain sensitive to the unique features of the health care context, and devote particular attention to identity mobilization and context change as key drivers of system transformation. Our article concludes with a set of "guiding questions" to help health care leaders recognize the group dimension of organizational problems, identify mechanisms for change, and move forward by working with and through social identities, not against them.