Medical and nursing professional culture after thirty years of corporatization in the Italian healthcare system

In the last decades, the Italian healthcare system (as the majority of the European countries’ healthcare systems) has been interested by processes of rationalization of governance structures, of administrative procedures and of professional practice. Effects and impacts of these innovations are mainly measured in terms of services effectiveness/efficiency. Nevertheless it has been reported how these structural changes have been accompanied by a vertical segmentation within the medical profession, including: clinical-physician (the professional), manager-physician (the administrator) and researcher-physician (the academic). These peculiar roles within the same professional profile diverge for power and influence on others, formal knowledge and professional duties. Analogue but less articulated differentiation can be identified within the nursing profession, where some people perform managerial tasks aimed at managing working activities and information spreading. This paper discusses the results of a qualitative study carried out in an Italian healthcare organization, and aimed at investigating the impacts of these changes on the professional cultures (medical and nursing in particular). The empirical dataset is composed by thirty-three interviews with physicians and nurses in charge of managerial and academic responsibilities. Three main cultural frames emerge from the content analysis of data: the corporate-managerial culture, the clinical-professional culture and the academic-technological culture. In this paper we will discuss these cultural profiles on details, identifying for each of them professional identity changes, social expectations and styles of leadership in both medical and nursing staff.