Public Healthcare Organizations Research Articles

Leadership development programs for healthcare professionals in low-and middle-income countries: A systematic review.

Leadership development programs are integral to the future success of public health and healthcare organisations. Despite low-and middle-income countries (LMICs) bearing a greater burden of unmet medical needs, fewer professional development opportunities exist in these settings. This study aims to provide a comprehensive understanding of available leadership development programs for healthcare professionals in LMICs. This study conforms to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-P systematic review and traditional meta-analyses guidelines. Articles were identified through five academic databases: Embase, PubMed, Web of Science, ERIC, and Business Source Complete. Eligibility criteria included original research published in peer-reviewed journals on non-clinical, leadership development programs offered to healthcare professionals in LMICs worldwide. Forty-one peer-reviewed articles met inclusion criteria, of which physicians, nurses, and public health professionals were the most common types of providers to attend leadership development programs; no programs exclusively targeted surgeons. The greatest proportion of programs were short-term interventions (ranging from 1day to 12weeks). Communication, organizational structure and leadership, and personal development were identified as the three most common leadership themes in the review. Regionally, leadership programs were reported most commonly in Africa, specifically in Anglophone countries. Other regions worldwide, including Latin America and the Caribbean, were underrepresented in the review. The findings from this review identify gaps in leadership development programs for certain groups of healthcare professionals from certain geographical regions, supporting the need for further provision of and participation in these opportunities in LMICs.

Aging queer in a pandemic: intersectionalities and perceptions

PurposeThe purpose of this study is to highlight the experiences and issues of an overlooked demographic: older LGBTQ + adults in the US, in the context of the COVID-19 pandemic. This allows the authors to explore possible changes in policy and practice regarding the management of the pandemic with attention to elderly LGBTQ.Design/methodology/approachBuilding on the authors’ experience in disaster research and a study of older LGBTQ + adults in the San Francisco Bay Area, the authors analyze key trends in COVID-19 pandemic management while drawing lessons from the AIDS epidemic.FindingsThe authors have found that LGBTQ + people, especially older and transgender individuals, have unique experiences with hazards and public safety and healthcare professionals and organizations (e.g. heteronormative care, traumatic insensitivity, deprioritizing essential treatments as elective). Second, older LGBTQ + adults' perceptions of state responses to pandemics were heavily influenced by experiences with the HIV/AIDS pandemic. And third, experiences with the COVID-19 pandemic have important implications for preventing, responding to and recovering from future epidemics/pandemics.Originality/valueThe authors point to two parallel implications of this work. The first entails novel approaches to queering disaster prevention, response and recovery. And the second is to connect the management of the COVID-19 pandemic to the principles of harm reduction developed by grassroots organizations to suggest new ways to think about contagion and organize physical distancing, while still socializing to take care of people’s physical and mental health, especially the more marginalized like elderly LGBTQ + people.

Stress and Turnover Intentions Within Healthcare Teams: The Mediating Role of Psychological Safety, and the Moderating Effect of COVID-19 Worry and Supervisor Support.

Employees at healthcare organizations are experiencing more stress than ever given the current COVID-19 pandemic. Different types of stress are affecting diverse organizational outcomes, including the employees’ voluntary turnover. This is the case of cognitive stress, a type of stress that affects how individuals process information, which can influence employees’ turnover intentions. In this study, we look at the mechanisms that can reduce the adverse effects of cognitive stress on turnover intentions, particularly the role of employees’ perceived psychological safety (i.e., how safe they perceive the interactions with their colleagues are). We hypothesize that psychological safety mediates the relationship between cognitive stress and turnover intentions, and COVID-19 worry and supervisor support moderate the relationship between cognitive stress and psychological safety. To test our hypothesis, we invited two public health care organizations in Chile to join this study. In total, we obtained a sample of 146 employees in 21 different teams. Using a multilevel model, we found that psychological safety prevents the harmful effects of cognitive stress on employees’ turnover intentions. In addition, while COVID-19 worry can worsen the relationship between cognitive stress and psychological safety, supervisor support only directly affects psychological safety. This study contributes to expanding the stress and psychological safety literature and informs practitioners in healthcare organizations about how to deal with cognitive stress in the “new normality” that the pandemic has brought.

Market‐focused flexibility and innovative performance in public healthcare: Evidence from India

The healthcare sector is increasingly facing changing demand patterns and escalating pressures for innovative services during the COVID‐19 pandemic. Market‐focused flexibility refers to the capabilities of adaptation and facilitating the innovative performance of the firm. Accepting the overall role of innovation in COVID‐19 response, this study aims to explore how public healthcare organizations exhibit market‐focused flexibility to introduce new and innovative services. This study conducts an exploratory case study in a national‐level healthcare firm in India. This study identifies four specific dimensions of market‐focused flexibility that healthcare firms execute to deliver customized services. The study's findings contribute to an integrative framework of market‐focused flexibility and innovative performance in public healthcare. The mechanisms of market‐focused flexibility are unearthed and explained how the different facets influence innovative services in various manners. The implications to theory and practices are discussed, and future research avenues are sketched.

Integration intrapreneurship: implementing innovation in a public healthcare organization

AimAs global events impact the way organizations operate and innovate in response to regional, workforce and consumer needs, the concept of intrapreneurism is attracting growing interest from policymakers and executives, particularly within the healthcare sector. The aim of this study was to capture the key learnings from the implementation of a telementoring pilot, to understand how intrapreneurship can embed innovation within an established organization to effect more integrated healthcare.PurposeA qualitative approach was used with a phenomenological lens to explore the key learnings of the Project ECHO® (Extension for Community Healthcare Outcomes) pilot implementation to provide an understanding of what the project team’s strategies and tactics were during the process of embedding a new business innovation. The implementation and piloting of Project ECHO®, a telementoring model, in a large-scale public healthcare organization in Queensland, Australia, was investigated as an exemplar of integration intrapreneurship.FindingsThrough an inductive approach, this qualitative study found the implementation of the Project ECHO® pilot had specific dimensions and strategies/tactics which were exemplars of intrapreneurism. The organizational context and workforce characteristics described in this study presented new knowledge of how intrapreneurs implemented an innovation to address fragmentation of healthcare service delivery, professional isolation and instances of low-value care. This research contributes to a better understanding of the strategic and tactical approaches to implementing intrapreneurial innovations within a public healthcare organization, with learnings that can be adapted by intrapreneurs in other contexts.

The Relationship between Organizational Culture and Employees’ Work Attitudes in Hospitals in Greece

Purpose: The volatile socioeconomic conditions that prevail in Greece, significantly affect the healthcare sector. The match of employees’ and organizational values is considered as the critical factor in determining the level of employees’ work attitudes, such as work engagement, job satisfaction, and job burnout. The more employees accept the organization’s values and beliefs, assumptions, the stronger the Organizational Culture is, and the more influence has on the employees’ work attitudes. Thus, Organizational Culture is recognized to be the essential tool to shape the employee’s behavior and work attitudes. This paper aims to explore the Organizational Culture that prevails on Hospitals in Greece and at what extent the organizational culture is related to employees' working attitudes as work engagement, job satisfaction and job burnout. It also analyses these elements of the Greek hospital culture that cause negative affect to employees' working attitudes and how this may change. Method: This study collected data from public healthcare organizations, using questionnaires which are reliable from other researches in order to verify the results. These questionnaires were used to examine the culture of the hospitals in Greece that prevails and at what extent this culture affects employees' working attitudes. It is analyzed the correlation between the variables by using the structural equation model SEM. Findings: In the specific research our results support that Organizational Culture cannot predict employees’ Work Engagement and Job Satisfaction. Organizational Culture significantly influences the level of employees’Job Burnout. From the SEM analysis, we indicate a good fit of the hypothesized model. The type of Organizational Culture that prevails in the Health sector in Greece is the Hierarchic type. Originality: This research emerges the importance of organizational culture and at what extent affects employees' working attitudes. It reveals which is the prevailing culture of the hospitals in Greece in the public sector. Also, it shows the specific characteristics of the culture that can be improved in order to affect positively employees' working attitudes.

Emotional labour in the collaborative data practices of repurposing healthcare data and building data technologies

This article focuses on emotions, conceptualised as emotional labour, evoked during data practices used to repurpose and enable healthcare data journeys for Finnish public healthcare. Combined approaches from critical data studies and the sociology of emotions were used to contribute to a better understanding of the mundane but often invisible work of the emotions of experts involved in data practices, such as facilitating data journeys and building data technologies. The article is based on a two-and-a-half-year ethnographic study conducted in a Finnish regional public healthcare and social service organisation. The study results were derived from the analysis of 39 interviews and fieldnotes produced by observing 170 h of various meetings, events and work activities performed by experts. The results were organised into three forms of observed experts’ emotional labour related to three phases of healthcare data journeys: (a) caring for data production and preparing data for travel, (b) managing excitement and frustration in data processing for continually building the data management system, and (c) reassuring users in making sense of obtained data analytics. The results contribute to a greater understanding of the emotions and emotional labour generated by healthcare data journeys and in relation to the volatile nature of healthcare data and the collaborative character of data practices. This work advocates for a better recognition of the emotional aspects of data practices and their implications on data-based knowledge and datafication processes in healthcare.

HIV Viral Suppression among People Living with HIV on Antiretroviral Therapy in Haut-Katanga and Kinshasa Provinces of Democratic Republic of Congo.

Human immunodeficiency virus (HIV) infections and less-than-optimal care of people living with HIV (PLHIV) continue to challenge public health and clinical care organizations in the communities that are most impacted by HIV. In the era of evidence-based public health, it is imperative to monitor viral load (VL) in PLHIV according to global and national guidelines and assess the factors associated with variation in VL levels. Purpose: This study had two objectives—(a) to describe the levels of HIV VL in persons on antiretroviral therapy (ART), and (b) to analyze the significance of variation in VL by patients’ demographic and clinical characteristics, outcomes of HIV care, and geographic characteristics of HIV care facilities. Methods: The study population for this quantitative study was 49,460 PLHIV in the Democratic Republic of Congo (DRC) receiving ART from 241 CDC-funded HIV/AIDS clinics in the Haut-Katanga and Kinshasa provinces of the DRC. Analysis of variance (ANOVA) was performed, including Tamhane’s T2 test for pairwise comparisons using de-identified data on all patients enrolled in the system by the time the data were extracted for this study by the HIV programs in May 2019. Results: The VL was undetectable (<40 copies/mL) for 56.4% of the patients and 24.7% had VL between 40 copies/mL and less than 1000 copies per mL, indicating that overall, 81% had VL < 1000 and were virologically suppressed. The remaining 19% had a VL of 1000 copies/mL or higher. The mean VL was significantly (p < 0.001) higher for males than for females (32,446 copies/mL vs. 20,786, respectively), persons <15 years of age compared to persons of ages ≥ 15 years at the time of starting ART (45,753 vs. 21,457, respectively), patients who died (125,086 vs. 22,090), those who were lost to follow-up (LTFU) (69,882 vs. 20,018), those with tuberculosis (TB) co-infection (64,383 vs. 24,090), and those who received care from urban clinics (mean VL = 25,236) compared to rural (mean VL = 3291) or semi-rural (mean VL = 26,180) clinics compared to urban. WHO clinical stages and duration on ART were not statistically significant at p ≤ 0.05 in this cohort. Conclusions: The VL was >1000 copies/mL for 19% of PLHIV receiving ART, indicating that these CDC-funded clinics and programs in the Haut-Katanga and Kinshasa provinces of DRC have more work to do. Strategically designed innovations in services are desirable, with customized approaches targeting PLHIV who are younger, male, those LTFU, with HIV/TB co-infection, and those receiving care from urban clinics.

Managers do it their way: How managers act in a decentralised healthcare services provider organisation - a mixed methods study.

Purpose: Decentralisation is considered a way to get managers more committed and more prone to respond to local needs. This study analyses how managers perceive a decentralised management model within a large public healthcare delivery organisation in Sweden. Design/methodology/approach: A programme theory evaluation was performed applying direct content analysis to in-depth interviews with healthcare managers. Balance score card data were used in a blinded comparative content analysis to explore relations between performance and how the delegated authority was perceived and used by the managers. Findings: Managers' perceptions of the decentralised management model supported its intentions to enable the front-line to make decisions to better meet customer needs and flexibly adapt to local conditions. The managers appreciated and used their delegated authority. Central policies and control on human resources and investments were accepted as those are to the benefit of the whole organisation. Leadership development and organisation-wide improvement programmes were of support. Units showing high organisational performance had proactive managers, although differences in manager perceptions across units were small. Originality: This, one of the first of its kind, study of a decentralisation in service delivery organisation shows a congruence between the rationale of a management model, the managers' perceptions of the authority and accountability as well as management practises. These observations stemming from a large public primary and community healthcare organisation has not, to our knowledge, been reported and provide research-informed guidance on decentralisation as one strategy for resolving challenges in healthcare service delivery organisations.

The Use of Simethicone in a Public Healthcare Organization in Riyadh Region

Aim: Simethicone is anti-flatulence medicine that is used to relieves abdominal pain due to excessive gas in the digestive tract. The present study aimed to describe the use of simethicone in a public healthcare organization in Riyadh Region.&#x0D; Methodology: This is a retrospective study that includes reviewing the outpatient electronic prescriptions of simethicone in a public healthcare organization in Riyadh Region.&#x0D; Results: During the study period, 113 patients received simethicone. More than 56 % of them were females and the age of 22.12% of them was between 50 and 59 years. More than 26% of the patients received simethicone for 1 week and 23.90% of them received simethicone for 1 month. Most of the prescriptions were written by residents (90.27%) and more than 57% of the prescriptions were prescribed by emergency department.&#x0D; Conclusion: The present study showed that simethicone was prescribed frequently in a public healthcare organization in Riyadh Region. More studies are needed to explore the frequency of use and the appropriateness of prescribing simethicone and other anti-flatulence medicines.

The Outpatient Use of Ascorbic Acid in a Public Healthcare Organization in Riyadh Region

Aim: The present study aimed to describe the outpatient use of ascorbic acid in a public healthcare organization in Riyadh Region.&#x0D; Methodology: This is a retrospective study included reviewing the outpatient electronic prescriptions that contained ascorbic acid in a public healthcare organization in Riyadh Region.&#x0D; Results: More than 51% of the patients who received ascorbic acid in the hospital during 2018 were females and the age of 57.14 % of them was less than 30 years. Most of the prescriptions were regular prescriptions (88.57%) and only 5.71% of the prescriptions were urgent prescriptions. More than 42% of the patients received ascorbic acid for 1 week and 37.14% of them received it for 1 month. Most of the prescriptions were prescribed by residents (85.71%) and most of these prescriptions were prescribed by emergency department (80.00%).&#x0D; Conclusion: The prescribing of ascorbic acid was uncommon in the public hospital. More studies are needed to know the frequency and the pattern of using ascorbic acid in the public hospital and in other healthcare organizations in Riyadh Region.

The Use of Fluorometholone Eye Drops in a Public Healthcare Organization in Riyadh Province

Aim: This study aimed to describe the use of fluorometholone eye drops in a public healthcare organization in Riyadh Province&#x0D; Methodology: This is a retrospective study that includes reviewing the electronic prescriptions of fluorometholone eye drops among outpatients in a public healthcare organization in Riyadh Province&#x0D; Results: During the study period, only 42 patients received fluorometholone eye drops. More than 64% of them were females and the age of 28.57% of them was between 20 and 29 years. More than 73% of the patients received fluorometholone eye drops for 1 week. Most of the prescriptions were prescribed by residents. More than 95% of the prescriptions were written by ophthalmology department.&#x0D; Conclusion: The present study showed that fluorometholone eye drops was uncommonly prescribed in Al-Kharj. More studies are needed to describe the frequency of using and the pattern of prescribing fluorometholone eye drops.

The Use of Zinc Oxide in a Public Healthcare Organization in Riyadh Region

Aim: The present study aimed to describe the use of zinc oxide in a public healthcare organization in Riyadh Region.&#x0D; Methodology: This is a retrospective study that includes reviewing the electronic prescriptions of zinc oxide among outpatients in a public healthcare organization in Riyadh Region.&#x0D; Results: More than 52% of the patients who received zinc oxide were males and the age of 79.41% of them was less than 10 years. More than 55% of the patients received zinc oxide for 1 week and 17.65% of them received zinc oxide for 2 weeks. All of the prescriptions were prescribed by residents (100.00%). Most of the prescriptions were written by emergency department (76.47%).&#x0D; Conclusion: The present study showed that zinc oxide was uncommonly prescribed in Al-Kharj. Additional studies are needed to explore the frequency of and the pattern of using it in different settings.

Towards Explaining Knowledge Hiding through Relationship Conflict, Frustration, and Irritability: The Case of Public Sector Teaching Hospitals

Organizations grow and excel with knowledge sharing; on the other hand, knowledge hiding is a negative behavior that impedes innovation, growth, problem solving, and timely correct decision making in organizations. It becomes more critical in the case of teaching hospitals, where, besides patient care, medical students are taught and trained. We assume that negative emotions lead employees to hide explicit knowledge, and in the same vein, this study has attempted to explain the hiding of explicit knowledge in the presence of relational conflicts, frustration, and irritability. We collected data from 290 employees of a public sector healthcare organization on adopted scales to test conjectured relationships among selected variables. Statistical treatments were applied to determine the quality of the data and inferential statistics were used to test hypotheses. The findings reveal that relationship conflicts positively affect knowledge hiding, and frustration partially mediates the relationship between relationship conflicts and knowledge hiding. Irritability moderates the relationship between relationship conflicts and frustration. The findings have both theoretical and empirical implications. Theoretically, the study tests a novel combination of variables, and adds details regarding the intensity of their relationships to the existing body of literature. Practically, the study guides hospital administrators in managing knowledge hiding, and informs on how to maintain it at the lowest possible level.

Implementation Science for Managers and Healthcare Organizations Responding to Emergencies

The purpose of the article is to illustrate how implementation science concepts and methods can be applied by researchers and implementers to understand and assist emergency management in a large primary and community healthcare organization. The article refers to a single-case implementation action evaluation of an emergency management system in a healthcare organization. It describes the methods used in this study and findings to explain how a joint healthcare and university research team were able to use the science and methods both to help implementation and contribute to science. We report two sets of findings. First, findings about implementation of emergency management to illustrate how the investigation adapted implementation science and concepts to achieve the objectives evaluation. We discovered that implementation science provides useful concepts to understand contextual factors and adds to knowledge about organizational change and emergency management in the uncertain and evolving situation we encountered. The second set of findings are the strengths and limitations of both implementation science and the action evaluation methods we used to achieve the dual objectives of practical help with implementation and to contribute to science. The article uses the first implementation action evaluation study of the response of large public primary and community healthcare organization to a pandemic to illustrate how implementation science can be applied. This type of study was able to improve implementation of the response as well as contribute to scientific knowledge about emergency healthcare management and organization.

Increasing the medico-economic efficiency of preventive counseling for patients with arterial hypertension and behavioral risk factors for non-communicable diseases

Objective:to evaluate behavioral risk factors (BRF) in patients with arterial hypertension (AH) and to determine the ways of improvement of the approaches to preventive consulting targeted to increase medico-economic efficiency of the prevention of cardiovascular diseases (CVDs).Material and methods.A total of 107 patients aged 40–60 years old that attended health-promoting schools for patients with AH at the institutions of primary medical help in Moscow in 2017–2019 were surveyed. The authors used diagnostic criteria of the risk factors for noncommunicable diseases that have behavioral character according to the classification of the World Health Organization (WHO). Along with that, the authors reviewed the opinion of 128 top managers of the institutions of primary medical help that attended the courses of their qualification improvement “Organization of public healthcare” in 2019. The course was dedicated to the possible ways of improvement of preventive consulting of patients with AH and BRF. The methods of content analysis, synthesis, statistical analysis, comparison, etc. were applied. The authors analyzed the documentation on the prevention of CVDs, scientific publications on the subject from eLibrary, Cochrane Library, PubMed, Scopus databases, and official sites of biomedical journals.Results.The sociological survey revealed data on the presence of BRF of non-communicable diseases in patients aged 40–60 years old with verified AH based on scientifically proven criteria and WHO classification. These criteria allowed to evaluate the degree of the proneness of patients with AH to the influence of harmful risk factors (smoking, alcohol consumption, lack of physical activity, unhealthy eating habits) and their combinations. The sociological survey data obtained from the top management of institutions of primary medical help indicated the necessity of the improvement of approaches to group preventive consulting of patients with AH and BRF.Conclusion.The results of the study revealed the main areas of the systemic mistakes in the preventive consulting of patients with AH that have BRF, associated with the evaluation of individual-psychological peculiarities of a personality, and in the organizational aspects of preventive counseling.

How do street‐level bureaucrats manage high workloads? Collegial mechanisms at the organisational level—experiences from public healthcare organisations

AbstractThe aim of this study is to understand and explain how street‐level bureaucrats manage high workloads in public healthcare organisations. Data was collected through observations, interviews and documents. The results show that high workloads are reduced through use of collegial mechanisms at the organisation level. The study shows that workloads are reduced in a two‐step process, the first is a negotiation between professionals and the second in the meeting with patients. The two‐step process explains the limitation problems in more detail and makes an important contribution by explaining how high workloads are reduced in public health services.

Age-related vulnerability of employees to factors of the occupation environment

Introduction. When predicting individual health risks associated with a person’s profession, first of all, the state of their health, age and experience of harmful work are studied. A practical approach to studying the age-related vulnerability of a person to the factors of the working environment is the use of fatigue indicators. Objective: to establish age-related patterns of the influence of factors of the occupation environment on employee fatigue Materials and methods. Three thousand eight hundred fifty-one employees of industrial enterprises, public catering enterprises, healthcare and educational organizations were examined. The employees evaluated the degree of influence of factors of the production environment on fatigue - noise, microclimate, working area air, dust in the working area air, vibration. The frequency of influence (FI) of each factor of the production environment on employee fatigue was considered an indicator of age-related vulnerability (vulnerability risk). The relative risk of exceeding the FI in older age groups of employees was calculated. Results. In older medical workers, the relative risk (RR) of vulnerability to noise was =1.19 (0.88-1.60); to the microclimate OR=1.26 (0.96-1.64); RR due to the air of the working area =1.19 (0.92-1.54). School teachers have a significantly higher frequency of complaints about noise than doctors and nurses, and their age-related increase in vulnerability to noise was OR=1.23 (0.98-1.55). Employees of public catering enterprises showed an increase in age-related vulnerability to all environmental factors. Employees of older age groups of industrial enterprises are more vulnerable to all factors of the production environment. The values of FI in the groups of 30-49 years and 50-69 years, respectively, were: for noise, OR=1.20 (1.01-1.43) and OR=1.15(0.88-1.50); for microclimate, OR=1.21(1.04-1.39); for working area air, OR=1.02 (0.87-1.19) and OR = 1.31 (1.06-1.62). Conclusion. Compared with the age group of 20-30 years, the probability of the influence of factors of the working environment - “noise”, “microclimate”, “air of the working area”, on the fatigue of workers increases by 10-15% at the age of 30-49 years and by 15-25% at the age of 50-60 years.

Organisational Justice and Political Agency among Nurses in Public Healthcare Organisations: A Qualitative Study Protocol.

Nurses are rarely treated as equals in the social, professional, clinical, and administrative life of healthcare organisations. The primary objective of this study is to explore nurses’ perceptions of organisational justice in public healthcare institutions in Majorca, Balearic Islands, Spain, and to analyse the ways in which they exercise their political agency to challenge the institutional order when it fails to reflect their professional ethos. An ethnomethodological approach using critical discourse analysis will be employed. The main participants will be nurses occupying different roles in healthcare organisations, who will be considered central respondents, and physicians and managers, who will be considered peripheral respondents. Data generation techniques include semi-structured interviews, a sociodemographic questionnaire, and the researcher’s field diary. This is one of the first studies to address organisational justice in healthcare organisations from a macrostructural perspective and to explore nurses’ political agency. The results of this study have the potential to advance knowledge and to ensure that healthcare organisations are fairer for nurses, and, by extension, for the patients in their care.

Lower-status experts' influence on health-care managers' decision-making.

The purpose of this paper is to investigate and theoretically explain how line managers and lower-status experts work together in public health-care organizations. Hence, this study explores how lower-status experts influence line managers' decision-making and task prioritizing in order to guide staff experts' cooperation and performance improvements. The authors used a qualitative method for data collection and analysis of the experts' and line managers' explanations about their cooperation. A theoretical approach of experts' identity positioning, in terms of differences and similarities, was used in analyzing the interaction between managers and experts. This study shows that similarities and differences in positioning acts exist simultaneously. Similarity is constructed by way of strategic and professional alignment with the line managers' core tasks. Differences stem from the distinction between knowledge-grounded skills and professional attributes such as language, analytical tools, and jargon. Lower-status experts need to leave their entrenched positions and match the professional status of line managers in both knowledge aspirations and appearance to reach a respected approach of experts' identity positioning. Unlike many previous studies, this study demonstrates that similarities and differences in positioning acts exist simultaneously.