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To improve health‐care delivery from within, managers need to engage physicians in organisational development work. Physicians and managers have different mindsets/professional identities which hinder effective communication. The aim of this paper is to explore how managers can transform this situation.

The authors' interview study reveals physicians' own perspective on engagement for organisational improvement. They discuss identities from three theoretical perspectives and explore the mindsets of physicians and managers. They also explore the need to modify professional identities and how this can be achieved.

If managers want physicians to engage in improvements, they must learn to understand and appreciate physician identity. This might challenge managers' identity. The paper shows how managers – primarily in a Swedish context – could act to facilitate physician engagement. This in turn might challenge physician identity.

Studies from the western world show a coherent picture of professional identities, despite structural differences in national health‐care systems. The paper argues, therefore, that the results can be relevant to many other health‐care systems and settings.

The paper provides an alternative to the prevailing managerial control perspective. The alternative is simple, yet complex and challenging, and as the authors understand it, necessary for health care to evolve, from within.

The purpose of this paper is to uncover paradoxes emerging from physicians’ experiences of a patient-centered and team-based ward round, in an internal medicine department.

Abductive reasoning relates empirical material to complex responsive processes theory in a dialectical process to further understandings.

This paper found the response from physicians, to a patient-centered and team-based ward round, related to whether the new demands challenged or confirmed individual physician’s professional identity. Two empirically divergent perspectives on enacting the role of physician during ward round emerged: We-perspective and I-perspective, based on where the physician’s professional identity was centered. Physicians with more of an I-perspective experienced challenges with the new round, while physicians with more of a We-perspective experienced alignment with their professional identity and embraced the new round. When identity is challenged, anxiety is aroused, and if anxiety is not catered to, then resistance is likely to follow and changes are likely to be hampered.

For change processes affecting physicians’ professional identity, it is important for managers and change leaders to acknowledge paradox and find a balance between new knowledge that needs to be learnt and who the physician is becoming in this new procedure.

This paper provides increased understanding about how physicians’ professional identity is interacting with a patient-centered ward round. It adds to the knowledge about developing health care in line with recent societal requests and with sustainable physician engagement.