Healthcare organizations are characterized by tensions emanating from multiple and sometimes divergent objectives and interests, different power and influence bases, as well as distributed knowledge required for decision making. Tensions tend to be particularly strong between managers and physicians. In North America and Europe, there have been significant efforts to bring management and medical communities forward constructively toward overarching goals. Pilot projects involving the assignment of senior co-management roles to medical professionals were conducted in four healthcare organizations in Quebec from February 2012 to October 2013. These new roles of medical co-directors involved being jointly responsible for reaching the objectives of a clinical program with an administrative co-director.  These initiatives are based on the assumptions that organizations benefit from involving professionals in strategic decision making and that medical co-directors are able to influence fellow physicians’ practice. We conducted a longitudinal study involving 167 interviews, observation of 102 meetings as well as a document analysis. The presentation will focus on 1) the challenges faced by medical professionals as they enter senior co-management roles; 2) the influence of medical co-directors on strategic decisions and physicians’ practice; and 3) the strategies put forward in the organizations to overcome these challenges and enhance the influence of the medical co-directors.

This research was supported by the Social Sciences and Humanities Research Council (SSHRC) and the Fonds de recherche du Québec – Société et culture (FRQSC).