What seems to be the problem? Locum doctors, liminality and concerns about performance

Area of Science:

• Medical Sociology
• Healthcare Management
• Organizational Psychology

Background:

• Locum doctors occupy a unique "liminal space" within healthcare organizations, often excluded from formal support and professional networks.
• This marginalization can affect their professional identity, performance, and integration into healthcare teams.

Purpose of the Study:

• To explore the experiences of locum doctors regarding performance concerns and their impact on professional identity and patient care.
• To understand how organizational, professional, and socio-cultural liminality shapes perceptions and management of locum doctors' performance.

Main Methods:

• Qualitative semi-structured interviews with 88 participants (locums, permanent doctors, nurses, governance/recruitment staff).
• Data collected from primary and secondary care settings within the English National Health Service (NHS) during 2021-22.
• Analysis employed reflexive thematic and abductive approaches.

Main Results:

• Locum doctors are often "othered" and blamed, leading to low tolerance for errors and escalation of concerns.
• A lack of reciprocity in relationships results in unresolved issues, and structural gaps can lead to avoidance of responsibility for patient care quality and safety.
• The liminality experienced by locums shapes narratives, positioning them as "the problem" and negatively impacting their professional identity and performance.

Conclusions:

• The liminality experienced by locum doctors significantly affects their professional identity, performance, and patient care quality.
• Healthcare organizations should actively mitigate locum marginalization to enhance patient safety, improve locum integration, and boost performance.