Abstract

Across the NHS workforce sites, Egyptian IMG accounts evidence five distinct generative mechanisms operating concurrently within most participant accounts: survival-mode adaptation, performative compliance, transparency buffering, strategic compliance, and sponsorship-dependent reproduction. This developmental paper, drawn from twenty-two semi-structured interviews under a critical realist framework, treats the National Health Service as an institutional protagonist whose reproductive architecture is recruited across professional domains. This study foregrounds the multi-mechanism findings for cross-disciplinary management readers. Preliminary conclusions suggest that an institution-centred reading recovers explanatory traction without dissolving agency. Three working hypotheses propose trajectories for further development.