Silos and Social Identity: The Social Identity Approach as a Framework for Understanding and Overcoming Divisions in Health Care
Open accessAbstract
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.
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- Authors
- KREINDLER, S. A., DOWD, D. A., DANA STAR, N., & GOTTSCHALK, T.
- Affiliations
- Winnipeg Regional Health Authority (CA)
- University of Manitoba (CA)
- Corresponding author
- KREINDLER, SARA A.
- Venue
- The Milbank Quarterly
- Publisher
- Wiley
- Published
- 2012-06
- Volume
- 90
- Issue
- 2
- Pages
- 347-374
- ISSN
- 0887-378X (ISSN-L)
- 1468-0009
- PMC
- PMC3460209
- OpenAlex
- W1841892384
- Cited by
- 167
- References
- 97
- Citations by year
- 2026: 15 · 2025: 10 · 2024: 12 · 2023: 9 · 2022: 16 · 2021: 11 · 2020: 12 · 2019: 16 · 2018: 17 · 2017: 8 · 2016: 11 · 2015: 12 · 2014: 10 · 2013: 4 · 2012: 2
- FWCI
- 1.28
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Milbank Quarterly (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research
- Topics
- Social Sciences › Psychology › Social Psychology › Team Dynamics and Performance
- Social Sciences › Sociology and Political Science › Social and Intergroup Psychology
- Health Sciences › Health Professions › General Health Professions › Interprofessional Education and Collaboration
- Keywords
- social identity approach, integrated care, intergroup relations, group membership, social identity, health care organization, organizational change, identity mobilization, health care collaboration, healthcare leadership
- MeSH terms
- Cooperative Behavior, Delivery of Health Care, Health Personnel, Humans, Interprofessional Relations, Social Identification
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