Medical management: hostage to its own history? The case of Italian clinical directors

The article is based on a review of the existing literature and extensive field research on Italian clinical directorates. The article shows how in contexts in which doctors in management roles exist and are provided with legitimacy deriving from legal norms, historical settlements between professions and taken for granted arrangements, medical management becomes institutionalized, stability prevails and change towards new doctor-in-management roles is seriously hampered. The paper contributes to existing knowledge on professionals’ managerial role-taking, underlining the relevance of contextual and nation-specific factors on this process. It provides implications for research and for policymaking in healthcare and other professional public services.