The divisionalized professional bureaucracy model in hospital organizations: Challenging the role of professionalism and managerialism

Abstract

Following up on previous reflections (Correia, 2012), this presentation seeks now to provide the debate with a more systematized reading of the adaptation of hospital organizations in the context of globalized managerialism, notably the implication for its design and functioning while a professional bureaucracy and for the interplay between managerialism and professionalism. The presentation reports to a qualitative research whose fieldwork was conducted in a general public hospital during the process it adopted a corporatized model now dominant in Portugal. Direct observations were systematically made over a year and half from 2008 to 2010, followed by 26 in-depth, semi-structured interviews with all managers on the hospital’s board of directors, doctors from internal medicine and from surgery. Evidence shows a new, unpredicted organizational structure in Mintzberg’s theory – the divisionalized professional bureaucracy – that combines professionalism and balkanization as prime coordinating mechanisms. Divisionalized professional structures are created within hospitals standing medicine and management closely together. Implications are discussed in the light of two fields of debate. One is health professions, as professionalism seems to be reinforced through the control of both managerial and self-regulated clinical tools. The other is management studies, as it is significant to find professionalism and balkanization coupled though they are conceived as barely articulable in theory. Therefore, the reflection allows to illustrate empirically how these organizations successful adapt by following processes assumed not only as impossible but also as responsible for disintegrating large bureaucracies.