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As a consequence of new public management reforms, leading professionals in public service organizations have increasingly been involved in management roles. The phenomenon of clinical directors in the healthcare sector is particularly representative of this, as this medical manager role has been adopted in many countries around the world. However, professionals’ managerial role taking still falls quite short of expectations. While most research has searched for the causes of this gap at the individual level by exploring the clash between management and professionalism, the purpose of the paper is to argue that a contextualized understanding of the antecedents at the organizational level, and particularly the existing medical management roles, provides a more thorough picture of the reality.

The paper adopts an institutional perspective to study the development of existing medical management roles and the rise of new ones (clinical directors). The analysis focuses on the case of Italy, a country with a tradition in medical management where, following the example of other countries, clinical director roles were introduced by law; yet they were not incisive. The paper is based on a review of the existing literature and extensive field research on Italian clinical directorates.

The paper shows how in contexts in which doctors in management roles exist and are provided with legitimacy deriving from legal norms, historical settlements between professions and taken for granted arrangements, medical management becomes institutionalized, stability prevails and change towards new doctor-in-management roles is seriously hampered.

The paper contributes to existing knowledge on professionals’ managerial role taking, underlining the relevance of contextual and nation-specific factors on this process. It provides implications for research and for policy making in healthcare and other professional public services.

This study investigates the perceptions of intellectual capital (IC) among senior managers at Italian local healthcare units (LHUs) and the interrelations among IC components. It also provides a comprehensive definition of IC in the healthcare context and managerial guidance on improving IC to enhance LHU performance.

A survey was carried out to investigate perceptions among LHU senior management and identify characteristics of each primary IC component. The pilot study's results were examined using principal component analysis.

The findings illustrate senior management's perceptions of IC in LHUs and the extent to which management identifies and manages IC. A comprehensive definition of IC components in the healthcare sector is derived from these findings.

The research provides a better understanding of IC in the healthcare context and facilitates further research into how IC may be incorporated in quotidian organizational procedures. Results suggest that LHU managers should invest in increasing trust and respect and engage employees in organizational processes to provide recognition for the active role they play. Ongoing management of the three primary IC components is shown to have clear advantages, particularly on their connectivity.

The paper contributes to an increasingly important strand of theoretical research – IC in the healthcare context – and also adds new knowledge on the practical applications of IC in LHUs.