This paper examines clinician–manager interactions within healthcare organizations in the UK and contrasts the notions of dialetics and dialogues within such interactions. We draw particularly on Bakhtin’s work on dialogue to frame our focal research question, which considers the extent to which clinician–manager interactions are dialogic. Using data drawn from a thirty-two month study of five UK healthcare organizations we suggest that clinician-manager interactions are more dialectic than dialogic in their orientation. Further, we suggest that, despite the appearance of dialogical possibility between clinicians and non-clinicians, the tendency to dialectic positioning reinforces opposition between these groups and we conclude that local, rather than system-wide interventions, offer the best means of disrupting these dialectics and fostering productive dialogues.
► Provides new insights into the manager–clinician relationships in the UK using the theoretical lens of dialogues and dialectics. ► Highlights the limitations of healthcare policy on attempted incorporation of clinicians into management. ► Reveals the dialectical rather than dialogical relationship among clinicians and managers. ► Argues local rather than system-wide interventions offer the best means of disrupting dialectics to foster productive dialogues