Doctor in the lead: balancing between two worlds

The article examines the leadership of department heads in a university hospital in day-to-day practice. These ‘doctors in the lead’ bridge the medical and the management world in the hospital organization.They are better able to influence their colleagues’ clinical activities than a non-medical manager. This is, however not a trouble-free task. The concepts of Pierre Bourdieu—habitus, field and capital—guide the analysis of empirical material. The medical habitus influences the questions and dilemmas department heads face, as well as the ways in which they can exert influence on their colleagues. ‘Janus-faced’ they look at the medical and the management world with their two different logics. Sometimes they display managerial behaviour, but the medical habitus remains their second nature. Based on these findings we argue that the formal hierarchy of the hospital organization should be brought more in line with the informal professional hierarchy.