Identity undoing
Deconstruction of the heroic leader identity
Tension: unable to engage others in adopting a vision	Deconstruction
‘I developed an application for pregnant women in which they can follow their own care trajectory. […] So now my goal is to convince the midwives. [Then thinks deeply.] Yes, as a leader I think it is extremely important to get along the laggards. You see, I know what I want, but is much more important that I convince others too. Midwives can be very conservative’. (Respondent 3, in‐house session 15 January 2018)	‘What really helps me in projects where everyone holds a different view is to ask them ‘what do you need to get attached? And how can I help you?’ You really have to realize that it is a new game you are playing. A very difficult game’. (Hospital director)
‘There are people in our organization … they just do not care at all. I found that extremely difficult …’ (Respondent 19, module 3)	‘Choose your battles. There are people who do listen [name respondent 19]. Who do want to change’. (Guest speaker 4)
‘Trust is lacking [in my project]. That's the big issue. I'm standing still for two years now’. (Respondent 3, module 4)	‘Ok, but what is your circle of influence? You all have the ambition to put the patient central. […] So which people do you need to address? And how?’ (Guest speaker 5)
‘Do you have a tool for pure reluctance? But when you cannot fire them’. [everyone laughs loudly] (Respondent 18, module 3)	‘The answer is attention. […] So, [name respondent 18] trust me, it's also because of you that those others do not want to change. So have a look at yourself too’. (Guest speaker 4)
‘Sometimes I just wish that someone just take a decision instead of having to argue over and over again and have another three meetings about the same issue’ (Respondent 11, module 2)	‘But you can also turn it around right. We wanted to change the mamma clinic into a multidisciplinary center. Every physician was reluctant. But then we asked PR to interview everyone, the radiologists, the pathologists. Slowly everyone became enthusiastic, you have to create a feeling of ownership. It can help to just give other people credits’. (Respondent 6)
Deconstruction of the clinical leader identity
Tension: others influence professional work	Deconstruction
‘I noticed that [name Michelin‐star restaurant] created their own quality norms. Compared to hospitals, so many quality norms are imposed upon us by outsiders …’ (Respondent 3, module 3)	‘Mister Michelin is just one norm, but we don't think this is high enough. So, how do you deal with norms that are imposed upon you from the outside? I think that you really need to know yourselves that you deliver high quality of care and determine your own norms’. (Guest speaker 4)
‘External parties determine how you work and you have almost no influence on that’. (Respondent 18, module 5)	‘And therefore it is so important to acquire knowledge of your external environment. There is so much knowledge available, but maybe you don't possess it yet’. (Guest speaker 2)‘I thought that the hospital board would deal with that, but I guess I shouldn't count on that’. (Respondent 9)
‘Our department is a flat organization, like a family. Who doesn't like that is the hospital. It is extremely hard for them to involve with us. So what you get is that managers are trying to do stuff behind our backs. And that causes friction’. (Respondent 19, module 3)	‘You reign too much in your bastions and take too little notice of your surroundings. I would hate you too. And I blame you for the consequences. […] Although you think you are accessible… you are not, and so there is friction’. (Guest speaker 4)
‘It is often a battle between managers and physicians. Managers don't have any insight into quality of care. Only into costs. So a medical leader has to do both. Causes a lot of tensions. Collaboration is very difficult. […] They are not the ideal partner’. (Respondent 20, module 5)	‘I don't really recognize this. If you have an experienced business manager. […] We are lucky with business managers with backgrounds in nursing and they have insights in both quality and costs. […] There is often more room than you think there is’. (Respondent 24)
‘I am extremely bothered by managers. We're just not like minded. […] They have their budget and I see my patients and those are two totally different worlds. I don't know what he does and he doesn't have a clue what I am doing’. (Respondent 18, module 4).	‘I get the creeps from managers too. But I do sit down with business managers very consciously because they often are the key to logistics [in change projects]’. (Respondent 6)